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Chapter 7

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Chapter 7 Somatoform disorder – complaints of bodily symptoms that suggest physical defect or dysfunction, but no physiological evidence. Some types: - Pain disorder – onset and maintenance of pain caused largely by psychological factors. o 3 subtypes:  Pain disorder associated psychological factors  Pain disorder associated with both psychological factors and a general medical condition  Pain disorder associated with a general condition o MRI showed decrease in grey matter in prefrontal, cingulated, and insular cortex which related to modulation of subjective pain - Body dysmorphic disorder – preoccupation with imagined or exaggerated defects in physical appearance o Chronic o Related to OCD—could even pass as a subtype o Could pass as a social phobia, mood disorder, or even an eating disorder - Hypochondriasis – preoccupation with fears of having a serious illness o Chronic – 60% still have it after 5 years o Likely to have mood or anxiety disorders o People who experience abnormally intense sensations may be particularly vulnerable to hypochondriasis o “health anxiety disorder” o hypochondriasis “I think I have this”, illness phobia “I’m afraid to get this” o Illness Attitude Scale (IAS)  Worry about illness and pain  Disease conviction  Health habits  Symptom interference with lifestyle - Conversion disorder – sensory or motor symptoms without any physiological cause o Usually in adolescence or early adulthood after life stress o *some people actually get this diagnosis when there is actually something wrong. Problematic o Psychoanalytic theory of conversion disorder  unresolved Electra complex. The daughter becomes sexually attached to father, but this is repressed. Anxiety converted to physical symptom o behavioural theory of conversion disorder  to secure some kind of end. Have a motive to doing so o social and cultural factors in conversion disorder – high in france and Austria, more common in lower socio-economic status and rural areas o biological factors have been proposed, but no research evidence has been given. But there may be a relation between brain structure and conversion disorder (right hemisphere) - Somatization disorder – recurrent, multiple physical complaints that have no biological basis o 4 pain symptoms in different locations o 2 gastrointestinal symptoms o 1 sexual symptom o 1 pseudoneurological symptom o MALINGERING type – complains consciously for some clear external incentive o FACTITIOUS – complains consciously but with unclear external incentive o Culture varied o Emotion heavy o Happens early adulthood o Runs in families o High awareness and bias towards pain o Etiology – high levels of cortisol Somatization disorder, hypochondriasis, pain disorder, undifferentiated somatoform disorder = all share same features (somatic symptoms and cognitive distortions) = share common name “complex somatic symptom disorder” (CCSD). Symptoms are: - multiplicity of somatic complaints (somatization disorder) - high health anxiety (hypochondriasis) - pain disorder Some argue that somatoform disorders should be taken out of DSM-5 because: - the terminology is often unacceptable to patients - the distinction between disease-based symptoms versus those that are psychogenic may be more apparent than real - there is great heterogeneity among the disorders—the only common link is physical illness that is not attributable to an organic cause - the disorders are incompatible with other cultures - there is ambiguity in the stated exclusion criteria - the subcategories fail to achieve accepted standards of reliability - the disorders lack clearly defined thresholds in terms of the symptoms needed for a diagnosis Some want it renamed to somatic symptom disorders The focus of the symptoms now is the extent to which it impairs the subject’s quality of life Treatment - addressing secondary gain (their ends)/ iatrogenic disability - addressing underlying anxiety and depression - cognitive behavioural approach o validating that the pain is real, and not just in the patient’s head o relaxation training o rewarding the person for behaving in ways inconsistent with the pain Dissociative disorder – disruption of consciousness, memory and/or identity Dissociative amnesia – memory loss following a stressful situation Dissociative fugue – memory loss accompanied by leaving home and starting a new identity Depersonalization disorder – altered experience of the self (nothing is real) Dissociative identity disorder – (split personality) These usually follow traumatic experiences Etiology - stress may store trauma in a way that they are not accessible to awareness. Possible outcomes are amnesia or fugue DID (split personality) – theory is physical or sexual abuse as a child Treatment of DID – hypnosis to enter different personalities. NO CONTROLLED OUTCOME STUDIES Chapter 6 Anxiety disorders: Phobia – fear and avoidance of objects or situations that do not present any real danger - 5% of women incapacitated by their phobias - psychoanalysis – phobia as a redirection of unconscious fear. E.g. fear of father to horses - specific phobias (categories) o agoraphobia (fear of crowded places) o fear of heights or water o threat fears (e.g. needles, storms, thunder) o fears of being observed o speaking fears o (these fears highlight two high-order categories: specific fears and social fears) - 12 month prevalence – 7.1% - lifetime prevalence – 9.4% - most common phobias o animal phobias including insects o heights o being in closed spaces o dentist o seeing blood or injection o storms, thunder, lightning - social phobias – fear of presence of other people - etiology of phobia (theories) o behavioural  avoidance conditioning – relating something to an unconditioned source of fear. Not all phobias are like this though.  Modeling – learning what to fear by someone else’s fears  Prepared learning – not every stimulus can become a source of fear. There has to be some prepared background to the item.  Aversive environments when growing up could be the catalyst to developing phobias o Cognitive  People who are more preoccupied with hiding imperfections and hiding imperfections = more likely to develop anxiety = phobia o Biological  Autonomic lability – individuals’ autonomy is jumpy. Easily aroused  Genetic factors – phobias run down in family o Psychoanalytic theories  Defence againce anxiety produced by repressed id impulses. Directed to something else that has a symbolic connection to it - Therapies o Systematic desensitization o Virtual reality o In vivo exposure o Floodin
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