Chapter 6- dissociative disorders

diagnostic criteria for somatic symptom disorder

-1 or more somatic symptoms that are distressing or result in significant disruption of daily life -excessive thoughts, feelings or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: --disproportionate and persistent thoughts about the seriousness of one's symptoms --persistently high level of anxiety about health or symptoms --excessive time and energy devoted to these symptoms or health concerns -state of being symptomatic is persistent- typically more than 6 months

conversion disorder

-also known as functional neurological symptom disorder -presumed cause is some sort of psychological issue- symptom results from some sort of emotional conflict or stress- the individual converts the stress into a symptom- development of symptom is UNINTENTIONAL- the individual does believe their symptoms are real and there is no reward they receive from experiencing the symptom -individual loses neurological functioning in a part of their body, not because of a medical cause -most common symptoms include- paralysis, blindness, mutism, seizures, loss of hearing, severe loss of coordination or anesthesia in a limb

diagnostic criteria for conversion disorder

-at least one symptom of altered motor or sensory function that is not due to a recognized neurobiological or medical conditions and not attributed to another disorder

diagnostic criteria for dissociative identity disorder

-disruption of identity characterized by 2 or more distinct personality states- this disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition and/or sensory-motor functioning -individual experiences recurrent gaps in the recall of every day events, important personal information and/or traumatic events that are inconsistent with ordinary forgetting

somatic symptom disorder

-individual has 1 or more distressing physical symptoms and spends a great deal of time and energy thinking about their symptoms and seeking medical attention for them -focus is on the symptoms- person would be thrilled if the symptom just went away

psychological factors affecting other medical conditions

-person has a medical condition and they have some other psychological or behavioral factors that affects the condition's course, treatment, ability to comply with treatment, risks associated with condition or underlying pathophysiology of the condition ex- person needs to get an MRI but is claustrophobic- person has a lung condition but they are unable to stop smoking -person might not be diagnosed with a mental disorder, but what raises it to the level of being considered a mental disorder is that it is affecting the individual's heath

diagnostic criteria for depersonalization/derealization disorder

-the presence of persistent or recurrent experiences of depersonalization, derealization or both -during depersonalization/derealization experiences, reality testing remains in tact- the individual knows that they are real/the situations they experience are real, they just don't feel real

illness anxiety disorder

-very similar to somatic symptom disorder- difference is that with illness anxiety disorder, the individual worries that they will develop or have a serious illness but do not always experience severe physical symptoms -concerned with underlying cause of symptoms- if headache went away, individual would think that the brain cancer they don't actually have had advanced

dissociative fugue

a subtype of dissociative amnesia- can be comorbid with dissociative amnesia individual travels to a new place and may assume a new identity with no memory of his or her previous identity

persecutor alter

alter inflicts pain or punishment on the other personalities by engaging in self harm behaviors (self cutting or self burning, suicide attempts)

diagnostic criteria for dissociative amnesia

an inability to recall important autobiographical info, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting most often consists of: -localized/selective amnesia for a specific event/events -generalized amnesia for identity and life history

psychogenic amnesia

arises in the absence of any brain injury or disease and is thought to have psychological causes rarely involves anterograde amnesia can involve retrograde amnesia- often this is only regards to personal information, not for general information

organic amnesia

caused by brain injury resulting from disease, drugs, accidents or surgery often involves anterograde amnesia can involve retrograde amnesia for both personal and general information

depersonalization/derealization disorder

characterized by frequent episodes during which the individual feels detached from their own mental processes or body, as if they are outside observers of themselves

dissociative amnesia

characterized by significant periods of amnesia without assuming new personalities or identities- person cannot remember important facts about their lives and personal identities and are typically aware of large gaps in their memory or knowledge of themselves NOT caused by an underlying physiological cause presumed cause is psychological trauma

derealization

experiences of unreality or detachment with respect to surroundings- an alteration in the experience or perception of outside world

depersonalization

experiences of unreality, detachment or being an outside observer with respect to one's thoughts, feelings, sensations, body or actions

dissociative identity disorder

formerly known as multiple personality disorder- people with this disorder appear to have more than one distinct identity or personality state- each personality has different ways of perceiving and relating to the world- the personalities are often different ages and different genders and they perform specific functions

treatments for DID

goal is to integrate all of the other alter personalities into 1 personality and helping patient rebuild the capacity for coping with distress and trusting healthy relationships

false memories can happen with recovered memories (memories that are recovered during treatment)

if a person has amnesia for events that have happened to them, they'll fill in what might have occurred and react accordingly- individual creates false memory

retrograde amnesia

inability to remember information from the past

anterograde amnesia

inability to remember new information

factitious disorder

individual deliberately fakes an illness specifically to gain medical attention and play the sick role- there's no obvious external reward besides attention think about the class diagnosis example- the lady always goes into the hospital for a racing heart beat so her kids will come visit her

diagnostic criteria for illness anxiety disorder

individual does not actually have the illness they're worried about -preoccupation with having or acquiring serious illness- focused on the illness itself, not so much the symptoms -somatic symptoms not present, or if they are present, are only mild in intensity- if another medical condition is present/there is high risk of developing a condition, preoccupation with this is excessive or disproportionate -high level of anxiety about health and individual is easily alarmed about personal health status -individual performs excessive health related behaviors (ex- the individual might repeatedly check body for signs of illness) or exhibits maladaptive avoidance (ex- individual avoids doctor appointments and hospitals) -illness preoccupation present for at least 6 months- specific illness that is causing fear may change over that period of time specify whether individual is care seeking type or care avoidant type

DID is the most controversial disorder

might be caused by bad therapy- individuals with DID tend to be highly suggestible people or people who can get involved easy in things- sometimes therapist diagnoses DID and the patient creates it

alters

multiple personalities with distinct qualities in the individual with dissociative identity disorder

labelle indifference

occurs with conversion disorder- person is not as upset about underlying physical problem that might be there

protector/helper alter

offers advice to other personalities or performs functions the host personality is unable to perform, like engaging in sexual relations or hiding from abusive parents

malingering

person fakes a symptom or disorder in order to avoid an unwanted situation or for a reward of some sort person is motivated to fake symptoms because the symptoms will help avoid an unwanted situation/will get them something ex- Child fakes sickness to stay home from school; person fakes an injury to receive worker's comp

treatment of conversion disorder

psychoanalytic treatment- focuses on expression of painful emotions and memories and on the insight into the relationship between these and the conversion symptoms cognitive-behavioral therapies- focus on relieving the person's anxiety centered on the initial trauma that caused the conversion symptoms and on reducing any benefits the person is receiving from the conversion symptoms

treatments for somatic symptom disorder and illness anxiety disorder

psychodynamic therapies- focus on providing insight into the connections between emotions and physical symptoms by helping people recall events and memories that may have triggered their symptoms behavioral therapies- attempt to determine the reinforcements individuals receive for their symptoms and health complaints and to eliminate these reinforcements while increasing positive rewards for healthy behaviors cognitive therapies- help people learn to interpret their physical symptoms appropriately and to avoid catastrophizing them cognitive-behavioral therapies- foucs on identifying and challenging illness beliefs and misinterpretations of physical sensations, as well as exposing clients to their anxiety triggers

child alters

very common- alters that are young children that do not age as the individual ages childhood trauma often is associated with DID- child alter might take over during traumatic experience so the host personality doesn't have to face the trauma -child alter that acts as a big brother or sister that protects the host personality from the trauma

factitious disorder imposed on another

when an individual falsifies illness on another- ex- parent fakes an illness in their children to gain attention