Abnormal chapter 6

While speculation regarding the cause of __________ continues, your authors note that almost every patient presenting with this condition reports a history of horrible, almost unspeakable abuse that they suffered in childhood.

DID

In which of the following countries would the experience of a dissociative trance be seen as inconsistent with cultural norms and expectations?

Denmark These trance states are most common in Asian and African countries, and are less culturally expected in more Western societie

How does the identification of a physical cause for symptoms affect the diagnosis of somatic symptom disorder?

The important issue is how distress affects the impairment, not the identification of a physical cause.

If the person in this scenario was diagnosed with dissociative fugue, what was most likely also true in that situation?

The man had traveled to the police station from far away to escape a traumatic situation.

Depersonalization-derealization disorder

When being forced to do things that she doesn't want to do, Bette often finds that she is not really herself, but more like an entity above or behind herself.

Amber Rose has been diagnosed with fibromyalgia which may, in some individuals, be consistent with diagnosis of somatic symptom disorder. The important factor in somatic symptom disorder is ____.

he level of distress, which compounds impairment

conversion disorder

physical malfunctioning suggesting neurological impairment but with no organic pathology to account for it (functional neurological symptom disorder)

Somatic symptom disorder and a related condition known as illness anxiety disorder involve the belief that a normal bodily change is a sign of the presence of a serious disease, causing a person to seek the help of a _________ first.

physician

alters

shorthand term for the different personalities or identities in dissociative identity disorder

derealization

situation in which the individual loses a sense of the actuality of the external world

Now that Alyssa has been diagnosed with conversion disorder, one aspect of treatment is

to identify and deal with the stressful life event that is causing the disorder. If this event can be identified, helping the person to psychologically deal with the ordeal will reduce the need to convert this stress into physical complaints. For Alyssa, this means helping her manage the demands of college life.

Many principles of treatment strategy for conversion disorder are similar to those for which disorder?

somatic symptom disorder Because conversion disorder has so much in common with somatic symptom disorder, many of the treatment principles for the two disorders are similar. Note that treatment strategies for both involve helping the patient learn to cope with the psychosocial stressors related to the disorder, as well as eliminating any secondary gains.

Once the symptoms of a somatic symptom or related disorder have been identified and diagnosed, a treatment plan can begin. Which of the following would be an effective treatment strategy to reduce a patient's fears and beliefs?

spend as much time as necessary to adequately discuss all of the patient's concerns. Reassurance and education that are considered explanatory therapy have proven effective in some cases. This type of therapy uses a more in-depth approach, with mental health professionals offering reassurance in a more effective and sensitive manner. Using this treatment strategy, a professional will spend adequate time with the patient to fully discuss all concerns, as well as the meanings behind the patient's symptoms, such as how the symptoms might relate to the stress in his or her life. Cognitive-behavioral treatment (CBT) has also proven effective for those patients willing to seek help from mental health professionals. This type of therapy focuses on identifying and challenging a person's interpretations of normal bodily changes, pointing out one's ability to create symptoms by simply focusing on parts of the body, and urging the patient to seek less reassurance for his or her concerns.

somatic

suggests illness or injury without any medical cause

In depersonalization-derealization disorder, patients have one or both of the following experiences:

1. Depersonalization: The experience of feeling as if you are detached from yourself, as if you are an outside observer looking down at your body or mental processes 2. Derealization: Feeling as if your sense of the external world is altered, as if items are changing in shape or size

Some psychologists have offered dissenting theories of dissociative identity disorder. Which of the following statements does not accurately reflect this dissenting professional opinion?

1. Dissociative identity disorder cases are artificial productions provoked by the attention that doctors give them. 2. Multiple personality and trauma are separate conditions, and they do not align or match into a single, distinct disorder. 3. People are persuaded that they have multiple personalities embedded within them and are encouraged to bring them out. 4. People with dissociative identity disorder are often unable to differentiate between imagined and actual personality states within them. (THIS ONE) Dissenting psychologists claim that dissociative identity disorder is an artificial production provoked by doctors, as people are persuaded that they have multiple personalities within them and are then provoked to bring them out. These psychologists assert that multiple personality and trauma are "two separate things" that are paired together, but "they only match in story form.

