Textbook Notes (362,796)
Canada (158,054)
HLTC43H3 (19)
zakzani (6)
Chapter 7

PSYB32 - Chapter 7 Notes.docx

9 Pages
Unlock Document

University of Toronto Scarborough
Health Studies

Chapter 7: Somatoform and Dissociative Disorders What are Somatoform + Dissociative Disorders? - both types of disorders are related to anxiety disorders  in early versions of the DSM, all these disorders were under the category of neuroses because anxiety = the dominant factor  after DSM-III, classification came to be based on observable behavior, and not on presumed etiology -> anxiety isn’t necessarily observable in these disorders - somatoform disorders: disorders in which physical symptoms suggest a physical problem but have no known physiological cause; they are therefore believed to be linked to psychological conflicts + needs but not voluntarily assumed  examples: somatization disorder, conversion disorder, pain disorder and hypochondriasis - dissociative disorders: disorders in which the normal integration of consciousness, memory or identity is suddenly and temporarily altered  examples: dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder - the onset of both classes of disorders is assumed to be related to some stressful experience and occasionally, the two classes co-occur Somatoform Disorders - soma -> body; in somatoform disorders, psychological problems take a physical form - these physical symptoms have no known physiological explanation and are linked to psychological factors (like anxiety) - the category of somatoform disorders has been controversial ever since the release of the DSM-IV, and some believe that they should be removed from the DSM-5  believe that the terminology is unacceptable to patients  there is a great heterogeneity among the disorders; only common link = physical illness  disorders are incompatible with other cultures  not reliable; lack clearly defined symptom thresholds - recommended changes included: revision of the entire category, elimination of pain disorder, terminology changes, and the shifting of certain disorders to other DSM categories - the DSM-5 work group wants to change the name of the disorder group to “somatic symptom disorders” with a focus o the extent to which physical symptoms result in distress, disturbance, and diminished quality of life - pain disorder: a somatoform disorder in which the person complains of severe and prolonged pain that isn’t explainable by organic pathology; tends to be stress- related or permits the client to avoid an aversive activity or to gain attention + sympathy  because the experience of pain is psychologically influenced, it’s hard to decide when a pain becomes somatoform pain - body dysmorphic disorder (BDD): a somatoform disorder marked by preoccupation with an imagined or exaggerated defect in appearance  ex: excess facial/body hair, size/shape of the nose  women tend to focus on skin, hips, breasts, legs  men look at size (height, genitals, etc)  some with this disorder either checking on the defect (looking in mirrors, etc) or avoid it (wearing clothes that hide things, etc)  BDD usually occurs among women after adolescence and is frequently found with depression, social phobia, eating disorders, substance abuse, personality disorders  Hard to diagnose BDD because someone who is excessively preoccupied with their appearance could also have OCD; some argue that BDD should be a subtype of OCD - hypochondriasis: a somatoform disorder in which the person, misinterpreting rather ordinary physical sensations, is preoccupied with fears of having a serious disease  typically begins in early adulthood and is frequently chronic  hypochrondriasis isn’t that different from somatization disorder, so some recommend that it should be changed to “health anxiety disorder” and be placed in the anxiety disorders categories - the Illness Attitudes Scale (IAS) is commonly used to assess health anxiety; consists of 4 factors: 1) illness fears 2) illness beliefs 3) health habits 4) disruptive effects of illness  using the IAS, researchers found a link between health anxiety and trait neuroticism, however, health anxiety is mostly learned (influenced by environmental factors) Conversion Disorder - conversion disorder: a somatoform disorder in which sensory or muscular functions are impaired, usually suggesting neurological disease, even though the bodily organs themselves are sound  ex: paralysis of arms/legs, seizures, loss/impairment of sensation  anesthesias: a loss of impairment of sensation that may be experienced by a person with a conversion disorder  aphonia -> loss of the voice; anosmia -> loss of the sense of smell = other conversion disorders  conversion symptoms appear suddenly in stressful situations -> individual wants to avoid something, energy of the repressed action is diverted to somewhere else  ie: anxiety and psychological conflict were converted into physical symptoms - hysteria: a disorder known to the ancient