Abnormal Psychology Chapter 8 Feb 5-10, 2009 Classes #8-9
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Transcript of Abnormal Psychology Chapter 8 Feb 5-10, 2009 Classes #8-9
Somatoform DisordersMass Psychogenic IllnessMalingering & Factitious DisordersDissociative DisordersDissociative Disorders
Abnormal PsychologyChapter 8
Feb 5-10, 2009Classes #8-9
Somatoform Disorders Physical symptoms with an absence of
physical reasons for the symptoms No physical damage results from the
disorder These individuals believe that
their illnesses are real
Psychosomatic Disorders
Tension headaches, cardiovascular problems, etc. which cause physical damage
State of mind appears to be causing the illness
Somatoform Disorders
Somatization Disorder (Briquet’s)
Pain Disorder Hypochondriasis Body Dysmorphic Disorder Conversion Disorder
Somatization Disorder
Diagnostic Criteria To be diagnosed a person must have
reported at least the following: Gastrointestinal symptoms (2) Sexual symptoms (1) Neurological symptoms (1) Pain (4 locations) These symptoms cannot be explained
by a physical disorder
Somatization Disorder Sex difference
F > M Primarily a female disorder with about 1% suffering
from this disorder Onset
Usually by age 30 but its seen from childhood on up Familial tendencies
5 to 10 times more common in female first-degree relatives
Genetic links to antisocial personality and alcoholism
A typical scenario… Typically, patients are dramatic and
emotional when recounting their symptoms
They are often described as exhibitionistic and seductive and self-centered
In an attempt to manipulate others, they may threaten or attempt suicide
These patients “doctor-shop”…
Often dissatisfied with their medical care, they go from one physician to another… What would be a recommended route for
these patients to choose insofar a medical/mental health care is concerned???
They usually don’t go and further than their General Practitioner…
Bottom line: Psychologists and psychiatrists rarely
manage the majority of patients with somatoform disorders -- this difficult undertaking falls predominantly on general practitioners
Somatization Disorder Explanations
Psychodynamic Explanation Behavioral (Learning) Explanation Physiological (Biological)
Explanation Cognitive Explanation
Psychodynamic Explanation
They have an unconscious conflict, wish, or need which is converted to a somatic symptom Pent-up emotional energy is converted to a physical
symptom They may have identification with an important
figure who suffered from the symptom They may have the need for punishment because of
an unacceptable impulse directed against a loved one
There may be an unconscious somatized plea for attention and care from these individuals
Learning Explanation A child with an injury quickly learns the
benefits of playing the sick role Reinforced by increased parental
attention and avoidance of unpleasant responsibilities
Physiological Explanation
Genes
Cognitive Explanation They do not accept doctors advice Therefore treatment is difficult
Treatments Really haven’t been successful because patient
usually won’t consider their problem as psychological
In rare cases when individual is receptive to treatment, both psychoanalysis and cognitive treatments have brought improvement
Drug treatments (anti-depressants and anti-anxiety meds) are often used to treat some of the residual symptoms but are not effective in helping with the somatization problems
Complications There are several major complications
to this disorder…
Etiology Unknown
We know it tends to run in families but the cause is unknown at this time
More research is needed for this one
Prognosis Poor
Its usually a lifelong disorder Complete relief of symptoms for any
extended period is rare
Pain Disorder
The patient complains of pain without an identifiable physical cause to explain the symptoms the person is complaining about
Basically, the same as somatization disorder except that pain is the only symptom
Body Dysmorphic Disorder
Preoccupation with an imagined or minor defect in one's physical appearance
It is distinguished from normal concerns about appearance because it is time-consuming, causes significant distress, and impairs functioning
Depression, phobias, and OCD may accompany this disorder
Sex difference: Females > Males Females: breasts, legs Males: genitals, height, and body hair
Symptoms Major concerns involving especially the face
or head but may involve any body part and often shifts from one to another Examples: hair thinning, acne, wrinkles, scars,
eyes, mouth, breasts, buttocks, etc.
