Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition) - a summary
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Clinical psychology
Chapter 8
Dissociative disorders and somatic symptom- related disorders
Introduction
Both types of disorders are hypothesized to be associated with stressful experiences, yet symptoms do not involve direct expressions of anxiety.
Dissociative and somatic symptom-related disorders tend to be comorbid.
The DSM-5 includes three major dissociative disorders:
The dissociative disorders are all presumed to be caused by a common mechanism, dissociation. Which results in some aspect of cognition or experience being inaccessible consciously.
Dissociation and memory
Psychodynamic theory suggests that in dissociative disorder traumatic events are repressed.
In this model, memories are forgotten because they are so aversive.
Memory for emotional relevant stimuli is enhanced by stress, while memory for neutral stimuli is impaired.
Dissociative disorders involve unusual ways of responding to stress.
Extremely high levels of stress hormones could interfere with memory formation.
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.
Dissociative disorders are considered an extreme outcome of this process.
Dissociative amnesia
The person with dissociative amnesia is unable to recall important personal information, usually information about some traumatic experience.
The holes in memory are too extensive to be explained by ordinary forgetfulness.
The information is not permanently lost, but it cannot be retrieved during the episode of amnesia, which may last for as short a period as several hours, or as long as several years.
The amnesia usually disappears as suddenly as it began, with complete recovery and only a small change of recurrence.
Most of the memory loss involves information about some part of a traumatic experience.
More rarely the amnesia is for entire events during a circumscribed period of distress.
During the period of amnesia, the person’s behavior is otherwise unremarkable, except that the memory loss may cause some disorientation.
In a more severe sub-type of amnesia, fugue, the memory loss is more extensive.
The person not only becomes totally amnesic but suddenly leaves home and work.
Recovery is usually complete, although it takes various amounts of time.
After recovery, people are fully able to remember the details of their life and experiences, except for those events that took place during the fugue.
Typically, dissociative disorders involve deficits in explicit memory, but not implicit memory.
In diagnosing dissociative amnesia, it is important to rule out other common causes of memory loss, such as dementia or substance loss.
Amnesia can occur after a person has experienced some severe stress.
But not all amnesias seem to immediately follow trauma.
DSM-5 criteria for dissociative amnesia
Depersonalization/derealization disorder
The person’s perception of the self or surroundings is disconcertingly and disruptively altered.
The altered perceptions are usually triggered by stress. It involves not disturbance of memory.
People suddenly lose their sense of self. This involves unusual sensory experiences.
Derealization: the sensation that the world has become unreal.
Depersonalization/derealization disorder usually begins in adolescence.
It can start either abruptly or more insidiously.
Once it begins, it has a chronic course, it lasts a long time.
Comorbid personality disorders are frequent.
Childhood trauma is often reported.
Disorders that commonly involve these symptoms:
Depersonalization also can be triggered by hyperventilzation.
DSM-5 criteria for depersonalization/derealization disorder
Dissociative identity disorder
DSM-5 criteria for dissociative identity disorder
Clinical description of DID
Dissociative identity disorder (DID) requires that a person have at least two separate personalities, or alters, different models or being, thinking, feeling, and acting that exist independently of one another and that emerge at different times.
Each determines the person’s nature and activities when it is in command.
The primary alter may be totally unaware that the other alters exist and may have no memory of what those other alters do and experience when they are in control.
Sometimes, there is one primary personality, and this is typically the alter that seeks treatment.
Usually, there are two to four alters at the time a diagnoses is made, but over the course of treatment, others may emerge.
The diagnoses requires that the existence of different alters be chronic.
Each alter may be quite complex, with its own behavior patterns, memories, and relationships. Usually the personalities of the different alters are quite different form one another, even polar opposites.
The alters are all aware of lost periods of time, and the voices of the others may sometimes echo an alter’s consciousness, even though the alter does not know to whom these voices belong.
DID usually beings in childhood, but it is rarely diagnosed until adulthood.
It is more severe and extensive than the other dissociative disorders, and recovery may be less complete.
More common in women.
Other diagnoses are often present, including posttraumatic stress disorder, major depressive disorder, and somatic symptom disorder.
DID is commonly accompanied by other symptoms such as headaches, hallucinations, suicide attempts, and self-injurious behavior, as well as by other dissociative symptoms such as amnesia and depersonalization.
Etiology of DID
Almost all patients with DID report severe childhood abuse.
Two major theories of DID:
Both theories suggest that sever physical or sexual abuse during childhood sets the stage for DID.
The posttraumatic model 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.
The sociocognitive model considers DID to be the result of learning to enact social roles.
According to this model, alters appear in response to suggestions by therapists, exposure to media reports of DID, or other cultural influences.
Evidence in the debate:
Treatment of DID
There seems to be widespread agreement on several principles in the treatment of dissociative identity disorder, whatever the clinician’s orientation.
The goal of treatment should be to convince the person that splitting into different personalities is no longer necessary to deal with traumas.
DID is conceptualized as a means of escaping from severe stress, treatment can help teach the person more effective ways to cope with stress.
There are also important discrepancies across approaches.