Greeks in which a physical incapacity (paralysis, anesthesia, etc) is not due to a physiological dysfunction  term “glove anesthesia” is an older term for conversion disorder  in the late 19 century, dissociative disorders were identified as such and considered hysterical states - conversion symptoms usually develop in adolescence or early adulthood, typically after a stressful event - an episode may end abruptly, but is likely to return, sometimes with a symptom of a different nature/site (on the body) - prevalence of conversion disorder = >1%; found more in women; frequently comorbid with other Axis I diagnoses (depression, substance abuse, anxiety, personality disorders, etc) - since the majority of paralyses, analgesias, and sensory failures have biological causes, true neurological problems may sometimes be misdiagnosed as conversion disorders - however, with technological advances in detecting illness + disease (MRI, CT) the rate of misdiagnosis is on the decline (around 4%) Malingering and Factitious Disorder - conversion disorder is often difficult to distinguish from malingering - malingering: faking a physical or psychological incapacity in order to avoid a responsibility or gain an end; the goal is readily recognized from the individual’s circumstances  distinguished from conversion disorder because the incapacity is under voluntary control  la belle indifference: the blasé attitude (lack of concern) people with conversion disorder have toward their symptoms  patients with conversion disorder appear willing and eager to talk about their symptoms without the concern one might expect  in contrast, malingers are likely to be more guarded and cautious when talking about their symptoms because it’s a lie - factitious disorder: a disorder in which the individual’s physical or psychological symptoms appear under voluntary control and are adopted merely to assume the role of a sick person  disorder can also involve a parent producing a disorder in a child; called a “factitious disorder by proxy” or “Munchausen syndrome by proxy”  this disorder came into public attention due to claims by Eminem about his mother Somatization Disorder - somatization disorder: a somatoform disorder in which the person continually seeks medical help for recurrent and multiple physical symptoms that have no discoverable physical cause; first discovered by Pierre Briquet  person must have 4 pain symptoms in different locations, 4 gastrointestinal symptoms, 1 sexual symptom other than pain and 1 pseudoneurological symptom  hard to differentiate from hypochondriasis  comorbidity is high with anxiety + mood disorders, substance abuse and personality disorder  specific symptoms (and physical ailments) vary across cultures Etiology of Somatoform Disorders Somatization Disorder - people with somatization disorder are more sensitive to physical sensations, overattend to them, or interpret them catastrophically - there may also be a memory bias involving information that is related to physical threat - a behavioural view holds that the various aches, discomforts and dysfunctions are the manifestation of unrealistic anxiety about bodily systems - people with somatization disorder also have high levels of cortisol, which indicates that they are under stress -> stress can cause tension in some muscles -> nausea, pain, etc - there is also an environmental influence in the development of somatization (learned responses by children of those exposed to parents with somatization disorder or parents who have a serious illness/health anxiety) Conversion Disorder - offered Freud an opportunity to explore the concept of unconscious - Freud proposed that conversion disorder is caused when a person experiences an event that creates a great emotional arousal, but the affect is not expressed and the memory of the event is cut off from conscious experience  The specific conversion symptoms were related to the traumatic event that preceded them - Freud also believed that conversion disorder in women was rooted in an unresolved Electra complex; repressed sexual impulses -> sexual anxiety -> physical symptoms - Some early behaviourists viewed conversion disorder as similar to malingering in that the person adopts the symptom to secure some end (reduce stress, reward)  Means that the person with conversion disorder attempts to behave according to his/her conception of how a person with a disease affecting the motor or sensory abilities would act - contemporary researchers agree with Freud in that some behavior is determined by unconscious processes, but reject the notions of repression, instead stating that we aren’t aware of everything going on around us at all time - these stimuli/processes we’re unaware of can have a powerful influence on behavior - in terms of social/cultural factors, studies show that conversion disorder is more common among peop
More Less

Related notes for HLTC43H3

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.