1. 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
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2. Somatic Symptom Disorders
Involve physical symptoms and complaints suggesting presence of medical condition
Contain no evidence of physical pathology
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3. 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.
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4. 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
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5. 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
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6. 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
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7. 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
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8. Somatization Disorder
Treatment
Difficult to treat
Combination of medical management and cognitive-behavioral therapy
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9. 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
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10. 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
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11. 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
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12. 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
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13. 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
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14. 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
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15. Conversion Disorder Categories of symptoms
Sensory symptoms or deficits
Motor symptoms or deficits
Seizures
Mixed presentation from first three categories
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16. Conversion Disorder True or false?
It is crucial that patients receive a thorough medical and neurological examination to rule out organic illness.
True
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17. 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
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18. 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
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19. 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
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20. Dissociative Disorders
What Are Dissociative Disorders?
Depersonalization/Derealization Disorder
Dissociative Amnesia and Dissociative Fugue
Dissociative Identity Disorder
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21. 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
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22. 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
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23. 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
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24. 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?
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25. Figure 8.1: Childhood Abuse of DID Patients
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26. 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
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27. Treatment and Outcomes in Dissociative Disorders
Hypnosis
Integration of separate alters
Treatments
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28. 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
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