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Chapter 7

Chapter 7 notes for FALL 2010 semester

Course Code
Konstantine Zakzanis

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-somatoform and dissociative disorders are related to anxiety disorders in that, in early versions
of the DSM, all these disorders were subsumed under the heading of neuroses b/c anxiety was
considered the predominant underlying factor in each case
-somatoform disorders: physical symptoms suggest a physical problem but have no know
physiological cause; theyre therefore believed to be lined to psychological conflicts and
needs but not voluntarily assumed;
-e.g. somatization disorder (Briquets syndrome), conversion disorder, pain disorder, and
-indiv complains of bodily symptoms that suggest a physical defect or dysfunction
sometimes rather dramatic in nature but for which no physiological basis can be
-dissociative disorders: normal integration of consciousness, memory, or identity is
suddenly and temporarily altered;
-e.g. dissociative amnesia, dissociative fugue, dissociative identity disorder (multiple
personality), and depersonalization disorder are examples
-in dissociative disorders, indiv experiences disruptions of consciousness, memory,
and identity
-the onset of both classes of disorders is assumed by many to be related to some stressful
experience, and the 2 classes sometimes co-occur
-SOMATOFORM DISORDERS: “soma means body; psychological problems take physical form;
physical symptoms have no known physiological explanation and arent under voluntary control;
thought to be linked to psychological factors, i.e. anxiety, and are assumed to be psychologically
-bodily symptoms of these disorders fall typically into 2 groups:
-one group of symptoms reflects arousal in the ANS and is accompanied by palpable
distress in
the form of anxiety and depression
-2nd group of symptoms reflects thoughts and intensions that arent consciously recognized
-pain disorder: a somatoform disorder in which the person complains of severe and prolonged
pain that is not explainable by organic pathology; it tends to be stress-related or permits the
patient to avoid an aversive activity or to gain attention and sympathy
-experiences pain that causes significant distress and impairment; psychological factors
are viewed as playing an important role in the onset, maintenance, and severity of the

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-patient may become unable to work and may become dependent on painkillers or
-the pain may have a temporal relation to some conflict or stress, or it may allow the indiv
to avoid some unpleasant activity and to secure attention and sympathy not otherwise
-accurate diagnosis is difficult because the subjective experience of pain is always a
psychologically influenced phenomenon
-patients with physically based pain localize it more specifically, give more detailed
sensory descriptions of their pain and link their pain more clearly to situations that inc or
dec it
-body dysmorphic disorder (BDD): a somatoform disorder marked by preoccupation w/an
imagined or exaggerated defect in appearance; i.e., facial wrinkles or excess facial or body hair;
freq in the face
-women focus on the skin, hips, breasts, and legs; men are more inclined to believe theyre
too short, that their penises are too small, or that they have too much body hair
-may spend hours each day checking on their defect, looking at themselves in mirrors;
others try to avoid being reminded of the defect, e.g., by wearing very loose clothes
-occurs mostly among women, typically begins in late adolescence, and is freq co-morbid
w/depression and social phobia, eating disorders, and thoughts of suicide
-BDD is chronic, with only 9% of BDD patients experiencing remission over the course of 1
-preoccupation with imagined defects in physical appearance may not be a disorder itself,
but a symptom that can occur in several disorders
-hypochondriasis: a somatoform disorder in which the person, misinterpreting rather ordinary
physical sensations, is preoccupied with fears of having a serious disease and is not dissuaded
(talk somebody out of something) by medical opinion; difficult to distinguish from somatizaton
-individuals are preoccupied with persistent fears of having a serious disease, despite
medical reassurance to the contrary
-typically begins in early adulthood and has a chronic course
-theory is that they overreact to ordinary physical sensations and minor abnormalities i.e.
irregular heartbeat, sweating, occasional coughing, a sore spot, or a stomach ache, seeing
these as evidence for their beliefs
-ppl w/high scores on a measure of hypochondriasis are more likely than others to
attribute physical sensations to an illness; similarly, patients w/hypochondriasis make
catastrophic interpretations of symptoms, i.e. believing that a red blotch on the skin is
skin cancer

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-hypochondriasis is not well differentiated from somatization disorder, which is also
characterized by a long history of complaints of medical illnesses
-also, often co-occurs with anxiety and mood disorders
-fear of having an illness, an illness phobia is a fear of contracting an illness
-Illness Attitude Scale (IAS): self-report measure thats used commonly by researchers to assess
health anxiety; consists reliably of 4 factors: (1) worry about illness and pain (i.e. illness fears);
(2) disease conviction (i.e. illness beliefs); (3) health habits (i.e. safety-seeking behaviors); (4)
symptom interference with lifestyle (i.e. disruptive effects)
-link between health anxiety and trait neuroticism
-twin study conducted in Canada found that after controlling for medical morbidity, health
anxiety was moderately heritable, but most of the variance in health anxiety, as assessed
by IAS, was due to environ. factors rather than genetic factors; supports idea that health
anxiety is mostly learned
-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; anaesthesias and paralyses of limbs are examples; to be distinguished from malingering,
in which actual impairment does not exist
-physiologically normal people experience sensory or motor symptoms, i.e. 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
-may experience paralysis of arms or legs; seizures and coordination disturbances; a
sensation of prickling, tingling, or creeping on the skin; insensitivity of pain; or the loss or
impairment of sensations, called anesthesias:
-loss of impairment of sensation that may be experienced by a person with
conversion disorder
-aphonia = loss of the voice and all but whispered speech; anosmia = loss or impairment of
the sense of smell, are other conversion disorders
-the psychological nature of conversion symptoms is demonstrated by the fact that they
appear suddenly in stressful situations, allowing the indiv to avoid some activity or
responsibility or to receive badly wanted attention
-anxiety and psychological conflict were once believed to be converted into physical
-hysteria: a disorder known to the ancient Greeks in which a physical incapacity a
paralysis, an anaesthesia, or an analgesia is not due to a physiological dysfunction; i.e.,
glove anaesthesia; it is an older term for “conversion disorder; in the late 19th C
dissociative disorders were identified as such and considered hysterical states
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