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    Chapter 6 Lecture Notes Page.doc Chapter 6 Lecture Notes Page.doc Document Transcript

    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 1Chapter 6 — Somatoform and Dissociative DisordersSlides, handouts, and answers keys created by Karen Clay Rhines, Ph.D., Seton Hall UniversityHandout 3: Somatoform and Dissociative Disorders Somatoform disorders are problems that appear to be physical or medical but are due to psychosocial factors 0. Unlike psychophysiological disorders, in which psychosocial factors interact with physical factors to produce genuine physical ailments and damage, somatoform disorders are psychological disorders masquerading as physical problemsHandout 4: Somatoform and Dissociative Disorders Dissociative disorders are syndromes that feature major losses or changes in memory, consciousness, and identity, but do not have physical causes 1. Unlike dementia and other neurological disorders, these patterns are, like somatoform disorders, almost entirely due to psychosocial factorsHandout 5: Somatoform and Dissociative Disorders The somatoform and dissociative disorders have much in common: 2. Both occur in response to traumatic or ongoing stress 3. Both are viewed as forms of escape from stressHandout 6: Somatoform Disorders When a physical ailment has no apparent medical cause, physicians may suspect a somatoform disorder People with 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: 4. Hysterical somatoform disorders 5. Preoccupation somatoform disordersHandout 7: What Are Hysterical Somatoform Disorders? People with hysterical somatoform disorders suffer actual changes in their physical functioning
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 2 6. Often hard to distinguish from genuine medical problems 7. It is always possible that a diagnosis of hysterical disorder is a mistake and the patient’s problem actually has an undetected organic causeHandout 9: 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 0. 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 rareHandout 10: What Are Hysterical Somatoform Disorders? Somatization disorder •People with somatization disorder have numerous long-lasting physical ailments that have little or no organic basis 1. Also known as Briquet’s syndrome •To receive a diagnosis, a patient must have multiple ailments that include several pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological symptom •Patients usually go from doctor to doctor seeking reliefHandout 12: What Are Hysterical Somatoform Disorders? Somatization disorder 8. This disorder usually lasts much longer than a conversion disorder, typically for many years 9. Symptoms may fluctuate over time but rarely disappear completely without psychotherapyHandout 13: What Are Hysterical Somatoform Disorders? Pain disorder associated with psychological factors •Patients may receive this diagnosis when psychosocial factors play a central role in the onset, severity, or continuation of pain •The precise prevalence has not been determined, but it appears to be fairly common 2. The disorder often develops after an accident or illness that has caused genuine pain •The disorder may begin at any age, and more women than men seem to experience it
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 3Handout 14: What Are Hysterical Somatoform Disorders? Hysterical vs. medical symptoms 10. It is often difficult for physicians to differentiate between hysterical disorders and “true” medical conditions •They often rely on oddities in the medical presentation to help distinguish the two 3. For example, hysterical symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesiaHandout 16: What Are Hysterical Somatoform Disorders? Hysterical vs. factitious symptoms 11. Hysterical somatoform disorders must also be distinguished from patterns in which individuals are 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 feigning symptoms simply from a wish to be a patientHandout 18: Factitious Disorder Munchausen syndrome is the extreme and chronic form of factitious disorder 12. In a related disorder, Munchausen syndrome by proxy, parents make up or produce physical illnesses in their children 4. When children are removed from their parents, symptoms disappearHandout 20: What Are Preoccupation Somatoform Disorders? People with these problems are healthy but mistakenly worry that there is something physically wrong with them 13. They misinterpret and overreact to bodily symptoms or features Although these disorders also cause great distress, their impact on personal, social, and occupational life differs from that of hysterical disordersHandout 21: What Are Preoccupation Somatoform Disorders? Hypochondriasis 14. People with hypochondriasis unrealistically interpret bodily symptoms as signs of serious illness •Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating 15. Although some patients recognize that their concerns are excessive, many do not
