Abnormal Psychology Chapter 8 lesson 8

iatrogenic

*centered within treatment* In reference to DID, a person often learns to role-play these symptoms within treatment. This does not mean that DID is viewed as conscious deception. The issue is not whether DID is real but how it develops.

prevalence estimates of DID

1-3%

List the major sources of evidence for the sociocognitive model of DID

1. Base rates of the disorder increased with media attention to the disorder 2. Only a small proportion of therapists have ever seen DID cases, and the therapists who see the most DID cases rely on techniques like hypnosis that could produce alters 3. Most clients are unaware of alters until after they receive psychotherapy 4. DID can be role-played 5. Most people with DID do share memories among alters when sophisticated memory tests are used.

Cognitive behavioral treatment for somatic symptom and related disorders

1. identify and change the emotions that trigger somatic concerns 2. change cognitions regarding somatic symptoms 3. change behaviors to stop playing the role of a sick person and gain more reinforcement for engaging in other types of social interactions.

What % of men and women report they experienced some form of childhood sexual abuse?

19% of women and 5% of men.

etiology of DID

2 major theories are the posttraumatic model, and the sociocognitive model. Both theories suggest severe physical or sexual abuse during childhood sets the stage for DID

About 2.5% of the US population meet criteria for depersonalitzation/derealization, about ___ for dissociative amnesia, and about _____ for dissociative identity disorder

2.5% 7.5% 1-3%

Although different alters report an inability to share memories, Question 14 options: a) studies suggest that alters can share some implicit memories. b) studies suggest that alters share more explicit memories, but they are just repressed. c) studies indicate that most alters are completely fabricated. d) research suggests that role-playing is the best explanation of DID.

A

malingering

A person intentionally fakes a symptom to avoid a responsibility, such as work or military duty, or to achieve some reward, such as being awarded an insurance settlement.

Compared to the DSM-IV-TR diagnoses, the proposed DSM-5 system places more emphasis on __________ rather than the number or range of somatic symptoms. Question 8 options: a) distress and behavior accompanying somatic symptoms b) behavior associated with illness detection c) distress about impending illness or death d) none of the above

A??

Dissociative identity disorder

At least 2 distinct personalities that act independently of each other (Multiple Personality Disorder)

The finding that functional neurological disorder is currently more common in Libya than in England means that cultures with increased medical sophistication are less likely to have somatoform disorders. What is a flaw in this argument? Question 4 options: a) Functional neurological disorder was actually more common in 19th century England. b) It fails to recognize that differing rates may be caused by variations in diagnostic practices. c) Functional neurological disorder is fundamentally different from the somatoform disorders. d) None of the above is correct.

B

The proposed DSM-5 criteria for depersonalization/derealization disorder involves a change from the DSM-IV-TR regarding: Question 7 options: a) depersonalization. b) derealization. c) both depersonalization and derealization. d) no changes were proposed.

B

Which of the following best illustrates hypochondriasis? Question 15 options: a) An ulcer caused by stress. b) A persistent unsubstantiated fear of having cancer. c) Having obsessions with an imagined physical defect, such as facial wrinkles. d) Experiencing recurring pain with no physical basis.

B

Dissociative identity disorder must involve a) at least 3 distinct personalities. b) selective amnesia. c) at least 2 distinct personalities. d) depersonalization.

C

In the case of Anna O., her functional neurological disorder symptoms involved her Question 10 options: a) left leg. b) sexual dysfunction. c) her right side, beginning with her arm. d) scalp, nose, and lips.

C

Isaac was being treated for somatoform pain disorder, and his psychiatrist prescribed imipramine, an antidepressant, in a very low dose for his symptoms. Assuming Isaac is also depressed, what is his likely treatment outcome? Question 5 options: a) His depression will improve, but his pain will persist. b) All his symptoms will improve. c) His pain will subside, but his depression may still persist. d) He will not improve.

C

Roseanne is suffering from hysterical blindness or blindsight. She participates in a study, and it is shown that she Question 3 options: a) is actually faking her blindness. b) cannot respond to any visual stimuli. c) responds to visual stimuli but is unaware that she did so. d) appears to respond to visual stimuli but in fact has learned to detect other sensory cues (e.g., heat, noise, etc.).

C

The goal of treatment of dissociative disorders should be to Question 6 options: a) encourage repression of the underlying trauma. b) encourage others to reinforce symptoms. c) convince the person that splitting into different personalities is no longer necessary to deal with traumas. d) provide a confrontational setting where symptoms are not needed.

