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Chapter 7

Abnormal Psych Chapter 7.doc

Course Code
Konstantine Zakzanis

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Somatoform Disorders & Dissociative Disorders
Somatoform disorders: the individual complains of bodily symptoms
that suggest a physical defect or dysfunction but for which there is no
physiological basis
Dissociative disorder: the individual experiences disruptions of
consciousness, memory, and identity, as illustrated in the opening case
The onset of both classes of disorders is typically related to some
stressful experience, and the two classes sometimes co-occur
Somatoform Disorders
Psychological problems take a physical form
Not under voluntary control
Thought to be linked to anxiety and all psychologically caused
2 main somatoform disorders: conversion disorder & somatisation
Overall DSM-IV categories of somatoform disorder
oPain disorder: Psychological factors play a significant role in the
onset and maintenance of pain
oBody dysmorphic disorder: preoccupation with imagined or
exaggerated defects in physical appearance
oHypochondriasis: preoccupation with fears of having a serious
oConversion disorder: sensory or motor symptoms without any
physiological cause
oSomatization disorder: recurrent, multiple physical complaints
that have not biological basis
Pain disorder
oPerson experiences pain that causes significant distress &
oPsychological factors are viewed as playing an important role in
the onset, maintenance, and severity of the pain
oUnable to work and may become dependent on pain killers or
oConflict or stress or avoid some unpleasant activity and to secure
attention and sympathy not otherwise available
oHard to find where the pain is coming from
oPeople with true physiological pains describe their pain as more
localized and with magnitude, while pain disorder patients can’t
Body dysmorphic disorder
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oPerson is preoccupied with an imaged/exaggerated defect in
appearance, frequently in the face (facial wrinkles, excess facial
hair, shape of nose)
oSpend hours each day checking on their defect in the mirror
oLeads to frequent consultations with the plastic surgeon
oMostly among women
oTypically beings in late adolescence
oFrequently comorbid with depression & social phobia
oPreoccupation with imaged defects in physical appearance may
therefore not be a disorder itself, but a symptom that can occur
in several disorders (OCD, delusional disorder)
oIndividuals are preoccupied with persistent fears of having a
serious disease, despite medical reassurance to the contrary
oTypically beings in early adulthood and tends to have a chronic
oThey make catastrophic interpretations of symptoms
oPrevalence of 5%
oNot well differentiated from somatisation disorder (long history of
oOften co-occurs with anxiety and mood disorders
oHealth anxiety – health related fears and beliefs
oHealth anxiety would be present in both hypochondriases and an
illness phobia, whereas hypochondriasis is a fear of having an
illness, an illness phobia is fear of contracting an illness
oIllness Attitude Scale (IAS) : self report measure that is used
commonly by researchers to assess health anxiety (used to
confirm link between health anxiety and trait neuroticism)
Worry about illness and pain
Disease conviction (illness beliefs)
Health habits
Symptoms interference with lifestyle
oCognitive factors
A critical precipitating incident
A previous experience of illness and related medical
The presence of inflexible or negative cognitive assumption
are always a sign of serious illness
The severity of anxiety
Conversions Disorder
Conversion disorder: Physically normal people experience sensory or
motor symptoms such as a sudden loss of vision or paralysis,
suggesting an illness related to neurological damage of some sort,
although the body organs and nervous system are found to be fine
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They may experience paralysis of arms or legs; seizures and
coordination disturbances; a sensation of prickling, tingling or creeping
on the sink, insensitivity to pain; or loss of impairment of sensations
They appear suddenly in stressful situations (allowing the individual to
avoid some activity or responsibility) or receive badly wanted attention
Freud believed the anxiety and psychological conflict were being
converted into physical symptoms
The role of stress plays in the development
Hysteria: used to describe what are known as conversion disorders
Hippocrates thought it limited to women and due to the wandering of
the uterus in the body
Symptoms usually develop in adolescents or early adulthood, typically
after undergoing life stress
Prevalence is less than 1%
More likely in women than men (but during the war more men did)
Co-morbid with other axis 1 diagnoses, such as depression and
substance abuse, and with personality disorders
Glove anaesthesia: a rare syndrome where the person experiences
little or no sensation in the part of the hand that would be covered by a
Malingering: an individual fakes an incapacity in order to avoid a
responsibility, such as work or military duty, or to achieve some goal,
such as being awarded a large insurance settlement (under voluntary
La belle indifference: helps to distinguish malingering and
conversion disorder
oCharacterized by relative lack of concern or a blasé attitude
toward the symptoms that is out of keeping with their severity
and supposedly long-term consequences
oPatients with conversion disorders like to talk endlessly about it
oMalingerers are more cautious, perhaps because they consider
interviews a challenge or threat to the success of the lie
oOnly 1/3 of people with conversion disorder show la belle
Factitious disorder: patients intentionally produce physical
symptoms (sometimes psychological ones)
oIn contrast to malingering, the symptoms are less obviously
linked to a recognized goal
oFor some reason they want to assume the role of a patient
oAlso may involve a parent creating physical illnesses in a child
(Factious disorder by proxy or Munchausen syndrome by
Somatization Disorder
Used to be known as Briquet’s syndrome
C h a p t e r 7 : S o m a t o f o r m a n d D i s s o c i a t i v e D i s o r d e r s
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