PSYB32H3 Chapter Notes - Chapter 7: Conversion Disorder, Identity Disorder, Depersonalization

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14 Dec 2010
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 study
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 disorder
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 illness
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 & impairment
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 tranquilizers
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
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
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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 course
oThey make catastrophic interpretations of symptoms
oPrevalence of 5%
oNot well differentiated from somatisation disorder (long history of complaints)
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 factors
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
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 (anaesthesias)
Aphonia: loss of the voice and all but whispered speech
Anosmia: loss or impairment of the sense of smell
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
The role of stress plays in the development
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Hysteria: originally used to describe what are known as conversion disorders
Hippocrates thought it was 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 glove
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 control)
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 conversion4 disorder show la belle indifference
Factitious disorder: patients intentionally produce physical symptoms (sometimes
psychological ones)
oIn contrast to malingering, the symptoms are less obviously linked to a recognized
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 proxy)
Somatization Disorder
Used to be known as Briquet’s syndrome
Somatization disorder: recurrent, multiple somatic complains, with no apparent physical
cause, for which medical attention is sought
To meet diagnostic criteria a person must have
o4 pain syndromes in different location
o2 gastrointestinal symptoms
o1 sexual symptom other than pain
o1 pseudoneurological symptom
oMore pervasive than in complaints than in hypochondriasis
Usually causes impairment in work and symptoms may vary across cultures
Burning hands or experience of ants crawling under the skin are more frequent in Asia
and Africa
Comorbid with anxiety and mood disorders, substance abuse, and several personality
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