C

psychodynamic perspectives on etiology of conversion disorder

Conversion disorder occupies a central place in psychodynamic theories because the symptoms provide a clear example of the role of the unconscious. Psychodynamic theory suggests that the physical symptom is a response to an unconscious psychological conflict.

Pain and somatic symptoms can be increased by Question 13 options: a) anxiety. b) depression. c) hormones. d) all of these factors can increase somatic symptoms.

D

Research on the effectiveness of psychological treatment of dissociative identity disorder Question 12 options: a) shows that behavioral-cognitive therapy is moderately effective. b) has been hampered by the publicity surrounding known cases. c) supports the post-traumatic model of its etiology. d) is limited to observations of a few specialized therapists.

D

The controlled outcome studies on dissociative identity disorder (DID) show Question 2 options: a) superior outcome when psychodynamic treatment is employed. b) integration of alters is easily achieved in most people with DID. c) psychotropic medications are effective in eliminating alters. d) none of the above; no controlled outcomes studies on DID exist.

D

What is the difference between malingering and conversion disorder?

In malingering, the symptoms are under voluntary control, which is not thought to be the case in conversion disorder.

Malingering

Intentionally faking psychological or somatic symptoms to gain from those symptoms

what other factors affect pain and somatic symptoms?

It is well known that pain and somatic symptoms can be increased by anxiety, depression, and stress hormones. Depression and anxiety are also directly related to activity in the ACC. Emotional pain, such as remembering a breakup can also activate the ACC and the anterior insula.

are somatic symptom related disorders heritable?

No.

sociocognitive model

People who have been abused seek explanations for their symptoms and distress, and alters appear in response to suggestions by therapists, exposure to media reports of DID or other cultural influences

dissociative identity disorder etiology

People with this disorder often report severe physical or sexual abuse during childhood. It has been suggested that people use dissociation to fend off overwhelming feelings from abuse puts people at risk for developing dissociative identiy disorder. sociocognitive model suggests that symptoms are elicited by treatment.

posttraumatic model for DID

Proposes that some people are particularly likely to use dissociation to cope with trauma, and this is seen as a key factor in causing people to develop alters after trauma. There is evidence that children who are abused are at risk for developing dissociative symptoms.

What is questionable about repressed memories and their validity?

Techniques such as hypnosis may actually create false memories. Research has shown the ability to create memory in college students that never really occurred.

What is a famous case in support of the sociocognitive model of DID?

The famous case of Sybil is now widely cited as an example of how a therapist might elicit and reinforce stories of alters. Reinforcing this, a very small number of clinicians contribute most of the diagnoses of DID. Researchers have shown that people are capable of role-playing the symptoms of DID. One defining feature of DID is the inability to recall information experienced by one alter when a different is present, but people with DID seem to demonstrate more accurate memory than they tend to acknowledge.

What are behavioral consequences of fear of a bodily sensation?

The person may assume the role of being sick and avoid work, exercise, and social tasks. These avoidant behaviors in turn can intensify symptoms by limiting other healthy behaviors. The person may become reassurance seeking.

How is DID treated?

Widespread agreement on several principles in the treatment of dissociative identity disorder: emphasis on empathetic and gentle stance, with the goal of helping the client function as one wholly integrated person. The goal of treatment should be to convince the person that splitting into different personalities is no longer necessary to deal with traumas. Focus on teaching the the patient to cope with stress. Psychoeducation can help the person understand why dissociation occurs and begin to identify the triggers for dissociative responses in day - to - day life.

complex somatic symptom disorder

Worry over actual physical symptoms that cause distress and/or interfere with daily functioning. aka conversion disorder

fugue

a more severe subtype of dissociative amnesia. The memory loss is more extensive. The person disappears from home and work typically. Some wander in a bewildered manner, others take on a new name, new home, and new job, even a new personality. First established case was 1887

Acceptance and Commitment Therapy (ACT)

a variant of cognitive behavioral treatment. The therapist encourages the client to adopt a more accepting attitude toward pain, suffering, and moments of depression and anxiety, and to view these as a natural part of life. The person might be coached not to struggle so intensely to avoid these difficult moments.

comorbid disorders of conversion disorder?

about 50% meet criteria for dissociative disorder. Other common comorbid disorders include MDD, Substance abuse disorder, and personality disorders.

When does conversion disorder develop?

adolescence or early adulthood, typically after a major life stressor.