Psychodynamic treatment is probably used more for DID and the other dissociative disorders than for any other psychological disorder.
DID is often comorbid with anxiety and depression, which can sometimes be lessened with antidepressant medication. These medications have no effect on the DID itself.
Somatic symptom and related disorders are defined by excessive concerns about physical symptoms or health.
Includes somatic symptoms regardless of whether they can be explained medically.
Three major somatic symptom-related disorders:
People with somatic symptom and related disorders tend to seek frequent medical treatment, sometimes at great expense.
Often dissatisfied with their medical care. For many, no medical explanation or cure can be identified.
Somatic symptom and related disorders have been criticized for several reasons:
Clinical description of somatic symptom disorder
Three core criteria for somatic symptom disorder
The somatic symptoms may begin or intensify after some conflict or stress.
DSM-5 criteria for somatic symptom disorder
Clinical description of illness anxiety disorder
The main feature of illness anxiety disorder is a preoccupation with fears of having a serious disease despite having no significant somatic symptoms.
These fears must lead to excessive care seeking or maladaptive avoidance behaviors that persists for at least 6 months.
Illness anxiety disorder often co-occurs with anxiety and mood disorders.
DSM-5 criteria for illness anxiety disorder
Clinical description of conversion disorder
In conversation disorder, the person suddenly develops neurological symptoms.
The symptoms suggest an illness related to neurological damage, but medical tests indicate that the bodily organs and nervous system are fine.
Aphonia: loss of the voice other than whispered speech.
Amosia: loss of the sense of smell.
Some people with conversion disorder seem complacent or even serene, are not particularly eager to part with their symptoms, and do not connect their symptoms with their stressful situations.
Symptoms of conversion disorder usually develop in adolescence or early adulthood, typically after a major life stressor.
An episode may end abruptly, but sooner or later the disorder is likely to return, either in its original form or with a different symptom.
The prevalence is less than 1 percent.
More women than men.
Patients with conversion disorder are highly likely to meet criteria for another somatic symptom disorder.
DSM-5 criteria for conversion disorder
DSM-5 criteria for factitious disorder
Etiology of somatic symptom-related disorders
Somatic symptom disorder and conversion disorder are not heritable.
Neurobiological factors that increase awareness of and distress over somatic symptoms
Pain and uncomfortable physical sensations increase activity in regions of the brain called the anterior insula and the anterior cingulate.
These regions have strong connections with the somatosensory cortex.
Heightened activity in these regions is related to greater propensity for somatic symptoms and more intense ratings of the unpleasantness of a standardized painful stimulus.
Some people may have hyperactive brain regions that are involved in evaluating the unpleasantness of body sensations, which would help explain why they are more vulnerable to experiencing and noticing somatic symptoms and pain.
Pain and somatic symptoms can be increased by anxiety, depression, and stress hormones.
Anxiety and depression are also directly related to activity in the anterior cingulate.
Experiences of emotional pain can also activate the anterior cingulate and the anterior insula.
Cognitive behavioral factors that increase awareness of and distress over somatic symptoms
Cognitive behavioral models focus on the mechanisms that could contribute to the excessive focus on and anxiety over health concerns. .
Once a somatic symptom develops, two cognitive variables appear important:
People prone to worries about their health also demonstrate an attributional style that involves interpreting physical symptoms in the worst possible way.
The exact form of the cognitive bias may vary, but once these negative thoughts begin, the resultant elevations of anxiety and cortisol may exacerbate somatic symptoms and distress over those symptoms.
The tendency to be overly concerned about one’s health may have evolved from early experiences of medical symptoms or from family attitudes to physical illness.
Fear that bodily sensation signifies illness is likely to have two behavioral consequences:
Etiology of conversion disorder
Psychodynamic perspective on conversion disorder
On a conscious level, a patient is telling the truth
On a on unconscious level, some psychological factor is at work, making the patient (for example) unable to more her arm despite the absence of any physical cause.
Perceptions formed outside of consciousness can influence behavior.
One way to understand conversion disorder is that there is a disruption in consciousness, such that the person fails to have an explicit awareness of sensory and motor information.
The second stage focuses on motivation. Some people are motivated to appear ill.
Social and cultural factors in conversion disorder
More common in countries that may place less emphasis on psychologizing distress.
Treatment of somatic symptom and related disorders
One of the major obstacles to treatment is that most people with somatic symptom-related disorders do not want to consult mental health professionals.
It is better to work with patients on ways to improve their lives than on debating them about the source of their symptoms.
Cognitive behavioral treatment
Cognitive behavioral therapists have applied many different techniques to help people with somatic symptom-related disorders
Treating anxiety and depression often reduces somatic symptoms.
Antidepressant treatment for somatic symptom disorder with pain
Antidepressants are likely to be helpful when pain is a dominant symptom of somatic symptom disorder.
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This is a summary of Abnormal Psychology by Kring, Davison, Neale & Johnson. This summary focuses on clincal psychology and mental health. Discussed are etliolgies of disorders and treatments.
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PSYCHOLOGY JUDITH BAUGH contributed on 02-04-2020 06:53
STUDY OF BEHAVIOR
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