Basic Statistics for the Behavioral Sciences
Chapter Seven
Somatic Symptom and Dissociative Disorders
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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
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Somatic Symptom Disorders (cont’d.)
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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
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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
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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
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Illness Anxiety Disorde
Also refe
ed 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
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Illness Anxiety Disorder (cont’d.)
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Functional Neurological Symptom Disorde
Also known as conversion disorde
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
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Functional Neurological Symptom Disorder (cont’d.)
Most common symptoms:
Psychogenic movement
Distu
ances 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
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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
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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
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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.
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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
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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
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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
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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
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Treatment of Somatic Symptom Disorders
Psychological:
Focus is understanding client’s view regarding problem
Demonstrate empathy
View within social context
Cognitive-behavioral therapy
Co
ect cognitive distortions
Interoceptive exposure
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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 disorde
Dissociative identity disorder (multiple personality)
Relatively rare
No objective assessment: possibility of feigning
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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 a
upt and complete
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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 disorde
Diagnosis given only when feelings of unreality and detachment cause major impairments in social or occupational functioning
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Dissociative Disorders (cont’d.)
Dissociative identity disorder (DID):
Formerly called multiple personality disorde
Two or more relatively independent personality states appear to exist in one person or an experience of possession
Diagnostic controversy
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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.
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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
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Etiology of Dissociative Disorders (cont’d.)
Biological dimension:
Variations in
ain activity when comparing different personalities
Hippocampus
Differences in temporal lobe activity have been found, but causes are uncertain
Permanent structural changes in
ain due to trauma may play a role
Reduction in amygdalar volume
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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
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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
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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).
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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
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Treatment of Dissociative Disorders
Variety of treatments including:
Supportive counseling
Hypnosis
Personality reconstruction
Cu
ently no specific medication for DID, but used to treat accompanying anxiety or depression
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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
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Treatment of Dissociative Disorders (cont’d.)
Depersonalization disorde
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)
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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
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