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Chapter 7

Chapter 7 - Detailed

7 Pages
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Department
Psychology
Course Code
PSYB32H3
Professor
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 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
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)
Hypochondriasis
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%
Chapter 7 : Somatoform and Dis s ociat i ve Disorders
Page 1
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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)
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 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 conversion disorder show la belle indifference
Chapter 7 : Somatoform and Dis s ociat i ve Disorders
Page 1
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Description
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 o Pain disorder: Psychological factors play a significant role in the onset and maintenance of pain o Body dysmorphic disorder: preoccupation with imagined or exaggerated defects in physical appearance o Hypochondriasis: preoccupation with fears of having a serious illness o Conversion disorder: sensory or motor symptoms without any physiological cause o Somatization disorder: recurrent, multiple physical complaints that have not biological basis Pain disorder o Person experiences pain that causes significant distress & impairment o Psychological factors are viewed as playing an important role in the onset, maintenance, and severity of the pain o Unable to work and may become dependent on pain killers or tranquilizers o Conflict or stress or avoid some unpleasant activity and to secure attention and sympathy not otherwise available o Hard to find where the pain is coming from o People with true physiological pains describe their pain as more localized and with magnitude, while pain disorder patients cant Body dysmorphic disorder o Person is preoccupied with an imagedexaggerated defect in appearance, frequently in the face (facial wrinkles, excess facial hair, shape of nose) o Spend hours each day checking on their defect in the mirror o Leads to frequent consultations with the plastic surgeon o Mostly among women o Typically beings in late adolescence o Frequently comorbid with depression & social phobia o Preoccupation 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) Hypochondriasis o Individuals are preoccupied with persistent fears of having a serious disease, despite medical reassurance to the contrary o Typically beings in early adulthood and tends to have a chronic course o They make catastrophic interpretations of symptoms o Prevalence of 5% 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 Page 1 www.notesolution.com
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