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Chapter VIII.docx

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University of Toronto St. George
Martha Mc Kay

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 symptoms 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 Malingering Deliberate faking of physical symptoms to avoid an unpleasant situation (ex. military duty) Factitious Disorders Deliberate faking of physical illness to gain (Munchhausens Syndrome) 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 Hypochondriasis 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. 1 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) Theories: - 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 , ulnar nerve effects - 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 Treatment: - 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 1 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
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