The exact causes of dissociative identity disorder are hard to pinpoint, but there are certain characteristics shared by patients with this disorder. Which of the following have researchers discovered regarding the development of DID? Check all that apply.

1. Patients are more likely to develop DID during childhood than adulthood. 2. The vast majority of patients with DID were abused during childhood.

According to the DSM-5, all of the following are symptoms of dissociative identity disorder except one. Which of the following is not noted as a symptom of dissociative identity disorder, according to the DSM-5?

1. Recurrent imagined or actual symptoms of anxiety or trauma (THIS ONE IS FALSE) 2. The presence of two or more distinct identities or personality states 3. At least two of the distinct identities or personality states recurrently taking control of a person's behavior 4. An inability to recall important personal information As noted in the research, the DSM-5 characterizes dissociative identity disorder by the presence of two or more distinct identities or personality states, and at least two of these identities or personality states recurrently take control of a person's behavior, resulting in an inability to recall important personal information. Although there is suggestion of abuse and trauma as antecedents to dissociative identity disorder, symptoms of anxiety and trauma are not included as diagnostic criteria.

this case involved

3 alters, and Juanita as the host personality The host personality is usually the alter that becomes the patient who seeks treatment. Very rarely will the host be the patient's original personality.

dissociative trance disorder

A culturally specific subtype of dissociative identity disorder, dissociative trance disorder, involves a person being in a trancelike state—often involving what appears to be possession by a spirit—that is undesirable to members of the person's culture. Dissociative trance disorder is identified when a person exhibits personality changes indicative of possession by a spirit. This often creates a trancelike state and must be considered undesirable by the person's culture. These experiences of trance and possession are extremely rare in Western cultures but are among the most common forms of dissociative disorders in other cultures.

Requirements of dissociate fugue

A diagnosis of dissociative fugue has two major requirements. First, a person will engage in either purposeful travel or bewildered wandering. The person may be trying to escape from something traumatic, or he or she may just pick up and leave. Second, confusion over one's identity is often present; the person may be confused as to the details of his or her identity or may assume an entirely new identity.

Disscoative fugue

A man walked into a police station claiming to have no recollection of his past or who he was. After searching through missing-persons reports, police discovered that the man had been missing for the past two months.

The validity of dissociative identity disorder (DID) is a controversial subject. Which of the following best describes why patients are motivated to fake their symptoms, according to scientists who are skeptical of dissociative identity disorder (DID)?

A therapist suggests the possibility that a patient has multiple identities and responds positively when a new identity is produced. Patients with DID often have high levels of suggestibility and may be following the lead of their therapists. If a therapist raises the possibility of having multiple identities, someone that is highly suggestible will be more likely to comply with the suggestion. When this happens, the therapist feels good about having uncovered this disorder, and he or she provides reinforcement that pushes the patient to develop additional identities. This pattern can be observed in the case of Kenneth Bianchi, the Hillside Strangler. When a therapist asked to speak to "another part of Ken," he responded by producing an alternate identity.

According to research, why do people with dissociative identity disorder develop multiple personalities, or alters?

Alters are developed as a means by which to cope with abuse or trauma. According to research, most people with dissociative identity disorder develop alters as a way to cope with abuse or trauma, as if to say, "This did not happen to me, and this is not going to happen to me again."

The key is illness anxiety disorder, the patient is worried about a very specific disease. I.e mom had breast cancer, so I want 10 mammograms a year. Are you sure I don't have breast cancer? Somatic symptom disorder is a collection of unrelated bodily complaints + fatigue.

Difference between IAD and SSD

A person experiencing a conversion symptom called globus hystericus would experience which of the following?

Feeling a lump in the throat that interferes with swallowing, eating, or talking

Dissociative identity disorder

Felix was recently hospitalized for recovery following surgery on his appendix. During his time there, the doctors and nurses noticed Felix often acted differently, sometimes being quite outgoing and other times painfully shy. He also asked to be called by as many as four different names.

Which of the following statements is true about dissociative identity disorder?

For prevalence rates, the ratio of females to males is approximately 9 to 1. his dominance of women diagnosed with this disorder has caused some to wonder if it is real or if it is more of a culturally and socially constructed condition.

