Abnormal Psych, Chapter 6

in the past, the factitious disorder was called

hospital addiction or professional patient syndrome

those having been diagnosed with illness anxiety disorder were once called..

hypchondriacs

Now called conversion disorder; used to be called ... (Freud's)

hysteria

Which type of 'disorder' is most likely to have an individual 'doctor shop'?

illness anxiety disorder (hypchondriasis)

somatic symptom disorders

*broad grouping* of psychological disorders that involve physical symptoms or anxiety over illness including somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder; must persist for longer than 6 mo

Cognitive thought processes that are believed to be important in the etiology of somatic syndrome disorders;

-external triggers or internal ones produce, "well this could happen to me" thoughts -the individual then perceives bodily sensations such as headaches and increases in heart rates -thoughts and worries about possible disease begin to take more and more root in the brain -bodily sensations become more pronounced because of such thoughts, snowball effect -catastrophic thoughts increase in response to the magnified bodily sensations, creating a circular feedback pattern

The prevalence of depersonalization/derealization disorder is __$, which typically begins in about the ____ years

1; teenage

Chronic pain is common and affects about __% of the U.S. population

30

It is estimated that approx ____% of those who visit the doctors have illness anxiety disorer

4-6

Fleeting experiences of depersonalization are reported in up to __% of college students and __% of the general population in times of extreme stress; this is also accompanied by mood and anxiety disorders

7; 23

What is the mortality rate of factitious disorder imposed on another and what are the two determinants?

9% ; due to either mothers reports of abuse itself or from the invasive medical procedures

Why are the patterns of brain activity in individuals diagnosed with DID difficult to interpret?

Because it is unclear what causes them and what specific role they play, if any, in dissociative disorders

T or F; it is relatively easy to diagnose a patient when they complain of excessive pain or pain that is lingering for too long (i.e. in SSD with pain features)

F; it is often difficult; too subjective

T or F; in DID, more than one personality can be present at once

F; only one at a time; the alternation of personalities usually produce periods of amnesia in the personality that has been replaced

T or F; just like the somatic symptom disorders, there is too an objective test in which one can measure whether or not an individual has a dissociative disorder

F; there are no such tests to detect such disorders

T or F; individuals with somatic symptom disorder have been shown to unrealistically downplay and under estimate the severity of their bodily symptoms

F; they are more likely to unrealistically interpret and overestimate their bodily symptoms

Atypical brain functioning has been documented in various dissociative disorders such as...

MRIs show inhibited neural activity associated with memory repression in the hippocampus while PET scans show hypometabolism in an area of the prefrontal cortex that is involved in the retrieval of autobiographical memories

What is *one* biological explanation as to why one might develop a somatic disorder?

May truly have inherited a lower level of pain threshold (genetically) or an increased sensitivity to the nerves associated with pain and thus pain sensations/receptors

Dissociative amnesia is most like which phrase coined by Freud?

Regression

To treat the somatic symptom disorders biologically, what is often prescribed?

SSRIs; increase serotonin

Why do some argue the possibility and therefore validity of repressed memories?

Some point out that our memories are extremely malleable, subject to many environmental influences and influencers; details of the event can be distorted and false memories can be developed quite easily; not 'was there a gun' but instead, 'how big was the gun?'

T or F; A number of studies using PET scans and MRIs on individuals diagnosed with DID have found variations in brain activity when comparing different personalities

T

T or F; Currently, there are no specific medications for the dissociative disorders, instead the medications that are prescribed are prescribed to treat concurrent anxiety or depression

T

T or F; DID is rarely diagnosed outside of the United States and Canada

T

T or F; Some researchers contend that people with certain somatic like symptoms assume the 'sick role' because it is reinforcing and because it allows them to escape unpleasant circumstances or to avoid responsibilities

T

T or F; The mental health literature contains more information on the treatment of DID than on all of the other dissociative disorders combined

T

T or F; individuals with dissociative amnesia often score high on tests measuring hypnotizabiltiy and are likely to report depression, anxiety, or a history of trance states

T

T or F; one of several of the personalities in DID may be aware of the existence of the others

T

T or F; the personalities in DID often differ from one another and sometimes are direct opposites of each other

T

T or F; when viewing somatic symptom disorders within a social context, there is the belief that somatic complaints are a reflection of unsatisfying or inadequate social relationships

T

What is important to note of the dissociative disorders?

That they are also a matter of legal validity; (i.e. experiencing amnesia while committing a violent crime and or murder; repressed memories of CSA)

What does localized, selective, continuous, and systematized amnesia all have in common?