Functional neurological disorder was first studied by Freud; before then it was referred to as Question 9 options: a) la belle indifference. b) hysteria. c) hypochondriasis. d) Briquet's syndrome.

aka conversion disorder was referred to as... B

In the context of dissociative identity disorder, alter refers to:

an alternative personality

DID is often comorbid with ______

anxiety and depression

According to Claire's friends, she never exhibited signs of DID. However, after watching Sybil on TV and visiting a therapist regularly, Claire began exhibiting different personalities. A socio-cultural theory of the development of Claire's DID would suggest that Question 1 options: a) Claire must have been sexually abused as a child. b) Claire must have come from a dysfunctional family and had few friends growing up. c) Claire's alters appeared in response to exposure to media and therapists' suggestions. d) Claire has repressed memories for too long. Save

c

illness anxiety disorder

characterized by preoccupation and worry over the possibility of having a serious medical condition, even though the patient has no somatic symptoms unwarranted fears about a serious illness in the absence of any significant somatic symptoms High level anxiety about having or acquiring a serious disease. Excessive illness behavior (checking for signs of illness, seeking reassurance) or maladaptive avoidance (avoiding medical care). No more than mild somatic symptoms are present. Preoccupation lasts at least 6 months.

which has more detrimental effects on memory? Chronic or acute stress?

chronic stress. In the face of severe trauma, memories may be stored in such a way that they are not accessible to awareness later when the person has returned to a more normal state.

hypochondriasis

chronic worries about developing a serious medical illness.

treatment for dissociative identity disorder

clinicians focus their treatment efforts on helping clients cope with anxiety, face fears more directly, and operate in a manner that integrates their memory and consciousness.

psychodynamic conceptualization of conversion disorder

conversion disorder occupies a central place in psychodynamic theories because the symptoms provide a clear example of the role of the unconscious. Psychodynamic theory suggests the physical symptom is a response to an unconscious psychological conflict. In sum, psychodynamic models of conversion disorder focus on the idea that people could be unconscious of certain perceptions and could be motivated to have certain symptoms. may be the best example of the influence of psychoanalytic thought in current approaches to a particular disorder.

depersonalization

defined by a sense of being detached from one's self (being an observer outside one's body).

derealization

defined by a sense of detachment from one's surroundings, such that the surroundings seem unreal.

somatic symptom and related disorders

defined by excessive concerns about physical symptoms or health. Includes 3 major somatic symptom - related disorders: 1. somatic symptom disorder 2. illness anxiety disorder 3. conversion disorder People with somatic symptom disorders tend to seek frequent medical treatment, sometimes at great expense. They often see different physicians for a given health concern, and they may try many different medications. Hospitalization and surgery are common experiences for them.

dissociative disorders

disruptions in the conscious awareness of experience, memory, or identity. Defined as: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder ((AKA multiple personality disorder)

when do somatic symptom related disorders develop? Which gender do they affect more?

early in adulthood Tend to be more common in women than men.

interventions in primary care (for treatment of somatic symptom and related disorders)

establish a strong doctor-patient relationship that bolsters the patient's sense of trust and comfort so that the patient will feel more reassured about his or hear health. Those who received high levels of support showed more improvement in symptoms and quality of life over 6 weeks compared to those who received standard care.

somatic symptom disorder

excessive anxiety, energy, or behavior focused on somatic symptoms. To be diagnosed, this preoccupation must persist for at least 6 months. The person with this disorder is typically quite worried about his or her health, and even small physical concerns can be taken as a sign of looming disease. Somatic symptom disorder can be diagnosed regardless of whether symptoms can be explained medically. It is nearly impossible to determine whether some symptoms are biologically caused.

factitious disorder imposed on another/Munchausen syndrome by proxy

factitious disorder may also be diagnosed in a parent who creates physical illness in a child. The purpose/motivation in such a case appears to be the need to be regarded as an excellent parent who is tireless in seeing to the child's needs.

True or false? Conversion disorder is highly heritable

false

true or false?: somatic symptom disorder involves hyperactivation of the cerebellum

false

Factitious disorder

falsification of psychological or physical symptoms, without evidence of gains from those symptoms

psychodynamic theories of conversion disorder

focus on the idea that people can be unaware of their perceptions and may be motivated to have symptoms.

dissociative identity disorder

formerly multiple personality disorder. Requires that a person have at least 2 separate personalities or alters (Defined as different modes of being, thinking, feeling, and acting that exist independently of one another and emerge at different times.) Recurrent gaps in memory for events or important personal information that are beyond ordinary forgetting. Symptoms are not part of a broadly accepted cultural or religious practice symptoms are not due to drugs or a medical condition In children, symptoms are not explained by imaginary play acting or an imaginary playmate.

psychodynamic treatment of dissociative disorders

hypnosis and age regression may make symptoms worse.

social influences on conversion disorder

important because cases can sometimes cluster within small groups of coworkers or schoolmates.

