Chapter 8 Somatic Symptom and Dissociative Disorders ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 8 Somatic Symptom and Dissociative Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Somatic Symptom Disorders Involve physical symptoms and complaints suggesting presence of medical condition Contain no evidence of physical pathology © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

What Are Somatic Symptom Disorders? Somatic Symptom disorder patterns Hypochondriasis Somatization disorder Pain disorder Conversion disorder Must have one of the following three features: Disproportionate and persistent thoughts about the seriousness of one’s symptoms, Persistently high level of anxiety about health or symptoms, and/or Excessive time and energy devoted to these symptoms or health concerns. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Hypochondriasis Hypochondriasis Preoccupation with fears of having or getting serious disease Treatment Not a disorder in DSM-5, and about 75% of people with hypochrondriasis will meet criteria for somatic symptom disorder People with hypochondriasis are preoccupied with fears of getting a serious disease or the idea that they already have one Cognitive-behavioral views of hypochondriasis are most widely accepted Cognitive-behavioral therapy can be a very effective treatment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Somatization Disorder Characterized by many different complaints of physical ailments Subsumed into somatic symptom disorder Somatization disorder is characterized by many different complaints of physical ailments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Somatization Disorder Somatization disorder characteristics Lasting several years Beginning before age 30 Not adequately explained by independent findings of physical illness or injury Leading to medical treatment or to significant life impairment Somatization disorder is characterized by many different complaints of physical ailments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Somatization Disorder Prevalence Rates Causal factors Prevalence, Rates, and Causal Factors Usually begins in adolescence Is three to ten times more common in women than in men Often occurs with other disorders such as major depression or panic disorder There may be a genetic predisposition to the disorder Other contributory causal factors may include personality, cognitive, and learning variables © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Somatization Disorder Treatment Difficult to treat Combination of medical management and cognitive-behavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Experience of persistent and severe pain in one or more areas of body Pain Disorder Pain disorder Experience of persistent and severe pain in one or more areas of body Not intentionally produced or feigned Now a part of somatic symptom disorder The symptoms of pain disorder resemble the pain symptoms of somatization disorder, but with pain disorder, the other symptoms are not present © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Pain Disorder Treatment Cognitive-behavioral techniques Used in treatment of both subtypes of pain disorder Cognitive-behavioral techniques are widely used in the treatment of both subtypes of pain disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Illness Anxiety Disorder Experience high anxiety about having or developing a serious illness New to DSM-5 25% of people who met criteria for hypochondriasis will be diagnosed with illness anxiety disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Symptoms or deficits affecting sensory or voluntary motor functions Conversion Disorder Conversion disorder Symptoms or deficits affecting sensory or voluntary motor functions Leads one to think patient has medical condition Freud believed that the symptoms were an expression of repressed sexual energy One of the most intriguing and baffling disorders, with much left to learn © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Conversion Disorder Gains Primary gain Secondary gains In contemporary terms, the primary gain for conversion symptoms is continued escape or avoidance of a stressful situation Secondary gains include attention and financial compensation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Conversion Disorder Prevalence Decreasing prevalence Two to three times more common in women than men Comorbidity Highest estimated prevalence is .005% of general population Occurs most frequently with major depression and anxiety disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Conversion Disorder Categories of symptoms Sensory symptoms or deficits Motor symptoms or deficits Seizures Mixed presentation from first three categories © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Conversion Disorder True or false? It is crucial that patients receive a thorough medical and neurological examination to rule out organic illness. True © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive-behavioral therapy Conversion Disorder Treatment Behavioral therapy Cognitive-behavioral therapy Hypnosis Motor conversion symptoms have been successfully treated with behavioral therapy Psychogenic seizures have been treated with cognitive-behavioral therapy Hypnosis can be successful when paired with other problem-solving strategies © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Malingering and Factitious Disorder Motivated by external incentives Factitious disorder Motivated by benefits of “sick role” It can be difficult to distinguish between malingering/factitious disorder and somatic symptom disorders such as conversion disorder Conscious intent can be a key distinction © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

What Are Dissociative Disorders? Conditions involving disruptions in normally integrated functions Consciousness Memory Identity Perception The dissociative disorders are a group of conditions involving disruptions in a person’s normally integrated functions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Dissociative Disorders What Are Dissociative Disorders? Depersonalization/Derealization Disorder Dissociative Amnesia and Dissociative Fugue Dissociative Identity Disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Depersonalization/Derealization Disorder In derealization, one’s sense of the reality of the outside world is temporarily lost In depersonalization, one’s sense of one’s self and one’s reality is temporarily lost If these recur and disrupt life, depersonalization/derealization disorder may be diagnosed © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Dissociative Amnesia and Dissociative Fugue Dissociative fugue now a subtype of dissociative amnesia Dissociative amnesia involves a failure to recall previously stored personal information when that failure cannot be accounted for by ordinary forgetting In a dissociative fugue the person also departs from home surroundings © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Dissociative Identity Disorder Patient manifests two or more distinct identities or personality states Formerly called multiple personality disorder Dissociative identity disorder is a dramatic dissociative disorder in which a patient manifests two or more distinct identities or personality states that alternate in some way in taking control of behavior Formerly called multiple personality disorder Alter identities are not in any meaningful sense personalities This disorder is quite rare The disorder usually starts in childhood © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Dissociative Identity Disorder Controversies Is the disorder real or faked? If the disorder is not faked, how does it develop? Are recovered memories of abuse in the disorder real or false? If abuse has occurred, did it play a causal role? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 8.1: Childhood Abuse of DID Patients © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Sociocultural Factors in Dissociative Disorders Prevalence, Differences, Examples Prevalence varies with cultural acceptance of dissociative phenomena DID identified in all racial groups, SES classes, and researched cultures Examples Prevalence varies with acceptance of dissociative phenomena in the culture DID has been identified in all racial groups, SES classes, and cultures in which it has been studied; No systematic controlled research has been conducted In some cultures, dissociative trances or possession trances may occur Amok is a dissociative rage seen in some cultures such as Malaysia, Laos, the Philippines, Papua New Guinea, and others © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment and Outcomes in Dissociative Disorders Hypnosis Integration of separate alters Treatments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Unresolved Issues How might “recovered memories” be linked to DID? “Recovered memories” of childhood abuse are thought by some to be causal in DID, but by others to be falsely planted by therapists Very controversial topic that presents various legal and ethical challenges © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.