- Review the information on Somatic Disorders that appears in Chapter 7 of your textbook. Provide a substantive response to the following questions:
- When do somatic complaints represent a psychological disorder
- What are the causes and treatments of these conditions?
- What are dissociations?
- Use chapter 7 only for research and information
- Do not use online or any other research
- Does not require any references
Basic Statistics for the Behavioral Sciences Chapter Seven Somatic Symptom and Dissociative Disorders * Somatic Symptom Disorders Somatic symptom disorders: Complex somatic symptom disorders (CSSD) Illness anxiety disorder (hypochondriasis) Functional neurological symptom disorder (conversion disorder) Factitious disorders Psychophysiological disorders (Chapter 6) Involve physical symptoms and/or anxiety over illness * Somatic Symptom Disorders (cont’d.) * Complex Somatic Symptom Disorders Involves physical symptoms or complaints that have no physiological basis; believed to occur due to an underlying psychological conflict or need Symptoms not under voluntary or conscious control * Complex Somatic Symptom Disorders (cont’d.) Diagnosis: Characterized by excessive distress over somatic symptoms that are accompanied with high levels of health related anxiety Symptom concern must be present for six months or more Can involve: Multiple somatic complaints (somatization disorder) Predominantly pain complaints * Complex Somatic Symptom Disorders (cont’d.) CSSD with somatization features: Chronic complaints of specific bodily symptoms that have no physical basis CSSD with pain features: Reports of severe or lingering pain that appears to have no physical basis * Illness Anxiety Disorder Also referred to as hypochondriasis Persistent health anxiety and concern that one has an undetected physical illness, despite physical evaluations that reveal no organic problems Symptoms must be present for at least six months * Illness Anxiety Disorder (cont’d.) * Functional Neurological Symptom Disorder Also known as conversion disorder Physical problems or impairments in sensory or motor functioning controlled by the voluntary nervous system That suggest a neurological disorder but with no underlying medical cause Symptoms are not being faked Individual believes there is a genuine problem * Functional Neurological Symptom Disorder (cont’d.) Most common symptoms: Psychogenic movement Disturbances of stance or gait Sensory symptoms Blindness, loss of voice, motor tics, and dizziness Psychogenic seizures Some symptoms are easily diagnosed as conversion disorders, while others require extensive neurological and physical examination * Factitious Disorders Factitious disorder: Symptoms of physical or mental illness are deliberately induced or simulated with no apparent incentive Differs from malingering: Faking a disorder to achieve some goal, such as an insurance settlement * Factitious Disorders (cont’d.) Factitious disorder imposed on another: Pattern of falsification of physical or psychological symptoms in another individual Relatively new diagnostic category and as a result, little information is available on prevalence, age of onset, or familial pattern Diagnosis of this condition is difficult * Etiology of Somatic Symptom Disorders Figure 7-2 Multipath Model for Somatoform Disorders The dimensions interact with one another and combine in different ways to result in a specific somatoform disorder. * Etiology of Somatic Symptom Disorders (cont’d.) Biological dimensions: Modest contribution of genetic factors Biological predisposition may be “hard-wired” into central nervous system Hypervigilance or exaggerated focus on bodily sensation Increased sensitivity to mild bodily changes Tend to react to somatic sensations with alarm Predisposition becomes fully developed disorder when person can’t deal with trauma or stress * Etiology of Somatic Symptom Disorders (cont’d.) Psychological dimension: Psychodynamic perspective: Symptoms seen as defense against awareness of unconscious emotional issues Primary and secondary gain Cognitive-behavioral perspective: Stress importance of reinforcement, modeling, cognitions, or combination of these Idea that somatic disorders may develop in predisposed individuals * Etiology of Somatic Symptom Disorders (cont’d.) Social and sociocultural dimensions: Rejection or abuse from family members History of sexual abuse Parental modeling Societal restrictions on women Cultural factors, including education levels, ethnicity, and immigrant status * Treatment of Somatic Symptom Disorders Biological: Antidepressant medications such as SSRI’s show promise with complex somatic symptom disorders Increased physical activity recommended for conversion disorders * Treatment of Somatic Symptom Disorders Psychological: Focus is understanding client’s view regarding problem Demonstrate empathy View within social context Cognitive-behavioral therapy Correct cognitive distortions Interoceptive exposure * Dissociative Disorders Dissociative