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  • Somatoform disorders include a variety of conditions in which psychological conflicts become translated into physical problems or complaints which cause distress or impairment in a person's life. In fact, the symptom reported by the individual probably would not correspond to the symptoms of any real physical disorder.
  • Conversion disorder is the translation of unacceptable drives or troubling conflicts into bodily motor or sensory symptoms that suggest a neurological or medical condition. Involves loss or alteration of bodily function even though there is no real physical impairment. Freud called this hysterical neurosis , implying it was a physical reaction to anxiety neurosis. La Belle Indifference: The “beautiful” lack of concern shown by some (though certainly not all) conversion disorder patients, in which the individual may pay little attention to the symptom and dismisses it as minor even though it is actually incapacitating.
  • This condition is difficult to diagnose. Disorder is rare, runs in families, more often in women, appears in adulthood, symptoms recur.
  • The difference between somatization disorder and conversion disorder is that somatization disorder involves multiple and recurrent bodily symptoms, rather than a single physical complaint.
  • Although such clients may appear to be “faking” a complex medical problem, they are not consciously attuned to the ways their psychological problems are being expressed physically. Because they do not consider their difficulties to have an emotional cause, these people do not seek psychotherapy. Somatization disorder is relatively rare. Sufferers may have grown up in homes with frequent illnesses. They compulsively seek medical and surgical treatment for their vague and unsubstantiated physical problems.
  • In some instances, there really is something abnormal about the body part, but the person’s concern is grossly exaggerated.
  • Some spend hours a day looking at the supposed “defect” in mirrors, whereas others go to great lengths to avoid any reflection of their “grotesque” problem People with BDD may seek cosmetic surgery or other medical treatment to correct their imagined defects. Research suggests that more than half of the people with BDD have personality disorders.
  • Hypochondriacs believe or fear that they have a serious illness, but they do not. Unlike conversion disorder or somatization disorder, hypochondriasis does not involve extreme bodily dysfunction or unexplainable medical symptoms. Instead, the hypochondriac misinterprets or exaggerates normal bodily occurrences.
  • Sufferers can be so concerned with trying to maintain good health that they become almost fanatical about their bodies. The course of hypochondriasis tends to be stable over time. Because clients often react with anger and impatience when they feel their concerns are not taken seriously, they often provoke intense frustration and exasperation in those trying to help them recognize the psychological origins.
  • Phenomena sometimes confused with somatoform disorders are malingering and factitious disorders. Malingering: The fabrication of physical or psychological symptoms for some ulterior motive. Factitious disorder: Conditions in which people fake symptoms or disorders, not for the purpose of any particular external gain but because of an inner need to maintain a sick role. They present themselves as dramatically as possible, trying to create scenarios in which their illness plays a starring role. Munchausen's syndrome: An extreme form of factitious disorder in which the individual goes to great lengths to maintain a sick role. The person’s whole life becomes consumed with the pursuit of medical care, inflicting injury on themselves to look sick and make hospitalization necessary. In factitious disorder with psychological symptoms , the individual feigns psychological problems. Symptoms tend to be vague and fail to correspond to any particular psychological disorder. In factitious disorder by proxy (or Munchausen’s syndrome by proxy ), a person induces symptoms in another person who is under that individual’s care. Desire for attention seems to motivate these individuals. Some cases are so extreme that murder takes place.
  • Primary gain is the avoidance of burdensome responsibilities because one is “disabled.” Secondary gain is the sympathy and attention the sick person receives from other people. An integrative explanation best explains somatoform disorders as an interplay of biological factors, learning experiences, emotional factors, and faulty cognitions.
  • Most contemporary approaches to treating somatoform disorders involve exploring the person’s needs to play the sick role, evaluating the contribution of stress in the person’s life, and providing the client with behavioral techniques to control symptoms. Irrespective of the specific techniques used, the clinician must develop a trusting and supportive relationship with the client and should be cautious about challenging the physical symptoms that are so real to client.
  • Intense emotional stress can increase vulnerability to getting sick and can seem to slow down recovery from an ailment. The DSM-IV diagnostic category psychological factors affecting medical conditions includes situations in which psychological or behavioral factors have an adverse effect on a medical condition.
  • This diagnosis is given to clients who suffer from a recognized medical condition that is adversely affected by emotional factors including a variety of Axis I disorders (e.g., depression), psychological symptoms (e.g., anxiety), personality traits (e.g., hostility), maladaptive health behaviors (e.g., smoking, drinking), or stress-related physiological responses (e.g., aggravation of ulcers, asthma).
  • Stress: Unpleasant emotional reaction a person has when he or she perceives an event to be threatening. The stressor is the event itself, which may also be called a stressful life event . Making an effort to reduce stress is called coping . In problem-focused coping , the individual reduces stress by acting to change whatever makes the situation stressful. In emotion-focused coping , a person does not change the situation itself but tries to improve his or her feelings about the situation. Psychoneuroimmunology: The study of connections among stress, nervous system functioning, and the immune system. Emotional expression: Emotion suppression is unhealthy and weakens immune responses. Personality factors: Type A personalities are more susceptible to heart disease and hardening of the blood vessels. Type C personalities are more susceptible to cancer.