The episodes only last anywhere between days, weeks, and months, nothing more

Dissociative Identity Disorder (DID)

a condition in which *two or more* relatively independent personality states appear to exist in one person, including experiences of possession; also known as multiple personality disorder

Conversion disorder (functional neurological symptom disorder)

a condition involving sensory or motor impairment suggestive of a neurological disorder but with no underlying medical cause

Factitious disorder

a disorder in which symptoms of illness are *deliberately* induced, simulated, or exaggerated, with no apparent external incentive; characterized by the presentation of oneself to others as ill or impaired through the recurrent falsification of physical or psychological symptoms

Treatment of dissociative identity disorder (DID)

a major goal in this treatment is the use of trauma-based therapy to develop healthier ways of dealing with the stress and stressors involved in the disorder

Factitious disorder imposed on another

a pattern of falsification or production of physical or psychological symptoms in another individual; an individual deliberately feigns or induces an illness in another person (or even pet) in the absence of any obvious external rewards

Somatic symptom disorder (SSD) *with predominately somatic complaints* (previously known as somatization)

a subtype of SSD involving chronic complaints of specific bodily symptoms that have no physical basis; results in discomfort in different parts of the body; gastro (bloating, diarrhea, nausea), sexual (sexual indifference, irregular periods, ED) and pseudoneurological (amnesia or breathing problems)

Sociocognitive model (SCM)

an approach that takes both social and sociocultural factors into consideration (of the dissociative disorders)

Selective amnesia

an inability to remember certain details of an event, an example of this may be getting into a severe car accident, you might remember having been in it but you might not remember that your wife and kids didn't make it through; some bits and pieces are missing

Why is illness anxiety disorder considered to be cognitively based?

because the individual misinterprets bodily variations or sensations as indications of a serious illness or undetected disease

Continuous amnesia

cannot recall an event that occurred when they were at a certain age, up until the present

Somatic symptom disorder (SSD)

condition involving a pattern of reporting distressing physical symptoms combined with extreme concern about health or fears of undiagnosed medical conditions; considered life-disrupting

Neurologists report that about 2-3% of new referrals involve cases of

conversion disorders

Cognitive-behavioral approaches for treating somatic symptom disorders are focused on

correcting the misinterpretations of bodily sensations

Somatic symptom disorders are considered (difficult/easy) to treat

difficult

To develop DID, the person must have the capacity to ____

dissociate or separate -- certain memories or mental processes in response to traumatic events

Depersonalization/derealization disorder

dissociative condition characterized by feelings of unreality concerning the self and the environment (detachment); the most common dissociative disorder;

Somatic symptoms

distressing physical or bodily symptoms

Medical personnel often (do/do not) show negative reactions when interacting with individuals with somatic symptom disorders

do

Explanation of why a child who was a victim of sexual or physical abuse grew up and was diagnosed with DID

during the abuse had to 'go somewhere else' mentally to protect themselves; had no childhood in which they could really be themselves; thus may take on an opposite gender personality or even a child-like one to compensate

A newer approach to the treatment of somatic symptom disorders involves the demonstrating of _____ regarding the physical complaints and focusing on helping the individual develop better coping skills, as indicated in the following statement to the patient: "I don't know the exact cause of your pain but I *will* do the *best I can* to find solutions."

empathy

Dissociative Fugue

episode involving complete loss of memory of one's life and identity, unexpected travel to new location, or assumption of a new identity; might wander to a new city, having no idea who they are

Malingering

feigning illness for an external purpose

Because diagnosis of the dissociative disorders relies heavily on patients self reports, ___________ is always a possibility

feigning or faking

Localized amnesia

lack of memory for a *specific* event(s), often centered around some highly painful or disturbing event; short in duration -- after coming across a traumatic accident, within hours you may forget about the accident entirely, thinking that everyone just made it up

Signs of a factitious disorder

linger, unexplained illnesses with multiple surgical or complex treatments 'remarkable willingness' to undergo painful or dangerous treatments such as amputations or prophylactic double mastectomy a tendency to anger if the illness is questioned the involvement of multiple doctors

Systematized amnesia

loss of memory for certain categories of information; might not be able to remember information about their families or spouse; mother, after the death of her daughter, may forget she had a daughter at all

Cultural factors can influence the frequency, expression, and interpretation of somatic complaints; risk factors associated with somatic symptom disorders include

lower educational levels, ethnicity, and immigrant status; explain different cultural views regarding the relationship between mind and body