Explicit Memory

in explicit memory tests, researchers might ask a person to remember words.

Implicit memory

in implicit memory tests, experimenters determine if the word lists have subtler effects on performance. For example, if a person is first shown a word list that included the word lullaby, they might be quicker on a 2nd task to identify lullaby as a word that fills in the puzzle.

What is the major difference between somatic symptom disorder and illness anxiety disorder?

in somatic symptom disorder, the patient has physical or neurological symptoms such as pain with an unknown cause or blindness. In illness anxiety disorder, the patient is terrified of becoming ill, but does not have any actual symptoms.

treatment of somatic symptom and related disorders

interventions in primary care cognitive behavioral treatment

depersonalization/derealization

involves a form of dissociation involving detachment, in which the person feels removed from the sense of self and surroundings. The person may feel 'spaced out', numb, or as though in a dream. Alteration in the experience of self and reality. Symptoms are triggered by stress. Tend to begin in adolescence. Co-morbid personality disorders are frequent, and 90% of people with this disorder will experience anxiety disorders and depression.

dissociation

involves some aspect of emotion, memory, or experience being inaccessible consciously.

dissociative amnesia

lack of conscious access to memory, typically of a stressful experience. The fugue subtype involves traveling or wandering coupled with loss of memory for one's identity or past. Inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness. Amnesia not explained by other medical or psychological conditions. Bewildered or apparently purposeful wandering in fugue sub-type.

prevalence of conversion disorder? Gender differences?

less than 1% More typical in women than men

aphonia

loss of the voice other than whispered speech.

Gender and DID

more common in women than men.

conversion disorder

neurological symptoms that cannot be explained by medical disease or culturally sanctioned behavior (KS's mum) Neurological symptoms include blindness, seizures, or paralysis. The symptoms suggest an illness related to neurological damage, but medical tests indicate that the bodily organs and nervous systems are fine. symptoms caused significant distress or functional impairment or warrant medical evaluation

hysteria

original term to define conversion disorder by Hippocrates. Conversion originated with Sigmund Freud

anterior insula and the anterior cingulate cortex (ACC)

pain and uncomfortable physical sensations, such as heat, increase activity in these regions of the brain. These regions have strong connections with the somatosensory cortex, a region of the brain involved with processing bodily sensations. Heightened activity in these regions is related to greater propensity for somatic symptoms and more intense pain ratings in response to a standardized stimulus

factitious disorder

people intentionally produce physical symptoms (or psychological ones) to assume the role of a patient. They may make up symptoms - like reporting acute pain. Some will take extraordinary measures to make themselves ill, such as injuring themselves, taking damaging medications, or injecting themselves with toxins. Deceptive behavior is present in the absence of obvious rewards.

_____ treatment is probably used more for DID and the other dissociative disorders than for any other psychological disorder

psychodynamic the goal is to overcome repressions typically the person is hypnotized and encouraged to go back in his or her mind to traumatic events in childhood- a technique called age regression.

functional neurological disorder

rarely diagnosed in clinical settings. Exhibit seemingly severe physical difficulties that are often neurological in nature, but they act as if they do not care about their symptoms.

what can cause the amnesia?

severe stress such as; marital discord, personal rejection, financial occupational difficulties, war service, or a natural disaster. Not all amnesias immediately follow a trauma.

What does psychodynamic theory suggest about dissociative amnesia?

that traumatic events are repressed. Memories are forgotten because they are so aversive. Repression, as initially defined by Freud, involved suppressing unacceptably painful memories form consciousness. This idea is under debate.

tunnel vision

the visual field is constricted as would be if the person were peering through a tube.

True or False> DID was rarely diagnosed before the publication of Sybil

true

True or False? Most patients with DID report childhood abuse

true

true or false: the 2 stage psychodynamic model of conversion disorder emphasizes unconscious perceptions and motivation for having symptoms

true

The key feature of the fugue subtype of dissociative amnesia is:

wandering, whether purposeful or bewildered. Taking on a new life with no memory of the previous one.