Illness anxiety disorder

Ginny's father recently died of prostate cancer, and she is concerned that she also has cancer. Ginny has been experiencing mild abdominal pains, convinced that it is evidence of stomach cancer. All she can think or talk about is dying of cancer and leaving her three young children behind. in which a person experiences severe anxiety around developing a particular disease. Sometimes, mild symptoms are present but have been misinterpreted or overblown by a patient. Other times, a patient may not have any symptoms at all. Even when patients are given a thorough examination and told they don't have a disease, their fears are rarely extinguished. It's not unusual for patients to be preoccupied with a disease for several years, even when there is evidence to the contrary

Generalized amnesia example

Hannah's spouse recently took her to the hospital after she displayed some bizarre memory problems. One morning, Hannah woke up and couldn't recognize her spouse or children. She locked herself in the bathroom and kept asking, "Who are you? Where am I? What am I doing here?" After calming down, Hannah revealed that she didn't even remember her own identity.

Which of the following treatment methods would a therapist most likely recommend for Felix's form of conversion disorder?

Have Felix's family give him attention only when he is not showing symptoms of conversion disorder.

dissociative fugue

Hubert was in his car, driving down a major highway, when he realized that he had no memory of planning or taking the trip there. Not knowing what else to do, he turned around and went back home.

Malingering refers to a person faking the symptoms of a somatoform disorder. People who fake symptoms of conversion disorder are often trying to get out of something (such as going to work) or are looking to gain something (such as a financial settlement).

If a person is experiencing symptoms of a conversion disorder without having experienced stress, a clinician should carefully consider that the symptoms are most likely the result of a medical condition or malingering

Another example of difference

Illness anxiety disorder example-Young female with headaches comes in thinking she might have a brain tumor and that is causing her significant stress. Patients are significantly worried that their health is in danger and they fear severe illness/death. Somatic symptom disorder- Young female with a history of headaches, abdominal pain, diarrhea/constipation presents to the E.R. with abdominal pain. Abdominal USG/CBC/etc. etc. NORMAL. All tests and labs come back NORMAL. The patient continues to have symptoms from different organ systems, usually depression/anxiety is associated here as well but that's only important for psych exams

What does this do?

Informing his family about how the attention he receives from them may actually be reinforcing his condition. They will need to start giving Felix attention when he is not showing signs of the conversion disorder. This will be a slow process, but one the family must be diligent about to help Felix be motivated to walk again. The goal of treatment is for Felix to begin walking again. Asking Felix's family to speak to him only when he is showing signs of paralysis will simply reinforce the symptoms of the disorder and not help him start walking. The only successful treatment plan is the one that addresses the issue of Felix's family reinforcing his condition with attention.

la belle indifférence

It was long thought that patients with conversion reactions had the same quality of indifference to the symptoms thought to be present in some people with severe somatic symptom disorder. This attitude, referred to as la belle indifférence, was considered a hallmark of conversion reactions, but, unfortunately, this turns out not to be the case

Dissociative identity disorder, previously known as multiple personality disorder, is diagnosed when a person presents two or more distinct identities. Each separate identity has its own way of interpreting, interacting with, and thinking about the self and the world. Here is an example:

Juanita has recently approached a psychiatrist for help with sporadic bouts of amnesia and other unexplainable occurrences. She most recently had an encounter with a person she didn't recognize but who was certain that they knew each other, and this person kept calling her Hilary. This event had happened once before with another person thinking her name was Becky. The resulting anxiety from these occurrences brought Juanita to seek therapy. After identifying a diagnosis of dissociative identity disorder, the therapist found out that Juanita's birth name is Beth. They are now working toward identifying the cause of this disorder.

Somatic symptom disorder

Most of Eric's friends are health care professionals that he has gotten to know over the years from his dozens of trips to the hospital and clinic. Eric likes to meet with a different friend every week or two to catch each of them up on his latest symptoms. Whenever someone asks, "How are you doing?" Eric responds by listing the various physical ailments he has. in which a person feels excessive worry or distress about various physical complaints. Often, such patients will visit multiple doctors, avoid physical activity, and view themselves solely in terms of their symptoms. The distress associated with these symptoms will typically disrupt a person's social, emotional, or occupational functioning.