disorders: Involves some sort of dissociation, or separation, of a part of a person’s consciousness, memory, or identity Dissociative amnesia Depersonalization/derealization disorder Dissociative identity disorder (multiple personality) Relatively rare No objective assessment: possibility of feigning * Dissociative Disorders (cont’d.) Dissociative amnesia: Partial or total loss of important personal information; may occur suddenly after stressful/traumatic event Localized: Lack of memory for a specific event or events Dissociative fugue: Confusion over personal identity: complete loss of memory of one’s entire life, unexpected travel to a new location, or partial/complete assumption of new identity Recovery is often abrupt and complete * Dissociative Disorders (cont’d.) Depersonalization/derealization disorder: Characterized by feelings of unreality or being detached from oneself and the environment Depersonalization is the most common dissociative disorder Diagnosis given only when feelings of unreality and detachment cause major impairments in social or occupational functioning * Dissociative Disorders (cont’d.) Dissociative identity disorder (DID): Formerly called multiple personality disorder Two or more relatively independent personality states appear to exist in one person or an experience of possession Diagnostic controversy * Etiology of Dissociative Disorders Figure 7-4 Multipath Model for Dissociative Disorders The dimensions interact with one another and combine in different ways to result in a specific dissociative disorder. * Etiology of Dissociative Disorders (cont’d.) Diagnosis depends on self-report, making it difficult to differentiate between genuine and faked cases Two most influential models, posttraumatic and sociocognitive, are not sufficient to explain why only some develop disorders Must look at vulnerabilities in biological, psychological, social, and sociocultural dimensions * Etiology of Dissociative Disorders (cont’d.) Biological dimension: Variations in brain activity when comparing different personalities Hippocampus Differences in temporal lobe activity have been found, but causes are uncertain Permanent structural changes in brain due to trauma may play a role Reduction in amygdalar volume * Etiology of Dissociative Disorders (cont’d.) Psychological dimension: Psychodynamic theory Repression blocks unpleasant or traumatic events from consciousness When complete repression is impossible, dissociation or separation of mental processes may occur to protect individual from painful memories or conflicts * Etiology of Dissociative Disorders (cont’d.) Psychological dimension: (cont’d.) Four factors necessary for development of DID according to posttraumatic model (PTM) Exposure to overwhelming childhood stress Capacity to dissociate Encapsulating or walling off the experience Developing different memory systems DID results from these factors if supportive environment is unavailable or if personality is not resilient * Etiology of Dissociative Disorders (cont’d.) Figure 7-5 The Posttraumatic Model for Dissociative Identity Disorder Note the importance of each of the factors in the development of dissociative identity disorder. Source: Adapted from Kluft (1987); Loewenstein (1994). * Etiology of Dissociative Disorders (cont’d.) Social and sociocultural dimensions: Sociocognitive model (SCM): Rule-governed and goal-directed experiences and displays created, legitimized, and maintained by social reinforcement Patients learn about phenomenon and its characteristics from mass media, cues provided by therapist, personal experiences, and observation Iatrogenic disorder: unintentionally created by therapeutic situation (hypnotic suggestibility) Shortcomings of SCM model * Treatment of Dissociative Disorders Variety of treatments including: Supportive counseling Hypnosis Personality reconstruction Currently no specific medication for DID, but used to treat accompanying anxiety or depression * Treatment of Dissociative Disorders (cont’d.) Dissociative amnesia and fugue Symptoms usually spontaneously remit, but often associated with depression and/or stress Treating dissociative disorders indirectly by alleviating depression and stress Stress-management techniques for stress Antidepressants or cognitive-behavioral therapy for depression * Treatment of Dissociative Disorders (cont’d.) Depersonalization disorder Also subject to spontaneous remission, but at a slower rate Treatment focuses on alleviating feelings of depression, anxiety, or fear of going insane Antidepressants and antianxiety medications Occasionally behavioral therapy (reinforcement of appropriate responses) * Treatment of Dissociative Disorders (cont’d.) Dissociative identity disorder (DID) Controversial treatments, not always successful Major goal is fusion of personalities Working on safety issues, stabilization, and symptom reduction Identifying and working through traumatic memories Attempting to integrate personalities Hypnosis often used to accomplish this *