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ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 8 Somatic Symptom and Dissociative Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Somatic Symptom Disorders Somatic Symptom Disorders • Involve physical symptoms and complaints suggesting presence of medical condition • Contain no evidence of physical pathology © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. What Are Somatic Symptom Disorders? Hypochondriasis Somatization disorder Somatic Symptom disorder patterns Pain disorder Conversion disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • Must have one of the following three features: • Disproportionate and persistent thoughts about the seriousness of one’s symptoms, • Persistently high level of anxiety about health or symptoms, and/or • Excessive time and energy devoted to these symptoms or health concerns. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Hypochondriasis Hypochondriasis • Preoccupation with fears of having or getting serious disease • Treatment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •Not a disorder in DSM-5, and about 75% of people with hypochrondriasis will meet criteria for somatic symptom disorder •People with hypochondriasis are preoccupied with fears of getting a serious disease or the idea that they already have one •Cognitive-behavioral views of hypochondriasis are most widely accepted •Cognitive-behavioral therapy can be a very effective treatment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Somatization Disorder Somatization disorder • Characterized by many different complaints of physical ailments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Somatization Disorder Lasting several years Beginning before age 30 Somatization disorder characteristics Not adequately explained by independent findings of physical illness or injury Leading to medical treatment or to significant life impairment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Somatization Disorder Prevalence Rates Causal factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •Prevalence, Rates, and Causal Factors • Usually begins in adolescence • Is three to ten times more common in women than in men • Often occurs with other disorders such as major depression or panic disorder •There may be a genetic predisposition to the disorder •Other contributory causal factors may include personality, cognitive, and learning variables © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Somatization Disorder Treatment • Difficult to treat • Combination of medical management and cognitivebehavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Pain Disorder Now a part of Somatic Symptom Disorder • Experience of persistent and severe pain in one or more areas of body • Not intentionally produced or feigned © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Pain Disorder Cognitivebehavioral techniques Treatment Used in treatment of both subtypes of pain disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Illness Anxiety Disorder • Experience high anxiety about having or developing a serious illness. • New to DSM-5. • 25% of people who met the criteria for hypochondriasis will be diagnosed with this new disorder. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Conversion Disorder Conversion disorder • Symptoms or deficits affecting sensory or voluntary motor functions • Leads one to think patient has medical condition © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •Freud believed that the symptoms were an expression of repressed sexual energy •One of the most intriguing and baffling disorders, with much left to learn. •In contemporary terms, the primary gain for conversion symptoms is continued escape or avoidance of a stressful situation •Secondary gains include attention and financial compensation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Conversion Disorder Primary gain: cont. escape/avoidance of stressful situation Gains Secondary gains: attention, financial compensation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Conversion Disorder Prevalence: .005% of general population Decreasing prevalence Two to three times more common in women than men Comorbidity: major depression and anxiety disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Conversion Disorder Categories of symptoms Sensory symptoms or deficits Motor symptoms or deficits Seizures Mixed presentation from first three categories © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Conversion Disorder True or false? It is crucial that patients receive a thorough medical and neurological examination to rule out organic illness. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Conversion Disorder Behavioral therapy Treatment Cognitivebehavioral therapy Hypnosis © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Malingering and Factitious Disorder Malingering • Motivated by external incentives © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Factitious disorder • Motivated by benefits of “sick role” •It can be difficult to distinguish between malingering/factitious disorder and somatic symptom disorders such as conversion disorder • Conscious intent can be a key distinction © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. What Are Dissociative Disorders? Dissociative disorders • Conditions involving disruptions in normally integrated functions • Consciousness • Memory • Identity • Perception © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Dissociative Disorders Depersonalization/Derealization Disorder What Are Dissociative Disorders? Dissociative Amnesia and Dissociative Fugue Dissociative Identity Disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Depersonalization/Derealization Disorder Derealization © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Depersonalization •In derealization, one’s sense of the reality of the outside world is temporarily lost •In depersonalization, one’s sense of one’s self and one’s reality is temporarily lost •If these recur and disrupt life, depersonalization/derealization disorder may be diagnosed © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Dissociative Amnesia and Dissociative Fugue Dissociative amnesia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Dissociative fugue •Dissociative fugue now a subtype of dissociative amnesia •Dissociative amnesia involves a failure to recall previously stored personal information when that failure cannot be accounted for by ordinary forgetting •In a dissociative fugue the person also departs from home surroundings © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Dissociative Identity Disorder Dissociative identity disorder • Patient manifests two or more distinct identities or personality states (not personalities) • Formerly called multiple personality disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Controversies Dissociative Identity Disorder Is the disorder real or faked? If the disorder is not faked, how does it develop? Are recovered memories of abuse in the disorder real or false? If abuse has occurred, did it play a causal role? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Figure 8.1: Childhood Abuse of DID Patients © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Sociocultural Factors in Dissociative Disorders Prevalence, Differences, Examples Prevalence varies with cultural acceptance of dissociative phenomena DID identified in all racial groups, SES classes, and researched cultures Examples © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •Prevalence varies with acceptance of dissociative phenomena in the culture •DID has been identified in all racial groups, SES classes, and cultures in which it has been studied; No systematic controlled research has been conducted •In some cultures, dissociative trances or possession trances may occur •Amok is a dissociative rage seen in some cultures such as Malaysia, Laos, the Philippines, Papua New Guinea, and others © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatment and Outcomes in Dissociative Disorders Treatments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • Hypnosis • Integration of separate alters Unresolved Issues How might “recovered memories” be linked to DID? “Recovered memories” of childhood abuse are thought by some to be causal in DID, but by others to be falsely planted by therapists Very controversial topic that presents various legal and ethical challenges © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.