Because there are similarities in the etiology between dissociative identity disorder (DID) and ________, some have suggested that DID is actually a subtype of this other condition.

PTSD

What would be a secondary gain in this instance

Taking a break from classes A secondary gain for a person with conversion disorder is usually in the form of receiving attention or avoiding an unpleasant situation or behavior. In Alyssa's case, avoiding the stressful demands of college classes is an example of this type of gain.

Conversion disorder

Several of Ralph's coworkers were recently diagnosed with carpal tunnel syndrome and have received extra paid time off as a result. Ralph became very disgruntled by what he felt was a serious unfairness and even wrote a letter to the company's CEO. Soon after, he started to lose the use of his right wrist and hand. Ralph visited three doctors who all agree it isn't carpal tunnel; in fact, they can find no medical reason for the paralysis. is suffering from a conversion disorder, in which some form of physical malfunctioning, typically a loss of motor or sensory ability, is not due to physical injury or pathology. Far from faking the disorder, Ralph is truly experiencing issues with his wrist and hand, but the reason behind it cannot be explained by another physical or mental disorder.

What is another effective treatment plan

Show the patient how focusing on parts of the body actually creates physical symptoms. This type of therapy uses a more in-depth approach, with mental health professionals offering reassurance in a more effective and sensitive manner. Using this treatment strategy, a professional will spend adequate time with the patient to fully discuss all concerns, as well as the meanings behind the patient's symptoms, such as how the symptoms might relate to the stress in his or her life.

Somatic symptom disorders are chronic conditions, with the majority of cases meeting a diagnosis for such a disorder over the five years.

Somatic symptom disorders are chronic, long-term conditions, with the majority of cases maintaining a diagnosis over the five years. Although there is a slight decline of about 20%, the majority of cases in Dr. Cohen's research meet the criteria for the entire five-year period. You needed to recognize that this illustrates that somatic symptom disorders are chronic conditions and can continue for a number of years. An acute condition is short term, meaning a person does not continue to meet the diagnosis for a disorder over a number of years.

Localized amnesia example

Stelios was recently the victim of a suspected kidnapping and sexual assault. He was able to escape the place where he had been held but now has no memory of his captor or the location.

conversion disorder

Symptoms of conversion disorder affect voluntary motor or sensory functioning to such a degree that a neurological condition is thought to be responsible.

All somatic symptom and related disorders include an overwhelming preoccupation with the physical functioning of the body. The specific disorders are differentiated by either the types of symptoms present or the consequences of detecting symptoms. Which of the following best describes the key feature of somatic symptom disorder?

The patient feels physical symptoms that are disruptive or distressing. In somatic symptom disorder, patients have one or more physical complaints or dysfunctions that disrupt their lives and cause intense anxiety. These physical symptoms often lead a patient to seek medical, rather than psychiatric, help. Additionally, a preoccupation with the symptoms often exists. In some cases, these symptoms can dominate a patient's thoughts. The patient doesn't tend to be preoccupied with a particular ailment, but is instead worried about the physical symptoms he or she is experiencing.

In a somatic symptom disorder...

The presence of anxiety often makes a patient's physical symptoms worse.

Which conclusion can be made about the prevalence rate for conversion disorder from the findings illustrated?

The prevalence rate for conversion disorder will appear lower than it actually is if researchers include statistics from only mental health settings.

What is a primary gain

This reduction of anxiety is considered to be the primary gain or reinforcing event that maintains the conversion symptom.

A person who is malingering pretends to have symptoms of a physical or mental abnormality when in fact, none are present.

True Malingering refers to the misrepresentation of symptoms when none are actually present. For example, one could fake auditory hallucinations commonly associated with schizophrenia.

Conversion disorders generally have to do with some kind of physical malfunctioning (such as sudden blindness), with no other abnormalities to account for the malfunction.

True A conversion disorder occurs when physical malfunctioning occurs with no physical abnormalities to account for the malfunction. An example of a conversion disorder would be if someone were to suddenly go blind although all visual processes are normal.