A diagnosis depersonalization/derealization disorder is only given when the feelings of unreality and detachment cause

major impairment in social of occupational functioning

Proponents of SCM cite the large increase in DID cases after the...

mass media portrayals of this disorder as support for this perspective

Repressed memory

memory of a traumatic event that has been repressed and is therefore, unable to be recalled; resides below the level of consciousness; a major example of this is ones concerning CSA, only to be remembered years ago

Although medical professionals sometimes that those with SSD are faking their symptoms, ___________ do not consider SSD to be under voluntary or conscious control

mental health professionals

Possible reasons for increase in DID diagnoses?

more accurate diagnosis, false positives, hypnosis, or an actual increase in the incidence of the disorder --- all still being debated

Who is most likely to be a perpetrator and thus victim of factitious disorder imposed on another

mother; child - appears to be loving and attentive of little one all the while simultaneously sabotaging the child's health (sometimes by way of suffocating or poisoning the child)

When it comes to somatic disorders; which seems to have a larger impact on the likelihood of an individual being diagnosed with such? (nature[biology] or nurture[environment])

nurture (environment)

According to the Post Traumatic Model (PTM) of DID, the split in personality developed because

of traumatic early experiences combined with the inability to escape them

Difference between organic amnesia and dissociative amnesia

organic-you truly can't (ever) regain memory; there is a physiological basis of loss of memory (damaged area/neurons) dissociative-there is no physiological/neurological reason as to why one can't remember; more or like a metal block, in truth these memories can be recovered in time

Why might successful treatment of DID be difficult to achieve?; give stats from study

out of the 20 individuals who were diagnosed with DID, only 9 had partial or full recovery, but only 5 *maintained* it, the others dissociated again

Illness anxiety disorder

persistent health anxiety and concern that one has an undetected physical illness with no or minimal somatic symptoms; chronic pain lasting over 6 months

Somatopsychic perspective

physical problems are thought to produce psychological and emotional problems

Warning signs of factitious disorder imposed on another

physical symptoms that appear only when the mother or caretaker is around or insistent on medical tests that are unnecessary or invasive

Somatic symptom disorder (SSD) with pain features

previously known as pain disorder; characterized by reports of severe pain that either appears to have no physio or neurological basis, seems to be significantly greater than would be expected, or lingers long after a physical injurt has healed

The primary psychological explanation for the dissociative disorders come from the

psychodynamic theory

Psychosomatic perspective

psychological conflicts are expressed in physical complaints

Dissociative disorders highly publicized and sensationalized; yet except for depersonalization/derealizaiton disorder, they are considered ____.

rare

According to the psych perspective of somatic disorder etiology, all of the following can play a role into the development of somatic symptoms disorder

reinforcement, modeling, catastrophic, or a combination of these

Individuals who assume a 'sick role' often receive some ______, as such escape from responsibility or control of others through bodily complaint; therapy is therefore directed toward developing and improving the individual's _______

reinforcement; social network

Others argued that hysteria was more prevalent in women because

social mores did not provide them with appropriate channels for the expression of aggression or sexuality

Social perspective theory of somatic symptom disorder etiology

some individuals with this disorder may have been rejected or abused by family members or even encountered feelings of being unloved as a child; if sexually abused as a child may have chronic pelvis pain and gastrointestinal disorders; poor social support? never even had it as a child

Dissociative amnesia

sudden partial or total loss of important personal information or recall of events due to psychological factors; no real physiological reason for loss of memory -- the memory is still there, just can't retrieve it

According to the psychodynamic theory what can be said about the dissociative disorders?

that they are caused by an individual's use of repression to block from consciousness unpleasant or traumatic events; this product protects the individual from painful memories or conflicts

According to the Sociocognitive model (SCM), patients learn about DID and its characteristics from

the mass media and under certain circumstances, being to act out these roles; vulnerable individuals may demonstrate these behaviors when therapists inadvertently use questions or techniques that evoke dissociative types of problems descriptions by clients

Treatment for dissociative amnesia and dissociative fugue

the symptoms of this tend to end or abate spontaneously so a reasonable therapeutic approach is to threat these disorders by alleviating the depression and stress

Treatment of depersonalization/derealization disorder

treatment generally concentrates on alleviating the feelings of anxiety or depression or the fear of going insane; also subject to spontaneous remission but at a much slower rate

SSD with pain features is more common in what groups of people

women, and individuals from lower SES backgrounds