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Chapter 7

PSYB32_Chapter 7

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Konstantine Zakzanis

Chapter 7-Somatoform and Dissociative Disorders Somatoform and dissociative disorders were categorized with anxiety disorders earlier as neuroses because anxiety was considered an underlying factor or each case After the DSM-III classification was based on observable behaviour and they became separate In anxiety disorders, anxiety is obvious, but in somatoform disorders anxiety is not so observable Somatoform disorders the individual complains of bodily symptoms that suggest a physical defect but for which no physiological basis can be found In dissociative disorders the individual experiences disruptions in consciousness, memory, and identity The onset of both disorders is related to some stressful experiences Somatoform Disorders Psychological problems take a physical form The bodily symptoms of these disorders fall into two categories o Arousal in autonomic nervous system accompanied by anxiety or depression o Thoughts and intentions that are not consciously recognized In pain disorder the person experiences significant pain with psychological factors playing a role in onset, maintenance, and severity The pain may have a temporal relation to some conflict or stress or it may allow the individual to avoid some unpleasant activity or to gain attention and sympathy It is hard to differentiate if the pain is real or not because it is not a simple sensory experience like hearing or seeing Patients with physically based pain describe the pain more, localize it better, and link their pain to situations that increase it and decrease it Body dysmorphic disorder a person is preoccupied with an imagined or exaggerated defect in their appearance, frequently the face For women it is hips, skin, legs breasts, for men it is height, penis size, and body hair They eliminate mirrors in their houses and consult plastic surgeons and are never happy Occurs mostly among women and occurs in late adolescence and is comorbid with depression and social phobia It is unclear whether BDD as a specific disorder is warranted, because people who are preoccupied with their appearance might be diagnosed with OCD or a delusional disorder if they lose track with reality Preoccupation with imagined defects in physical appearance might thus be a symptom that occurs in several other disorders Hypochondriasis is a disorder in which individuals have persistent fears of having a serious disease, they overreact to ordinary sensations as evidence for their beliefs It is not well differentiated from somatisation disorder Contemporary researchers focus on health anxietyhealth related fears based on a misinterpretation of bodily signs as being a symptom of a serious illness Health anxiety is present in both hypochondriasis and illness phobiafear of contracting an illness (as opposed to having one) There is a link between health anxiety and the personality trait neuroticism Health anxiety is mostly learned Cognitive factors of health anxiety have four components o Precipitating incident o Previous experience of illness o Inflexible negative assumption about health o Negative interpretations Probability of illness vs awfulness Coping vs ability to be rescued Conversion Disorder Conversion disorder is when physiologically normal people experience sensory or motor symptoms such as loss of vision or paralysis The loss or impairment of sensations is called anaesthesias Aphonia is loss of voice, and anosmia is loss of smell Conversion symptoms appear in stressful situations allowing the individual to avoid some activity or responsibility or to receive badly wanted attention Originally derived from Freud who thought that repressed id impulses pushed for expression and the anxiety from the conflict is converted into physical symptoms Hysteria was the original term for this disorder Hippocrates considered hysteria as only for women due to the wanderings of their uterus through the body symbolizing a longing for a child Public attention for the disorder increased when a group of Amish kids got it Typically begins in adolescence or early adulthood after undergoing life stress It is important to distinguish conversion with true problems, sometimes this task is easy when the paralysis does not make anatomical sense o Example. Glove anaesthesiaa real illness thought to be anatomical nonsense Technological advances such as MRI allowed for the rate of misdiagnosis of conversion disorder to declineMalingering and Factitious Disorder Malingeringand individual fakes a incapacity in order to achieve some goal or avoid some responsibility It is diagnosed when conversion like symptoms seem to be under control Conversion disorder is UNCONSCIOUS and malingering is CONSCIOUS One way to distinguish between malingering and conversion disorder is the la belle indifference which is a lack of concern toward symptoms Patients with conversion disorder have this, but malingerers appear to be more cautious This distinction however, is not fool proof, only one third of people with conversion disorder show la belle indifference In factitious disorder, patients produce physical/psychological symptoms and the motivation for this is not clear (a psychological purpose) Factitious disorder by proxy or Munchausen syndrome by proxy is making others assume the role of a sick person that has no link to a goal or motivation Somatization Disorde
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