Higher levels of anxiety cause a person to perceive a symptom as more severe.

Unfortunately, anxiety increases a person's arousal, which in turn can make physical sensations seem more intense

In illness anxiety disorder, physical symptoms are

absent or very mild

dissociative trance

altered state of consciousness in which people firmly believe they are possessed by spirits considered a disorder only where there is distress and dysfunction.

Research has suggested a connection between somatic symptom disorder and ________ personality disorder that lies in a neurobiologically shared disinhibition syndrome characterized by impulsive behavior.

antisocial

The process of re-experiencing emotionally traumatic events as a means of purging them from the psyche was named ________ by Josef Breuer, and has proven to be an effective intervention with many emotional disorders.

catharsis The major idea behind catharsis is that if we have a releasing of the mental energies that cause problems, this will lead to symptom recovery.

psychological factors affecting medical condition

condition characterized by hallucinations or delusions and is the direct result of another physiological disorder Psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response.

Your textbook authors describe a treatment plan for one of the somatic symptom and related disorders that includes efforts to reduce any reinforcing or supportive consequences of the illness's symptoms. For which condition is this a particularly important goal?

conversion disorder When the loss of function symptoms of conversion disorder is reinforced, they tend to persist. When the reinforcement is removed, the process of extinction can help reduce the symptoms.

malingering

deliberate faking of a physical or psychological disorder motivated by gain can be financial

For example, while studying in the library, everything around Jamal began to look as if he was viewing things through a glass bottle. Jamal's experience is an example of

derealization

Individuals with ________ experience loss of sense of reality in their external world. Things may seem to change size or shape, and others may seem dead or mechanical.

derealization

While interviewing 129 women with documented histories of childhood sexual abuse, Williams (1994) found with extensive questioning that 38% of the women

did not recall the abuse

dissociative amnesia

disorder featuring the inability to recall personal information, usually of a stressful or traumatic nature

depersonalization-derealization disorder

disorder in which feelings of detachment are so severe they prevent normal functioning

dissociative disorder

disorder in which individuals feel detached from themselves or their surroundings and reality may disintegrate

dissociative identity disorder (DID)

disorder in which many personalities or fragments of personalities coexist within one body and mind Formerly known as multiple personality disorder; a disorder in which as many as 100 personalities or fragments of personalities coexist within one body and mind.

Somatic symptom disorder

disorder involving extreme and long-lasting focus on physical manifestations for which no medical cause is evident (previously known as somatization disorder) is any mental disorder which manifests as physical symptoms that suggest illness or injury, but which cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder

illness anxiety disorder

disorder involving severe concern over belief in having a disease process without any evident physical cause (previously known as somatoform disorder)

dissociative fugue is a subtype of

dissociative amnesia

Jack has been caring for his elderly father for some time, and is beginning to feel the pressure of being a caretaker. For no identifiable reason, he has begun doing things that cause his father to become sick, so that his father can spend time in the hospital. He also finds that he enjoys the attention he gets when his father is sick. Jack may be diagnosed with

factitious disorder imposed on another.

Medical conditions and malingering must first be ruled out as the basis for the dysfunction. Often, the motivation for the malingerer is ______________

financial gain

Jane has a constant worry about getting sick even though she does not have any immediate symptoms. Whenever there is a new story about a new bug of an outbreak of some virus like the flu, she finds herself feeling very worried about getting the latest sickness. If she gets a mild symptom like a runny nose or a small rash, she is immediately convinced that she is developing a serious illness. Jane would be best diagnosed with

illness anxiety disorder When the symptoms are either nonexistent or very mild but still cause anxiety about getting ill, the correct diagnosis is illness anxiety disorder (formerly hypochondriasis).

Former nurse Beverly Allitt, who is serving 13 life sentences for murder and attempted murder, has shown symptoms consistent with factitious disorder imposed on another. This disorder often presents as a form of atypical child abuse and includes ____.

initiation of contact with medical professionals by the perpetrator

DID

is highly associated with traumatic childhood experiences. Roughly 95% of patients with DID report having suffered some form of physical or sexual abuse. In fact, some researchers speculate that DID is highly related to, and may be an extreme form of, posttraumatic stress disorder (PTSD) because their symptoms share many features. Unlike PTSD, however, DID develops primarily during childhood. In fact, it's rare for a patient to begin developing symptoms past age 9. While researchers have speculated on the psychological and environmental factors that influence DID, they've been unable to pinpoint any definitive biological factors.

