Psychological Conditions Mimicking Physical Issues: Somatoform & Dissociative Disorders, Slides of Abnormal Psychology

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Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Somatoform and Dissociative Disorders Docsity.com Somatoform and Dissociative Disorders • In addition to disorders covered earlier, two other kinds of disorders are commonly associated with stress and anxiety: – Somatoform disorders – Dissociative disorders Docsity.com Somatoform and Dissociative Disorders • The somatoform and dissociative disorders have much in common: – Both may occur in response to severe stress – Both have traditionally been viewed as forms of escape from stress – A number of individuals suffer from both a somatoform and a dissociative disorder – Theorists and clinicians often explain and treat the two groups of disorders in similar ways Docsity.com Somatoform Disorders • When a physical ailment has no apparent medical cause, physicians may suspect a somatoform disorder • People with a somatoform disorder do not consciously want, or purposely produce, their symptoms – They believe their problems are genuinely medical • There are two main types of somatoform disorders: – Hysterical somatoform disorders – Preoccupation somatoform disorders Docsity.com What Are Hysterical Somatoform Disorders? • People with hysterical somatoform disorders suffer actual changes in their physical functioning – These disorders are often hard to distinguish from genuine medical problems – It is always possible that a diagnosis of hysterical disorder is a mistake and that the patient’s problem has an undetected organic cause Docsity.com What Are Hysterical Somatoform Disorders? • Conversion disorder – In this disorder, a psychosocial conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning • Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling – Most conversion disorders begin between late childhood and young adulthood – They are diagnosed in women twice as often as in men – They usually appear suddenly and are thought to be rare Docsity.com What Are Hysterical Somatoform Disorders? • Somatization disorder – People with somatization disorder have many long-lasting physical ailments that have little or no organic basis • Also known as Briquet’s syndrome – To receive a diagnosis, a patient must have a range of ailments, including several pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological symptom – Patients usually go from doctor to doctor in search of relief Docsity.com What Are Hysterical Somatoform Disorders? • Somatization disorder – Patients often describe their symptoms in dramatic and exaggerated terms • Most also feel anxious and depressed – Between 0.2% and 2% of all women in the U.S. experience a somatization disorder in any given year (compared with less than 0.2% of men) – The disorder often runs in families and begins between adolescence and young adulthood Docsity.com What Are Hysterical Somatoform Disorders? • Hysterical vs. medical symptoms – It can be difficult to distinguish hysterical disorders from “true” medical conditions • Studies across the world suggest that as many as one-fifth of all patients who seek medical care may actually suffer from somatoform disorders – Physicians sometimes rely on oddities in the patient’s medical picture to help distinguish the two • For example, hysterical symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesia Docsity.com Glove — anesthesia Area affected by ulnar nerve Area affected by radial nerve Docsity.com What Are Hysterical Somatoform Disorders? • Hysterical vs. factitious symptoms – Hysterical somatoform disorders are different from patterns in which individuals are purposefully producing or faking medical symptoms • Patients may be malingering – intentionally faking illness to achieve external gain (e.g., financial compensation, military deferment) • Patients may be manifesting a factitious disorder – intentionally producing or faking symptoms simply out of a wish to be a patient Docsity.com Factitious Disorder • Munchausen syndrome is the extreme and long-term form of factitious disorder • In Munchausen syndrome by proxy, a related disorder, parents make up or produce physical illnesses in their children Docsity.com What Are Preoccupation Somatoform Disorders? • Preoccupation somatoform disorders include hypochondriasis and body dysmorphic disorder – People with these problems misinterpret and overreact to bodily symptoms or features • Although these disorders also cause great distress, their impact on one’s life differs from that of hysterical disorders Docsity.com People who would change 99% something about their appearance if they could 93% People who daydream about being 16% beautiful or handsome 6% People who think that the 2ales cosmetics industry is very important ° or essential to our country 17% People who wear uncomfortable 45% shoes because they look good 20% People who have brushed their 22% teeth twice in the last 24 hours 18% People who have flossed their 30% teeth in the last 24 hours 20% People who have stuffed their 8% bras (women) or shorts (men) 4% © women 479 M@ Men People who have colored 7 their hair 8% Docsity.com What Are Preoccupation Somatoform Disorders? • Hypochondriasis – Although this disorder can begin at any age, it starts most often in early adulthood, among men and women in equal numbers – Between 1% and 5% of all people experience the disorder – For most patients, symptoms rise and fall over the years Docsity.com What Are Preoccupation Somatoform Disorders? • Body dysmorphic disorder (BDD) – People with this disorder, also known as dysmorphophobia, become deeply concerned over some imagined or minor defect in their appearance • Most often they focus on wrinkles, spots, facial hair, swelling, or misshapen facial features (nose, jaw, or eyebrows) – Most