  • Researchers and clinicians have focused on the processes by which people learn to deal with disruptive emotional experiences, and they have developed sophisticated theories and techniques pertaining to coping. Behavioral medicine: An interdisciplinary approach to medical conditions affected by psychological factors that is rooted in learning theory. Stress inoculation training: People are taught to anticipate stressful situations and are given help in practicing ways to control stress when they next encounter the situations.
  • Although sleep disorders do not technically fall into the category of psychological factors affecting medical conditions, they are relevant to our discussion of these topics. Primary Insomnia: Chronic difficulty sleeping. Primary Hypersomnia: An excessive need for sleep. Circadian Rhythm Sleep Disorder: Disturbance in functioning caused by disruptions in the normal sleep-wake cycle, usually due to rotating work shifts or jet lag. Breathing-Related Sleep Disorder: Frequent awakening because of breathing problems during sleep.
  • Nightmare Disorder: Recurrent vivid dreams from which a person wakes with detailed recollection of extended frightening images. Sleep Terror Disorder: Experiencing panic attacks during sleep. Sleepwalking Disorder: Recurrent episodes involving sleepwalking. Narcolepsy: Irresistible attacks of sleep that can take place at any time and any place, usually for 10-20 minutes.
  • Several “selves” or personalities, at least two distinct identities or personality states, called “alters” Core personality, the “I” associated with their given name, the “host” Most alters have distorted sense of time, gaps in memory, “lost” time Considerable skepticism about this diagnosis has emerged in recent years. Even the famous case of Sybil has been contested by psychiatric historians who regard the case as exaggeration and possible fabrication.
  • Primary explanation offered is that a highly traumatic childhood caused the child to develop alters as fantasy escape from horrors of daily life. However, only a small percentage of traumatized children develop dissociative disorders. Sociocognitive model of dissociative identity disorder: According to this model, clients enact roles they feel (consciously or unconsciously) are demanded by the therapeutic situation. Social attention to the condition, along with unintentional prompting by the therapist, can lead vulnerable individuals to develop this condition.
  • The goal for many therapists is to integrate the alters into a unified self and develop coping strategies to deal with painful memories of trauma. Through hypnotherapy , clients are encouraged to recall trauma while in a trance. However, a number of professionals have suggested that rather than helping clients discover truth, hypnotherapy increases the likelihood they will produce false memories. Cognitive Behavioral Techniques: Attempt to change dysfunctional attitudes and beliefs and bolster self-esteem
  • Dissociative amnesia: An inability to remember important personal details and experiences; is usually associated with traumatic or very stressful events. Localized Amnesia - Most common - Can’t recall any details of the event. Selective Amnesia - Recall some, but not all details. Generalized amnesia - Cannot recall anything at all from past life. Continuous Amnesia - Failure to recall past event from a particular date to the present time.
  • Results from result of trauma, extreme stress, need to escape punishment, or problems. Duration is variable (hours, day, weeks, or months). May assume a new identity, more outgoing than core personality.
  • Depersonalization can be experienced as a symptom of many conditions, including the effects of mind-altering drugs. It involves feeling that body is “unreal,” perhaps changing in size or shape, being controlled by outside forces, or feeling robotic Depersonalization disorder involves repeated alternation of mind-body perception, ranging from detachment to “out-of-body” feeling, not attributable to mind-altering drugs. The condition is often chronic for certain people, precipitated by stress.

Halgin6e ppt ch06 Halgin6e ppt ch06 Presentation Transcript

  • Richard P. Halgin Susan Krauss Whitbourne University of Massachusetts at Amherst slides by Travis Langley Henderson State University Abnormal Psychology Clinical Perspectives on Psychological Disorders 5e Clinical Perspectives on Psychological Disorders 6e Richard P. Halgin Susan Krauss Whitbourne slides by Travis Langley Henderson State University Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • Somatoform Disorders, Psychological Factors Affecting Medical Conditions, and Dissociative Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Chapter 6
  • Somatoform Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    • A wide variety of conditions in which psychological conflicts are translated into physical problems or complaints.
    • Impair functioning, cause distress.
    • No physiological basis.
    • Won’t be indicated on physical or neurological tests.
    SOMATOFORM DISORDERS Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. soma = “body” in Greek
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. CONVERSION DISORDER Conversion disorder (“hysteria”) sufferer Bertha Pappenheim, called “Anna O.” in Freud’s writings.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. CONVERSION DISORDER A somatoform disorder involving the translation of unacceptable drives or troubling conflicts into physical symptoms.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. CONVERSION DISORDER Four categories of symptoms:
      • Motor symptoms or deficits.
      • Sensory symptoms or deficits.
      • Seizures or convulsions.