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 4Handout 23: What Are Preoccupation Somatoform Disorders? Body dysmorphic disorder (BDD) •This disorder, also known as dysmorphophobia, is characterized by deep and extreme concern over an imagined or minor defect in one’s appearance 5. Foci are most often wrinkles, spots, facial hair, 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 2% of people in the U.S. experience BDD, and it appears to be equally common among women and menHandout 27: What Causes Somatoform Disorders? The psychodynamic view 16. Modern psychodynamic theorists have modified Freud’s explanation away from the Electra conflict •They continue to believe that sufferers of these disorders carry unconscious conflicts forth from childhoodHandout 28: What Causes Somatoform Disorders? The psychodynamic view 17. Modern 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 to receive kindness or sympathy from othersHandout 29: What Causes Somatoform Disorders? The behavioral view •Behavioral theorists propose that the physical symptoms of hysterical disorders bring rewards to sufferers 6. May remove individual from an unpleasant situation 7. May bring attention to the individual •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 disorderHandout 30: What Causes Somatoform Disorders? The cognitive view 18. Cognitive theorists propose that hysterical disorders are a form of
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 5 communication, providing a means for people to express difficult emotions •Like psychodynamic theorists, cognitive theorists hold that emotions are being converted into physical symptoms 8. This conversion is not to defend against anxiety but to communicate extreme feelingsHandout 31: What Causes Somatoform Disorders? A possible role for biology 19. The impact of biological processes on somatoform disorders can be understood through research on placebos and the placebo effect •Placebo: substances with no known medicinal value •Treatment with placebos (i.e., sham treatment) has been shown to bring improvement to many—possibly through the power of suggestion or through the release of endogenous chemicalsHandout 32: How Are Somatoform Disorders Treated? People with somatoform disorders usually seek psychotherapy as a last resort Individuals with preoccupation disorders typically receive the kinds of treatments applied to anxiety disorders: 20. Antidepressant medication •Especially selective serotonin reuptake inhibitors (SSRIs) 21. Exposure and response prevention (ERP)Handout 33: How Are Somatoform Disorders Treated? Individuals with hysterical disorders are typically treated with approaches that emphasize: 22. Insight—often psychodynamically oriented 23. Suggestion—usually an offering of emotional support that may include hypnosis 24. Reinforcement—a behavioral attempt to change reward structures 25. Confrontation—an overt attempt to force patients out of the sick roleHandout 36: Dissociative Disorders When such changes in memory have no clear physical cause, they are called “dissociative” disorders 26. In such disorders, one part of the person’s memory typically seems to be dissociated, or separated, from the rest
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 6Handout 38: How Are Somatoform Disorders Treated? It is important to note that dissociative symptoms are often found in cases of acute and posttraumatic stress disorders 27. When such symptoms occur as part of a stress disorder, they do not necessarily indicate a dissociative disorder (a pattern in which dissociative symptoms dominate) •However, some research suggests that people with one of these disorders may be highly vulnerable to developing the otherHandout 40: Dissociative Amnesia Dissociative amnesia may be: •Localized—most common type; loss of all memory of events occurring within a limited period of time •Selective—loss of memory for some, but not all, events occurring within a period of time •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 amnesiaHandout 41: 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) 28. Semantic memory—memory for abstract or encyclopedic information— usually remains intact It is not known how common dissociative amnesia is, but rates increase during times of serious threat to health and safetyHandout 42: 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: they may travel a short distance but do not take on a new identity •For others, the fugue is more severe: they may travel thousands of miles, take on a new identity, build new relationships, and display new personality characteristicsHandout 45: Dissociative Identity Disorder/Multiple PersonalityDisorder