cases of the disorder begin in adolescence but are often not revealed until adulthood – Up to 5% of people in the U.S. experience BDD, and it appears to be equally common among women and men Docsity.com What Causes Somatoform Disorders? • Theorists typically explain the preoccupation somatoform disorders much as they do the anxiety disorders: – Behaviorists: classical conditioning or modeling – Cognitive theorists: oversensitivity to bodily cues • In contrast, the hysterical somatoform disorders are widely considered unique and in need of special explanation – No explanation has received much research support, and the disorders are still poorly understood Docsity.com What Causes Somatoform Disorders? • The psychodynamic view – Today’s psychodynamic theorists take issues with Freud’s explanation of the Electra conflict • They continue to believe that sufferers of these disorders have unconscious conflicts carried from childhood Docsity.com What Causes Somatoform Disorders? • The psychodynamic view – Psychodynamic theorists propose that two mechanisms are at work in the hysterical disorders: • Primary gain: hysterical symptoms keep internal conflicts out of conscious awareness • Secondary gain: hysterical symptoms further enable people to avoid unpleasant activities or receive sympathy from others Docsity.com What Causes Somatoform Disorders? • The behavioral view – Behavioral theorists propose that the physical symptoms of hysterical disorders bring rewards to sufferers • May remove individual from an unpleasant situation • May bring attention from other people – In response to such rewards, people learn to display symptoms more and more – This focus on rewards is similar to the psychodynamic idea of secondary gain, but behaviorists view the gains as the primary cause of the development of the disorder Docsity.com What Causes Somatoform Disorders? • A possible role for biology – The impact of biological processes on somatoform disorders can be understood through research on placebos and the placebo effect • Placebos: substances with no known medicinal value • Treatment with placebos has been shown to bring improvement to many – possibly through the power of suggestion or through the release of endogenous chemicals – Perhaps traumatic events and related concerns or needs can also trigger our “inner pharmacies” and set in motion the bodily symptoms of hysterical somatoform disorders Docsity.com How Are Somatoform Disorders Treated? • People with somatoform disorders usually seek psychotherapy only as a last resort • Individuals with preoccupation disorders typically receive the kinds of treatments applied to anxiety disorders, particularly OCD: – Antidepressant medication – Exposure and response prevention (ERP) Docsity.com How Are Somatoform Disorders Treated? • Treatments for hysterical disorders often focus on the cause of the disorder and apply the same kind of techniques used in cases of PTSD, particularly: – Insight – often psychodynamically oriented – Exposure – client thinks about traumatic event(s) that triggered the physical symptoms – Drug therapy – especially antidepressant medication Docsity.com Dissociative Disorders • When such changes in memory lack a clear physical cause, they are called “dissociative” disorders – In such disorders, one part of the person’s memory typically seems to be dissociated, or separated, from the rest Docsity.com Dissociative Disorders • There are several kinds of dissociative disorders, including: – Dissociative amnesia – Dissociative fugue – Dissociative identity disorder (multiple personality disorder) • These disorders are often memorably portrayed in books, movies, and television programs • DSM-IV-TR also lists depersonalization disorder as a dissociative disorder Docsity.com DISSOCIATIVE AMNESIA 1, One or more episodes of inability to recall important personal infor- Et ae Be NLC oot sive to be explained by ordinary reas 2. Significant distress or impairment. DSSeaT aug PRS lo tected from home or one’s customary Pete Re mL MNCL Lia} ee ecar res Men renege cae AC ees cute a nat Cuba RAY alia DISSOCIATIVE IDENTITY DISORDER (MULTIPLE PERSONALITY DISORDER) Ceci distinct identities or personality Sen 2. Control of the person’s behavior Dee nM un ek ey Cae: eat ibg ren Pw Ute erat i UCU LCR ad extensive to be explained by ordi- peaches Docsity.com Dissociative Amnesia • Dissociative amnesia may be: – Localized (circumscribed) – most common type; loss of all memory of events occurring within a limited period – Selective – loss of memory for some, but not all, events occurring within a period – Generalized – loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends – Continuous – forgetting of both old and new information and events; quite rare in cases of dissociative amnesia Docsity.com Dissociative Amnesia • All forms of the disorder are similar in that the amnesia interferes primarily with episodic memory (one’s autobiographical memory of personal material) – Semantic memory – memory for abstract or encyclopedic information – usually remains intact • Clinicians do not known how common dissociative amnesia is, but many cases seem to begin during times of serious threat to health and safety Docsity.com Dissociative Fugue • People with dissociative fugue not only forget their personal identities and details of their past, but also flee to an entirely different location – For some, the fugue is brief – a matter of hours or days – and ends suddenly – For others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics Docsity.com Dissociative Identity Disorder (Multiple Personality Disorder) • At any given time, one of the subpersonalities dominates the person’s functioning – Usually one of these subpersonalities – called the primary, or host, personality – appears more often than the others – The transition from one subpersonality to the next (“switching”) is usually sudden and may be dramatic Docsity.com Dissociative Identity Disorder (Multiple Personality Disorder) • Cases of this disorder were first reported almost three centuries ago – Many clinicians consider the disorder to be rare, but some reports suggest that it may be more common than once thought Docsity.com Dissociative Identity Disorder (Multiple Personality Disorder) • Most cases are first diagnosed in late adolescence or early adulthood – Symptoms generally begin in childhood after episodes of abuse • Typical onset is before age 5 • Women receive the diagnosis three times as often as men Docsity.com Dissociative Identity Disorder (Multiple Personality Disorder) • How do subpersonalities differ? – Subpersonalities often display dramatically different characteristics, including: • Vital statistics – Subpersonalities may differ in features as basic as age, sex, race, and family history • Abilities and preferences – Although encyclopedic knowledge is unaffected by dissociative amnesia or fugue, in DID it is often disturbed – It is not uncommon for different subpersonalities to have different abilities, including being able to drive, speak a foreign language, or play an instrument Docsity.com Dissociative Identity Disorder (Multiple Personality Disorder) • How do subpersonalities differ? – Subpersonalities often display dramatically different characteristics, including: • Physiological responses – Researchers have discovered that subpersonalities may have physiological differences, such as differences in autonomic nervous system activity, blood pressure levels, and allergies Docsity.com Dissociative Identity Disorder (Multiple Personality Disorder) • How common is DID? – Traditionally, DID was believed to be rare • Some researchers even argue that many or all cases are iatrogenic; that is, unintentionally produced by practitioners – These arguments are supported by the fact that many cases of DID first come to attention only after a person is already in treatment » Not true of all cases Docsity.com How Do Theorists Explain Dissociative Disorders? • The psychodynamic view – Psychodynamic theorists believe that dissociative disorders are caused by repression, the most basic ego defense mechanism • People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness Docsity.com How Do Theorists Explain Dissociative Disorders? • The psychodynamic view – In this view, dissociative amnesia and fugue are single episodes of massive repression – DID is thought to result from a lifetime of excessive repression, motivated by very traumatic childhood events Docsity.com How Do Theorists Explain Dissociative Disorders? • The psychodynamic view – Most of the support for this model is drawn from case histories, which report brutal childhood experiences, yet: • Some individuals with DID do not seem to have these experiences of abuse – Why might only a small fraction of abused children develop this disorder? Docsity.com How Do Theorists Explain Dissociative Disorders? • Self-hypnosis – Although hypnosis can help people remember events that occurred and were forgotten years ago, it can also help people forget facts, events, and their personal identity • Called “hypnotic amnesia,” this phenomenon has been demonstrated in research studies with word lists • The parallels between hypnotic amnesia and dissociative disorders are striking and have led researchers to conclude that dissociative disorders may be a form of self-hypnosis Docsity.com How Are Dissociative Disorders Treated? • People with dissociative amnesia and fugue often recover on their own – Only sometimes do their memory problems linger and require treatment • In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality – Treatment for dissociative amnesia and fugue tends to be more successful than treatment for DID Docsity.com How Are Dissociative Disorders Treated? • How do therapists help people with dissociative amnesia and fugue? – The leading treatments for these disorders are psychodynamic therapy, hypnotic therapy, and drug therapy • Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness • In hypnotic therapy, patients are hypnotized and guided to recall forgotten events • Sometimes intravenous injections of barbiturates are used to help patients regain lost memories – Often called “truth serums,” the key to the drugs’ success is their ability to sedate people and free their inhibitions Docsity.com How Are Dissociative Disorders Treated? • How do therapists help individuals with DID? – Therapists usually try to help the client by: • Recovering memories – To help patients recover missing memories, therapists use many of the approaches applied in other dissociative disorders, including psychodynamic therapy, hypnotherapy, and drug treatment » These techniques tend to work slowly in cases of DID Docsity.com How Are Dissociative Disorders Treated? • How do therapists help individuals with DID? – Therapists usually try to help the client by: • Integrating the subpersonalities – The final goal of therapy is to merge the different subpersonalities into a single, integrated entity – Integration is a continuous process; fusion is the final merging » Many patients distrust this final treatment goal and many subpersonalities see integration as a form of death – Once the subpersonalities are integrated, further therapy is typically needed to maintain the complete personality and to teach social and coping skills to prevent later dissociations Docsity.com Depersonalization Disorder • DSM-IV-TR categorizes depersonalization disorder as a dissociative disorder, even though it is different from the other dissociative patterns • The central symptom is persistent and recurrent episodes of depersonalization, which is a change in one’s experience of the self in which one’s mental functioning or body feels unreal or foreign Docsity.com