Psych 2510 – Abnormal (Trull) Chapter 6: Somatoform and Dissociative Disorders Somatoform and dissociative disorders were once thought to be linked, but are now seen as largely separate entities.Somatic Symptom Disorders - Somatization: is a tendency to communicate distress through physical symptoms and to pursue medical help for these symptoms. o Somatization is common among medical patients, but formal somatoform disorders are less prevalent. The most common somatoform disorders are somatization disorder and hypochondriasis.- Somatic symptom disorder: experiences physical symptoms that may or may not have a discoverable physical causeo Excessive concern/worryo Devote much time to concern - Illness anxiety disorder (hypochondriasis) : preoccupied with the thought of having a serious illness - Conversion disorder: refers to medically unexplained pseudoneurological symptomso Experience motor or sensory problems that suggest a physical cause, although none has been foundo EX: paralysis, aphonia (cannot talk), blindness o Patients often feel stigmatized or crazy (all in their head) They are not making it up (or faking it) but told they are by others - Pain disorder: medically unexplained pain symptoms- Body dysmorphic disorder: refers to excessive preoccupation with imagined or slight flaws of the physical body.- Factitious disorders: deliberately falsifying or producing physical or psychological symptomso Reasoning is not clearo Munchausen syndrome (self)o Munchausen-by-proxy: involves adults inducing illness in children in order to present them for treatment.- Malingering: producing symptoms with some external motivationo EX: to get out of jail or prison, obtain drugs, etc. Biological risk factors - Genetic predispositions- Key brain changes in:o Amygdalao Hypothalamuso Limbic system o Cingulate o Prefrontal o Somatosensory corticesEnvironmental risk factors- Illness behaviors and reinforcement o Medically related behaviors potentially reinforced by significant otherso Secondary gain- Cognitive factors - attributions o Powerful influences in somatoform disorderso Many people with these disorders use somatic explanations for even minor bodily changes Somatosensory awareness – hypersensitive to sensations in the body - Cultural factors – people from non-Western countries tend to experience depression and anxiety, physically o May influence somatoform disorders as wello Poor medical attention and careo Problematic medical treatments o Stressful life eventso General emotional arousal Causes of Somatoform Disorders: - Focuses on misperception of symptoms1Psych 2510 – Abnormal (Trull) - Feelings of uncontrollability about symptoms- Over attention to minor bodily changesRisk factors - In children and adolescents may inform strategies for preventing somatoform disorders- Examples o Stressful life eventso Traumatic experienceso Unnecessary medical interventionso Comorbid anxiety and depressionStrategies to prevent somatoform disorders- Educating parents and children- Coping strategies- Anxiety managementAssessments- Therapists use interviews and questionnaires to assess people with somatoform disorders- These measures concentrate on o DSM-IV-TR criteriao History of symptomso Illness behaviors and beliefso Personality patternso Other relevant topicsBiological treatments for Somatoform Disorders- Antidepressant medicationo Ease comorbid depression, fears of disease, and body preoccupationPsychological treatments for Somatoform Disorders- Cognitive-behavioral strategies o Reduce illness behaviors and avoidanceo Improve physical functioningo Address traumao Limit checking and other excessive behaviorsLong-term outcome - Variable but may be somewhat worse for people with hypochondriasis- Severity of symptoms and degree of comorbid conditions are good predictors of outcome- Predictors of chronic somatoform disorderso Female gendero Low socioemotional statuso Substance useo Eating disorders and depressiono Severe cognitive disorderso Trauma 2Dissociative disorders: involve disturbance in consciousness, memory, or identity. - This continuum shows the spectrum of mild to severe behaviors.- Normal dissociation refers to separation of emotions, thoughts, memories, or other inner experiences from oneselfo Dissociation that occurs in a severe or very odd way may be a dissociative disorderDissociative disorders include: - Dissociative amnesia: refers to loss of memory for highly personal information o Gap in your memoryo Not due to drugs o There is some debate concerning the prevalence of dissociative amnesiao Ex: The Bourne Identity - Dissociative fugue: involves sudden movement away from home or work with loss of memories for personal and other informationo Don’t know how they got there and establish new life o Usually caused by trauma or a stressful event- Dissociative identity disorder: refers to two or more distinct personality states within a persono These states include a host personality and sub-personalities that often differ in their awareness of each other- Depersonalization/Derealization disorder: refers to persistent experiences where a person feels detached from his body as if in a dream stateo Common in people with mental disorders, though the prevalence of formal dissociative disorders in the general population is less commono Often associated with trauma and trauma related mental disorderso Disorder does not occur exclusively Cause of dissociative disorders - Remains unclear- Evidence is emerging that biological risk factors for dissociative disorders may include key brain changes in areas most responsible for memory and consciousness integration- Trauma and dissociation are linked but the causal relationship between the two remains unclearThe “Hillside Strangler,” Kenneth Bianchi, at one point claimed an “alternate personality” in order to avoid responsibility for violent acts he had committed at a time when a possible cultural shift led to more reported incidences of the disorder.Prevention of dissociative disorders - Not received much research attention- Prevention of child maltreatment has and may be helpful in this regardAssessment- Full medical examination – rule out biological conditions that may explain dissociative symptoms- Interviews – often cover recent and past stressors and the presence of amnesia, depersonalization, derealization, identity confusion, and identity alteration- Questionnaires – screen for dissociative symptoms such