The original term for neurosis was "hysterical neurosis," which took its name from the idea that

it was caused by a "wandering uterus."

Alison has recently been diagnosed with dissociative amnesia after being unable to remember anything of her fifth birthday, the day her mother died. Alison is showing signs of

localized amnesia Alison is showing signs of localized amnesia. Localized amnesia involves an inability to remember details of a specific event. Generalized amnesia involves an inability for a person to remember anything, including who he or she is. The amnesia may extend to his or her recent past or entire life.

generalized amnesia

loss of memory of all personal information, including identity

dissociative fugue

memory loss featuring sudden, unexpected travel along with an inability to recall the past

localized or selective amnesia

memory loss limited to specific times and events, particularly traumatic events

These findings illustrate that the majority of cases of conversion disorder occur in __________ setting

neurological Close to 30% of the cases in the neurological setting involved conversion disorder, with only about 5% of cases in the mental health setting involving conversion disorder.

Beth, the patient found to have dissociative identity disorder, is now working with a therapist to treat her symptoms. The therapist is outlining how they will identify cues that often precede a switch in identity in order to

neutralize these triggers Treatment for a person diagnosed with dissociative identity disorder starts with working with a therapist to neutralize the cues or triggers to reliving the traumatic event. These triggers are what prompt the dissociation to an alternate identity. To identify these triggers, a patient must confront and relive the traumatic event as it occurs in his or her mind, all the while gaining control over what happened. This is a slow process, with the goal of making the trauma more of a distant memory, requiring a skilled therapist to work with the patient on reducing the physical and emotional pain associated with the trauma.

Do all types of amnesia involve an inability to remember who you are?

no

Is hypochondriasis a term still used in the DSM-5?

no

factitious disorder

nonexistent physical or psychological disorder deliberately faked for no apparent gain except sympathy and attention

Somatic symptom disorder and a related condition known as illness anxiety disorder involve the belief that a _________ bodily change is a sign of the presence of a serious disease.

normal In somatic symptom disorder and illness anxiety disorder, patients often misinterpret a normal bodily change as a sign of the presence of a serious disease. The anxiety resulting from this preoccupation typically leads patients to visit a medical professional (a physician) first, rather than a mental health professional (a psychiatrist or counselor), in an effort to identify the disease causing the bodily change. Despite reassurances from medical professionals that a serious disease is not present, people with somatic symptom disorder and illness anxiety disorder will often visit a number of different doctors because they are convinced something is wrong.

The doctors involved in Alyssa's case have contacted a therapist, who is almost certain Alyssa has conversion disorder. The practitioner is not an expert in this area of disorders, but she does know that people diagnosed with conversion disorder are not ________

not faking their symptoms People diagnosed with conversion disorder are not faking their condition—they truly feel the symptoms about which they complain. If a person were found to be faking his or her symptoms, for instance to gain attention or sympathy from others, a diagnosis of conversion disorder would not be made.

exploratory therapy

patients say what comes to mind (free association) and are helped to understand their feelings, mental mechanisms, and relationships with people

Jonah suffers from a mild case of asthma. It usually only causes him a problem when the weather turns colder, as he finds it more difficult to breathe in chilly air. At the same time, whenever Jonah is having an increase in stress at work or with his wife, he finds that his asthma symptoms start to flare up. Jonah might be diagnosed as dealing with

psychological factors affecting medical condition Because Jonah has a legitimate medical condition that is exacerbated by psychological events, this would be correct.

The doctors involved in Felix's case have contacted a therapist, who is almost certain Felix has conversion disorder. The practitioner is not an expert in this area of disorders, but she does know that people diagnosed with conversion disorder often feel that

running away is acceptable

In both graphs, a greater number of cases of conversion disorder involve women. Like many other somatoform disorders, conversion disorder occurs more frequently in

women than in men.