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Chapter 7

PSY240 Chapter 7

7 Pages

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Hywel Morgan

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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  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.  Fraser’s military client’s case of being blind  Hysteria: coined by Hippocrates, who believed that it’s an affliction limited solely to women. It’s 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 Somatization Disorder (Briquet’s Syndrome)  It’s characterized by recurrent, multiple somatic complaints with no apparent physical cause.  Diagnostic criteria: 1. Four pain symptoms in different locations 2. Two gastrointestinal symptoms 3. One sexual symptom other than pain 4. One pseudo-neurological symptom  Usually cause impairment, behavioural and interpersonal problems.  Co-exists with conversion disorder and comorbid with anxiety, mood disorders, substance abuse and several personality disorders  Visit physicians and use medication often; have menstrual difficulties and sexual indifference.  Individuals often reject psychosomatic explanation because they do not experience sufficient correlation between symptoms and psychological states  Lifetime prevalence of somatization disorder is less than 0.5% of the population. More women than men  Vary across cultures, i.e. burning hands of ants crawling under the skin are more frequent in Asia and Africa than in North America  Because it’s varying from culture to culture, the treatments are not universally accepted. It is more reasonable to view person’s culture as providing a concept of what distress is and how it should be communicated.  Begin in early adulthood.  Heritable in the family  It should be more inclusive as “abridged somatization disorder” (DSM-V) because many people (at least 10%-15%) are with clinically meaningful medically unexplained symptoms but not diagnosed with somatization disorder. Etiology of Somatoform Disorders  Etiology of Somatization Disorder  Somatoform clients had memory bias and greater supraliminal interferences for physical threat words presented in a Stroop task.  Clients have high levels of cortisol – they are under stress.  Children can acquire/learn somatization disorders’ responses from their parents.  Psychoanalytic theory of conversion disorder  Freud: Studies in Hysteria indicates that specific conversion symptoms were said to be related causally to the traumatic event that preceded them.  Case of Anna O., who’s right arm was chronic paralysis due to psychological stress (dreaming).  Sackeim: Two-stage defensive reaction to account for the conflicting findings (base on the cases of two adolescent girls): 1. Perceptual representations of visual stimuli are blocked from awareness. People then report themselves blind. 2. Information is n
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