Download Chapter Outline

CHAPTER 6
CHAPTER OUTLINE
I.
II.
Dissociative and somatoform disorders The dissociative disorders show altered or
disrupted identity, memory, or consciousness; the somatoform disorders involve
physical symptoms that have no physiological basis. Both disorders occur because of
some psychological need and both rely on self-reports, and so are subject to faking.
Dissociative disorders. There are four dissociative disorders: dissociative amnesia,
dissociative fugue, dissociative identity disorder (formerly called multiple-personality
disorder), and depersonalization disorder. Except for depersonalization, dissociative
disorders are rare, although there has been a dramatic increase in reports of dissociative
identity disorder. Dissociative amnesia is the partial or total loss of important personal
information, often occurring in response to a stressful event. There are five types. Localized
amnesia is characterized by total memory loss for a particular, short time period, and is the
most common form. In selective amnesia, the memory loss is for details about an incident.
Total loss of memory for one’s past life is the criterion for generalized amnesia;
systematized amnesia involves the loss of memory for only selected types of information;
total loss of memory from one point in time to another occurs in continuous amnesia.
Repression of a traumatic event seems to be the main reason for psychogenic amnesia. In
dissociative fugue, memory loss is accompanied by flight to another area and establishment
of a new identity. Recovery from this and from psychogenic amnesia is usually abrupt and
complete. Depersonalization disorder is characterized by feelings of unreality or distorted
perceptions of the body or environment. It is more common than the other dissociative
disorders, tends to be chronic, is often accompanied by mood or anxiety disorders, and can
be precipitated by stress. In dissociative identity disorder (multiple-personality disorder)
two or more (often many more) distinct personalities exist in one individual. Not all
personalities are aware of one another. However, even objective testing with physiological
measurements produces conflicting findings about the existence of distinct personalities.
Although this condition was once thought to be rare, there has been a dramatic increase in
reported cases, perhaps because of the influence of therapists while clients are under
hypnosis. People with dissociative identity disorder often report a history of childhood
abuse. Diagnosis in childhood is possible, but misdiagnosis is common, both by seeing the
disorder in people who have other problems and by failing to see multiple personality in
people diagnosed with other disorders. Diagnosis is much more common in the United
States and Canada than in other parts of the world. The causes of dissociative disorders are
subject to a good deal of conjecture because faking is always a possibility. In the biological
dimension a number of studies using PET scans and MRIs on individuals diagnosed with
DID have found variations in brain activity when comparing different personalities .The
psychological perspective sees repression of, unpleasant emotions as the cause of
dissociative disorders. Splits in consciousness protect the individual from anxiety and pain.
The Social and sociocultural dimensions, conceptualizes DID as a syndrome with rulegoverned and goal-directed experiences, and displays of multiple role enactments created,
legitimized, and maintained by social reinforcement. The disorder may also be the
unintended effect of treatment, an iatrogenic condition. The expectations of therapists and
their use of hypnosis, which increases suggestibility, may create memories of abuse and
personalities. Recovery from dissociative amnesia, dissociative fugue, and
depersonalization disorder often occurs spontaneously; therefore, treatment often aims at
reducing the depression or anxiety these conditions produce. Dissociative identity disorder
is usually treated with psychotherapy and hypnosis, but not with notable success.
III. Somatoform disorders. The principal symptoms of somatoform disorders are
complaints of physical symptoms that have no apparent physiological cause. Faking is
possible, but when symptoms such as fever are consciously induced, they are considered
factitious disorders rather than malingering, which involves voluntary faking for
monetary or other rewards. In somatization disorder, individuals have physical
complaints in four or more different sites in the body, symptoms for which there are no
physiological explanations. Complaints include gastrointestinal, sexual and
pseudoneurological symptoms. If the individual does not fully meet the criteria but has
at least one physical complaint for six months, the diagnosis would be undifferentiated
somatoform disorder. Patients shop around for doctors and often have unneeded
surgery. Somatization disorder, formerly called hysteria, is rarely diagnosed in men
although over one third of males referred for unexplained somatic complaints meet the
criteria for the disorder. In conversion disorder, there is a significant physical
impairment, such as paralysis in a limb or sensory problems, without physical basis.
When neurological or other processes prove the symptoms impossible (such as in glove
anesthesia), diagnosis is readily made; otherwise, it is quite hard to differentiate
conversion disorder from actual illnesses or faking. Pain that is excessive, lingers too
long, or is unrelated to a physiological cause is characteristic of pain disorder. As with
ordinary pain, there is a complex interaction among perception, thinking, and behavior.
In hypochondriasis, there is a consistent preoccupation with illness in the face of
doctors’ repeated assurances of health. Those with hypochondriasis often have a history
of illness and parents who focused on illness. Fear, anxiety, and depression are common
complaints. Body dysmorphic disorder involves an excessive concern with an imagined
or slight physical defect such as facial features, excessive hair, or the shape of genitals.
Individuals with this disorder frequently check their appearance in the mirror and fear
that others are looking at the defect. They make frequent requests for plastic surgery
regardless of the treatment's outcome. Because the disorder involves obsessive thinking
and delusions, its placement in the diagnostic category of somatoform disorders has
been questioned. It is also not clear where normal concerns about appearance end and
the disorder begins. Etiology and treatment of somatoform disorders include the
following. The biological dimensions in general, using twin or family studies found
there is little evidence for heredity in somatoform disorders. Psychoanalysts believe that
repression accounts for the process of converting unconscious conflicts into physical
symptoms. There is primary gain in the reduction of anxiety and secondary gain in the
sympathy the individual receives. Behavioral theorists contend that a “sick role” is
reinforced by others and helps the person escape from responsibilities. The social and
sociocultural dimension stresses that, historically, social norms did not provide women
with appropriate channels for the expression of aggressive or sexual needs. As a result,
women developed hysterical symptoms.. Biological treatment includes antidepressant
medications; the SSRIs have shown promise with somatoforms disorders, primarily
somatization and somatoform pain disorders. The most promising interventions for
somatoform disorders involve the cognitive-behavioral approach. A fundamental focus
is an understanding of the clients’ views regarding their problem
IV. Implications. The two primary models for dissociative disorders include the
psychoanalytically based posttraumatic model (PTM) and the sociocognitive model
(SCM). Both models account for only certain etiological aspects of dissociative
disorders.