“Elise” from First Wives Club
Treatments Cognitive-Behavioral
Exposure is used to treat phobia-like symptoms
Therapy will focus on improving the distorted body image that these people possess
Treatments Physiological
Preliminary evidence that selective serotonin reuptake inhibitors may be helpful but data on drug treatment is limited
Treatments Family behavioral treatments can be
useful Support groups if available can also
help
Prognosis Poor
Since these individuals are reluctant to reveal their symptoms, it usually goes unnoticed for years
Very difficult to treat as they usually insist on a physical cause
More research is needed to determine any effective treatment for this disorder
Hypochondrasis Unrealistic belief that a minor symptom
reflects a serious disease Excessive anxiety about one or two symptoms Examination and reassurance by a physician
does not relieve the concerns of the patient
They believe the doctor has missed the real reason
Hypochondrasis Symptoms adversely affect social and
occupational functioning Diagnosis is suggested by the history
and examination and confirmed if symptoms persist for at least 6 months and cannot be attributed to another psychiatric disorder (such as depression)
Hypochondrasis Gender difference
More common in women than men (I couldn’t find any stats though)
Onset Usually in 30’s But seen in all age groups
Treatments Much research suggests a cognitive-
behavioral combo is best with therapist extremely gentle in his/her questioning the patient’s incorrect beliefs
Prognosis Its not good (perhaps 5% recover) for the
following reasons:
Major Differences between Somatization Disorder and Hypochondrasis
Focus of Complaint Style of Complaint Interaction with Clinician Age Physical Appearance Personality Style
Conversion Disorder Sensory/motor dysfunction in the absence of a
physical basis… Symptoms develop unconsciously and are
limited to those that suggest a neurological disorder Examples: numbness of limbs, paralysis, speech
problems, blindness and hearing loss, difficulty swallowing, sensation of a lump in your throat, difficulty speaking, difficulty walking, etc.
Symptoms are not feigned (as in factitious disorder or malingering)
Individual is often highly dramatic
Conversion Disorder History
Was first studied by the Nancy School of Hypnosis (Nancy, France) and Freud in examinations of hysteria (1880’s)
Onset Tends to be adolescence to adulthood but may occur at
any age Sex Difference
Appears to be "somewhat" more common in women No stats
Prevalence 1% - 3% of general population Tends to occur in less educated, lower socioeconomic
groups
Conversion Disorder: Important Characteristics
Glove anesthesia
Conversion Disorder: Important Characteristics
Doctor Shop They visit many physicians hoping to find
one who will propose a physical treatment for their non-physical problems
La Belle Indifference The tendency of these people to be
relatively unconcerned about their physical problem
Explanations Pure speculation at this point
Treatment Hypnotherapy
The patient is hypnotized and potentially etiologic psychological issues are identified and examined
Narcoanalysis Similar to hypnotherapy except the patient is also
given a sedative to induce a state of semi-sleep Relaxation training
Often combined with cognitive therapy
Prognosis
No treatment is considered very effective
Mass Psychogenic Illness
Also referred to as Mass Hysteria Epidemic of a particular manifestation of a
somatoform disorder
Mass Psychogenic Illness
Sex difference: F > M Age Difference: Adolescents and
children seem to be particularly at risk
Mass Psychogenic Illness
Physicians might consider a group sickness as being caused by mass psychogenic illness if: Physical exams and tests are normal Doctors can't find anything wrong with
the group's classroom or office (for example, some kind of poison in the air)
Many people get sick
Mass Psychogenic Illness
Symptoms Include the following: headache, dizziness, nausea,
cramps, coughing, fatigue, drowsiness, sore or burning throat, diarrhea, rash, itching, trouble with vision, anxiety, loss of consciousness, etc.
Treatment Removing patients from the place where the illness
started Separate patients Understand that the illness is real Reassure patients that they will be okay
Complications Do you see any complications here???
Are somatoform disorders real or faked?
