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PSY240H1 Chapter Notes -Somatic Symptom Disorder, Dissociative Identity Disorder, Somatization Disorder

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Martha Mc Kay

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Chapter VIII: Somatoform and Dissociative Disorders
- Long history within psychology
- Case of Anna O
- Launched psychoanalysis as a form of psychotherapy
- Consider these disorders as an extreme form of escapedissociation, a process
in which different parts of an individuals identity, memories, or consciousness
split off from one another
- Surrounded by controversy
Somatoform Disorders
- Group of disorders in which people experience significant physical symptoms
for which there is no apparent organic cause
- Often inconsistent with possible physiological processes
- Individual truly experience these symptoms, and they do not go away until
psychological problems are solved
- Easier to identify when
1. There are clear psychological factors that precipitate physiological
2. When examination can prove symptoms are not physiologically possible (ex.
pseudocyesis, false pregnancy)
- Distinctions between Somatoform and Related Syndromes:
Somatoform Disorders
Subjective experience of many physical
symptoms with no organic cause
Psychosomatic Disorders
Actual physical illness present and
psychological factors seem to be contributing
to the illness
Deliberate faking of physical symptoms to
avoid an unpleasant situation (ex. military
Factitious Disorders
(Munchhausens Syndrome)
Deliberate faking of physical illness to gain
medical attention
Factitious Disorders by Proxy
Parents faked or even created illnesses in
their children to gain attention for themselves
- Somatoform disorders come in 5 types:
Conversion Disorder
Loss of functioning in a part of the body for
psychological rather than the physical reasons
Somatization Disorder
History of complaints about physical symptoms,
affecting many different areas of the body, for
which medical attention has been sought but
appear to have no physical cause
Pain Disorder
History of complaints about pain for which
medical attention has been sought but that
appears to have no physical cause
Chronic worry that one has a physical disease in
the absence of evidence that one does; frequent
seeking of medical attention
Body Dysmophic Disorder
Excessive preoccupation with a part of the body
the person believes is defective
Conversion Disorder
- Diagnosed when individuals lose functioning in a part of their bodies
apparently because of neurological or other medical conditions
A. symptoms or deficits affecting voluntary motor or sensory function that
appear due to a neurological or medical condition
B. Psychological factors appear to be associated with the onset and worsening
of the symptoms or deficit
C. The symptom or deficit is not intentionally produced or faked
D. The symptom or deficit cannot be fully explained by a condition or the
effects of drugs
- Typically involves one specific symptom (ex. paralysis, blindness, mutism) but
can have repeated episodes involving different parts of the body
- Symptoms usually develops suddenly after an extreme psychological stressor
- Fascinating but controversial feature: la belle indifference (completely
unconcerned about the loss of functioning they are experiencing)
- Formerly known as conversion hysteria
- Glove anaethesia: lose feeling in one hand as if wearing a glove
No physiologically basis: nerves in hands do not provide feeling in a
glovelike patternradial nerve effects 大拇指(包括指尖),食指,中指,
无名指的一半, ulnar nerve effects 无名指的另一半、尾指(都包括指尖)
- Freud: The psychic energy attached to repressed emotions or memories
transferred into physical symptoms
Symptoms symbolize the specific concerns or memories being repressed
Study: apparently quite common during the two world wars when soldier
inexplicably became paralyzed or blingcannot return to the front
- Children usually have symptoms that mimic those of someone they are close
to who has a real illness
- May be more common among survivors of sexual abuse and other traumas
- People with conversion symptoms are highly hypnotizablespontaneous
self-hypnosis, dissociation of sensory or motor functions from consciousness
- Behavioural theory: people attempt to behave in accordance with their
conception of how a person with a neurological disease would act in order to
gain support, attention, or avoid an aversive situation
- Hurwitz: begin with a psychiatric illness (ex. depression)represent self as
physically ill as a somatic defence to increasing instabilitydevelop fixed
belief about neurological dysfunctionguide behaviour
Distinguishing conversion disorder from physical disorders:
- Must show no physiological cause exists for symptoms
- Missed organic illness account for 4-15% of patients initially diagnosed
- If diagnostic tests cannot establish a physical causedetermine whether the
conversion symptoms are consistent with the way the body works
- SPECTreduced activity in thalamus and basal ganglia on the sides of the
brain opposite to the side in which the patient had loss of functioning
Emotion stressors inhibit circuits between sensorimotor areas of the brain
and areas more involved in emotionsloss of sensation/motor control
- Psychoanalytic treatment focuses on the expression of painful emotions and
memories and insight into the relationship between these and the symptoms
- When symptoms are present for month, history often resembles
somatization disorder and treated as such
- Behavioural treatments focus on relieving the persons anxiety around the
causing initial trauma & reducing benefits received from symptoms
Systematic desensitization
- Difficult to treat because they do not believe there is anything wrong with
them psychologically
- La belle indifferenceno motivation to cooperate
Somatization Disorders and Pain Disorders
- Somatization diagnosed when individuals have a history of numerous physical
complains for which no medical causes can be found
A. A history of many physical complaints over a period of several years, for
which the person seeks treatment
B. Symptoms in each of the following areas must occur at some time during
the course of the disorder:
a. Pain symptoms in at 4± areas of the body (ex. head, back, rectum, legs)
b. 2± gastrointestinal symptoms other than pain (ex. nausea, diarrhea)
c. 1± sexual symptoms
d. apparently neurological symptom (ex. paralysis, double vision,
C. The symptom or deficit cannot be fully explained by a medical condition or
the effects of drugs
- Pain disorder: only complain of chronic pain
- People with these disorders may be prone to periods of anxiety and depression
that they cannot express or cope with
- Medically unexplained pain is particularly associated with generalized
anxiety disorder
Medically unexplained pain + GADlow quality of life, disability, poor
- More common in womenmore periods of depression and anxiety, not
comfortable in expressing distress directly
- More common in cultures that expresses distress in physical complaints