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 7 At any given time, one of the subpersonalities dominates the person’s functioning 29. Usually one of these subpersonalities—called the primary, or host, personality —appears more often than the others 30. The transition from one subpersonality to the next (“switching”) is usually sudden and may be dramaticHandout 47: Dissociative Identity Disorder/Multiple PersonalityDisorder Most cases are first diagnosed in late adolescence or early adulthood 31. Symptoms generally begin in childhood after episodes of abuse •Typical onset is before the age of 5 Women receive the diagnosis three times as often as menHandout 48: Dissociative Identity Disorder/Multiple PersonalityDisorder How do subpersonalities interact? •The relationship between or among subpersonalities differs from case to case 9. Generally there are three kinds of relationships: 10. Mutually amnesic relationships—subpersonalities have no awareness of one another 11. Mutually cognizant patterns—each subpersonality is well aware of the rest 12. One-way amnesic relationships—most common pattern; some personalities are aware of others, but the awareness is not mutual 13. Those who are aware (“co-conscious subpersonalities”) are “quiet observers”Handout 50: Dissociative Identity Disorder/Multiple PersonalityDisorder How do subpersonalities differ? •Subpersonalities often display dramatically different characteristics, including: 14. Vital statistics 15. Subpersonalities may differ in terms of age, sex, race, and family history 16. Abilities and preferences 17. Although encyclopedic knowledge is unaffected by dissociative amnesia or fugue, in DID it is often disturbed 18. It is not uncommon for different subpersonalities to have different areas of expertise or abilities, including driving a car, speaking foreign languages, or
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 8 playing an instrumentHandout 51: Dissociative Identity Disorder/Multiple PersonalityDisorder How do subpersonalities differ? 32. Subpersonalities often display dramatically different characteristics, including: •Physiological response 19. Researchers have discovered that subpersonalities may have physiological differences, such as differences in autonomic nervous system activity, blood pressure levels, and allergiesHandout 53: Dissociative Identity Disorder/Multiple PersonalityDisorder How common is DID? •The number of people diagnosed with the disorder has been increasing •Although the disorder is still uncommon, thousands of cases have been documented in the U.S. and Canada alone 20. Two factors may account for this increase: 21. Clinicians are more willing to make such a diagnosis 22. Diagnostic procedures have become more accurate •Despite changes, many clinicians continue to question the legitimacy of the category and are reluctant to diagnose the disorderHandout 55: How Do Theorists Explain Dissociative Disorders? The psychodynamic view 33. 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 awarenessHandout 58: How Do Theorists Explain Dissociative Disorders? The behavioral view •Behaviorists believe that dissociation grows from normal memory processes and is a response learned through operant conditioning: 23. Momentary forgetting of trauma decreases anxiety, which increases the likelihood of future forgetting 24. Like psychodynamic theorists, behaviorists see dissociation as escape behavior
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 9 •Like psychodynamic theorists, behaviorists rely largely on case histories to support their view of dissociative disorders 25. While the case histories support this model, they are also consistent with other explanations…Handout 59: How Do Theorists Explain Dissociative Disorders? State-dependent learning •If people learn something when they are in a particular state of mind, they are likely to remember it best when they are in the same condition 26. This link between state and recall is called state-dependent learning 27. This model has been demonstrated with substances and mood and may be linked to arousal levels 28. It has been theorized that people who develop dissociative disorders have state-to-memory links that are extremely rigid and narrow; each thought, memory, and skill is tied exclusively to a particular state of arousalHandout 61: How Are Dissociative Disorders Treated? People with dissociative amnesia and fugue often recover on their own 34. Only sometimes do memory problems linger and require treatment In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality 35. Treatment for dissociative amnesia and fugue tends to be more successful than treatment for DIDHandout 64: How Are Dissociative Disorders Treated? How do therapists help individuals with DID? •Therapists usually try to help the client by: 29. Recognizing the disorder •Recovering memories 30. To help patients recover missing memories, therapists use many of the approaches applied in other dissociative disorders, including psychodynamic therapy, hypnotherapy, and medication 31. These techniques tend to work slowly in cases of DIDHandout 65: How Are Dissociative Disorders Treated? How do therapists help individuals with DID? •Therapists usually try to help the client by: 32. Integrating the subpersonalities
    • Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 6: Student Handout Answer Key 10 33. The final goal of therapy is to merge the different subpersonalities into a single, integrated entity 34. Integration is a continuous process; fusion is the final merging 35. Many patients distrust this final treatment goal and many subpersonalities see integration as a form of death 36. Once the subpersonalities are merged, further therapy is needed to maintain the complete personality and to teach social and coping skills to prevent future dissociations