PSY240H1 Chapter Notes - Chapter 7: Anna O., Somatization, Malingering

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2 Feb 2013
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Chapter 7: Somatoform and Dissociative Disorders
7.1 Somatoform Disorders
Introduction
Somatoform disorders: the individual complains of bodily symptoms that
suggest a physical defect or dysfunction but with no physiological basis.
Dissociative disorders: the individual experiences disruptions of
consciousness, memory and identity.
Complex Somatic Symptom Disorder (CCSD): The common rubric for all the
somatoform disorders suggested by the work group (for DSM V).
Pain Disorder
The person experiences (physical) pain that causes significant distress and
impairment because of psychological factors.
Hard to diagnosis accurately because the subjective experience of pain is
always a psychologically influenced phenomenon.
Central changes in pain disorder: a recent case of a woman whose prefrontal,
cingulated, and insular cortex regions are decreased, which caused pain
disorder.
Body Dysmorphic Disorder
A person is preoccupied with an imagined or exaggerated defect in
appearance (face).
Women: skin, hips, breasts and legs
Men: height, penises, and body hair
Eliminating mirrors from homes/ wearing loose clothing/frequent plastic
surgeons.
Usually happens on late adolescent women; co-exists with depression, social
phobia, eating disorders, thoughts of suicide, and substance/personality
disorders.
Some people believe it should be the subtype of OCD; some people belive
that it should be double-coded with delusion (psychotic variant)
Anxiety and obsessive-compulsive spectrum disorders (DSM-V)
Hypochondriasis
Individuals are preoccupied with persistent fears of having a serious disease,
despite medical reassurance to the contrary
Usually happens on early adulthoods that have chronic courses
Accompany with mood/anxiety disorders
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Overreact to ordinary physical sensations and minor abnormalities.
Case of Mr. V, who kept scratching himself due to hypochondriasis and died
at age 25
5% of the general population has hypochondriasis
Health anxiety = hypochondriasis (fear of having an illness) + illness phobia
(fear of contracting an illness)
Health anxiety is heritable, but most of the variance was due to
environmental factors (mostly learned)
Cognitive model for healthy anxiety: 1. Critical precipitating incident 2.
previous experience of illness 3. the presence of negative cognitive assumption
4. The severity of anxiety
Perceiving likelihood of illness and cost, awfulness and burden of illness will
increase health anxiety; perceiving the ability to cope and presence of rescue
factors will decrease health anxiety.
Conversion Disorder (Hysteria)
Physiologically normal people experience sensory or motor symptoms.
Anesthesias: loss or impairment of sensations (the symptom of conversion
disorder) (Aphonia, losing voice; anosmia, losing sense of smell)
Appear suddenly in stressful situations to allow the individual to avoid
certain activity or responsibility.
Conversion is coined by Freud, who thought that the energy of a repressed
instinct was diverted into sensory-motor channels and blocked function; in the
other words, anxiety and psychological conflict were believed to be converted
into physical symptoms.
Frasers military clients case of being blind
Hysteria: coined by Hippocrates, who believed that its an affliction limited
solely to women. Its the conversion disorder today.
Case of five Amish girls
Conversion Disorder often develops in adolescence or early adulthood with
undergoing life stress.
Prevalence of conversion disorder is less than 1%; more women than men
Comorbid with depression, substance abuse, anxiety, dissociative disorders,
and personality disorders such as borderline and histrionic disorders
Glove anesthesia: a rare syndrome that individual experiences little or no
sensation in the part of the hand that would be covered by a glove, which does
not make anatomical sense
Across both genders and all age groups
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