      • Mixed presentations.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. SOMATIZATION DISORDER Somatization Disorder: A somatoform disorder involving the expression of psychological issues through bodily problems that have no basis in physiological function.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. SOMATIZATION DISORDER
    • May be exaggerating a real physical condition
    • Not deliberately “faking”
    • Mostly women sufferers
    • Most do not voluntarily seek psychotherapy
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. PAIN DISORDER In pain disorder , pain itself is the predominant complaint not related to a physical cause, whereas conversion disorder patients rarely complain of strong pain as part of their primary “affliction.”
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. BODY DYSMORPHIC DISORDER
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. BODY DYSMORPHIC DISORDER Body Dysmorphic Disorder: Somatoform disorder in which p eople are preoccupied, almost to the point of being delusional, with the idea that part of their body is ugly or defective.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. BODY DYSMORPHIC DISORDER
    • Gender based concerns.
      • Men - Body build, genitals, hair.
      • Women - Weight, breast size or shape, facial features, scars, aging.
    • The “defects” are imagined or grossly exaggerated.
    • Obsessed with looking at it, thinking about it, concealing it.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. HYPOCHONDRIASIS Hypochondriasis: Somatoform disorder that is characterized by the misinterpretation of normal bodily functions as signs of serious illness.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. HYPOCHONDRIASIS
    • Preoccupation with perceived abnormal functioning
    • Distress that medical tests do not confirm their fears
    • Many also suffer anxiety or depression
    • Unlike somatization or conversion disorder, there is no abnormal bodily function or medical symptoms
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. RELATED CONDITIONS These conditions and behaviors also involve a focus on the body, but are not somatoform disorders because the individuals know they are not really ill.
    • MALINGERING
    • FACTITIOUS DISORDER
    • MUNCHAUSEN’S SYNDROME
    • FACTITIOUS (or MUNCHAUSEN’S) BY PROXY
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. THEORIES OF SOMATOFORM DISORDERS
    • MOTIVATIONS FOR ILLNESS
      • Primary gain
      • Secondary gain
    • INTEGRATIVE EXPLANATION
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. TREATMENT OF SOMATOFORM DISORDERS
    • Explore need to play the sick role
    • Evaluate stress
    • Provide behavioral techniques to control symptoms
  • Psychological Factors Affecting Medical Conditions Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITIONS
    • AXIS I DISORDERS
    • PSYCHOLOGICAL SYMPTOMS
    • PERSONALITY TRAITS
    • MALADAPTIVE HEALTH BEHAVIORS
    • STRESS-RELATED PHYSIOLOGICAL RESPONSES
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • THEORIES OF MIND-BODY INTERACTION
    • STRESS
    • COPING STRATEGIES FOR STRESS
      • Problem-focused
      • Emotion-focused
    • PSYCHONEUROIMMUNOLOGY
    • EMOTIONAL EXPRESSION
    • PERSONALITY FACTORS
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • TREATMENT FOR PSYCHOLOGICAL FACTORS AFFECTING HEALTH
    • BEHAVIORAL MEDICINE
      • Take responsibility for health
      • Initiate and maintain healthy behaviors
      • Stop unhealthy behaviors
    • STRESS INOCULATION TRAINING
      • Cognitive focus and method
      • Guided self-dialogue
      • Coping self-statements
      • More adaptive lifestyle
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • Sleep Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Dyssomnias: Disturbances in the amount, quality, or timing of sleep. Primary Insomnia Primary Hypersomnia Circadian Rhythm Sleep Disorder Breathing-Related Sleep Disorder
  • Sleep Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Parasomnias: Conditions involving abnormal behavior or bodily events during sleep or sleep-wake transitions. Nightmare Disorder Sleep Terror Disorder Sleepwalking Disorder Narcolepsy
  • Dissociative Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • DISSOCIATIVE IDENTITY DISORDER
    • Dissociative identity disorder:
    • A dissociative disorder, formerly called multiple personality disorder , in which an individual develops more than one self or personality.
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • DISSOCIATIVE IDENTITY DISORDER
    • Alters
    • Usually fewer than 10 identities
    • Host
    • Memory Gaps
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. The disorder is highly controversial.
    • Highly Traumatic
    • Childhood Explanation
    • vs. Sociocognitive Model
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. THEORIES OF DISSOCIATIVE IDENTITY DISORDER
    • GOAL
      • Integrate alters
    TREATMENT OF DISSOCIATIVE IDENTITY DISORDER Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    • METHODS
      • Hypnotherapy
      • Cognitive Behavioral Techniques
  • DISSOCIATIVE AMNESIA
    • Inability to remember details and experiences associated with traumatic or stressful event
    • Four forms:
      • Localized
      • Selective
      • Generalized
      • Continuous
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  • DISSOCIATIVE FUGUE formerly called psychogenic fugue Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Dissociative fugue: A dissociative disorder in which a person, confused about personal identity, suddenly and unexpectedly travels to another place and is unable to recall past history or identity.
  • DEPERSONALIZATION DISORDER
    • Depersonalization:
    • An altered experience of the self, ranging from feeling that one's body is not connected to one's mind to the feeling that one is not real.
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    • For more information on material covered in this chapter, visit our Web site:
    Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. http:/ www.mhhe.com/halgin6e