Malingering Factitious Disorders
Munchausen Syndrome Munchausen Syndrome by Proxy
Malingering Faking physical illnesses to avoid
responsibility or for economic gain Seek medical care or hospitalization
under false pretenses Once they get what they want they
usually stop all complaining about their alleged problems
Factitious Disorders Here, a person is faking symptoms to
receive the attention and/or sympathy that comes with being sick… Munchausen Syndrome Munchausen Syndrome by Proxy
Munchausen Syndrome (Factitious Disorder By Proxy)
Condition characterized by the feigning of the symptoms of the disease in order to undergo diagnostic tests, hospitalization, or medical or surgical treatment
These people (almost always women) fake serious symptoms in someone close to them (usually a child) to gain attention and sympathy ( a form of child abuse)
Munchausen Syndrome by Proxy
Signs and tests
Munchausen Syndrome by Proxy
Treatment Offer parent help rather than accuse them Psychiatric counseling will likely be
recommended Family therapy is often helpful if the husband
is willing Prognosis
This is often a difficult disorder to treat and often requires years of psychiatric support
Dissociative DisordersDissociative Disorders Dissociative Amnesia Dissociative FugueDissociative Fugue Depersonalization DisorderDepersonalization Disorder Dissociative Identity DisorderDissociative Identity Disorder
Dissociative Amnesia Formerly termed Psychogenic Amnesia.
Name of illness also changed in DSM IV The sudden inability to remember
important personal information or events Usually begins as a response to
intolerable psychological stress Very rare (less than 1%)
Types of Dissociative Amnesia
Localized amnesia The person fails to recall events that occurred during a
particular period of time Selective amnesia
The person can recall some but not all of the events during a certain time frame
Generalized amnesia This lasts throughout a person’s entire life – very rare
Continuous amnesia The inability to recall events subsequent to a specific
time including the present Systemized amnesia
The loss of memory for certain categories of information
Dissociative Amnesia
Treatment Therapy can be useful to help with coping
but is not always needed Often, they become disoriented and may
forget who they are but usually the amnesia vanishes as abruptly as it began
Dissociative Fugue Formerly termed Psychogenic Fugue Name of illness also changed in DSM IV An episode during which an individual
leaves his usual surroundings unexpectedly and forgets essential details about himself and his lives
It is very rare, with a prevalence rate of about 0.2% in the general population
Symptoms Sudden and unplanned travel away from
home together with an inability to recall past events about one's life
Cause Is usually triggered by traumatic and
stressful events, such as wartime battle, abuse, rape, accidents, natural disasters, and extreme violence, although fugue states may not occur immediately
Treatment
Psychoanalysis Cognitive therapy ("creative therapies") Hypnotherapy Medications Family therapy
Depersonalization Disorder
These individuals report feeling detached from their mental processes or body
Occurs in as many as 30% of normal individuals at some time
Only constitutes a disorder if it interferes with a person’s functioning
Cause As with other disorders in this
category, an acute stressor is often the precursor to onset
Symptoms This disorder is characterized by
feelings of unreality, that your body does not belong to you, or that you are constantly in a dreamlike state
Symptoms are most common between 25-44
Treatment The disorder will typically dissipate on
its own after a period of time Therapy can be helpful to strengthen
coping skills
Prognosis Prognosis is very good
Dissociative Identity Disorder
Commonly referred to as Multiple Personality Disorder Very rare: Less than 1%. A person alternates between two or more
distinct personality systems Usually there is a main or basic
personality Sex difference: F > M (9 to 1 ratio)
Symptoms The individual may change from one
personality to another in a matter of a few minutes to several years (shorter time frames are more common)
The personalities are often dramatically different
Complications Sleep disorders
Night terrors and/or sleep walking Alcohol and drug abuse OCD-like rituals Eating disorders Depression High suicide rate
Probably the #1 “Hollywood Disorder”
Important Note Until 1970's extremely rare with few
reported cases (about 100) but since then its prevalence has increased dramatically.
Why this dramatic increase???
Dissociative Identity Disorder
Treatment Psychoanalysis -- try to give therapy
to the main personality who "knows" the others
Prognosis Not good