Includes disturbances of higher cognitive functions
Somatoform Disorders
Disorders that take physical form
Dissociative Disorders
Dissociative disorders involve dissociation of personality components
typically integrated
Psychological functions screened out of awareness
Dissociative disorders occur without demonstrable damage to brain
Dissociative Amnesia
Amnesia is partial or total forgetting of past experiences
Can occur by head injury or brain disorder
Dissociative amnesia occurs without any apparent organic
cause
Is anterograde, not retrograde
Is selective and includes memories most people would
want to forget
People much less disturbed over dissociative amnesia
People with dissociative amnesia remain well-oriented
to time and place; continue to learn new information
Forgotten events are simply screened out and not lost
altogether
Patterns of memory loss
Localized amnesia--all events occurring during specific period
of time are blocked
Selective amnesia--only certain events forgotten during specific
period of time
Generalized amnesia--entire life forgotten
Continuous amnesia--forgetting all events that occur after
specific period up to present including events occurring after
onset of amnesia
Systematized amnesia--only certain categories of information
forgotten
Episodic memory is lost
Semantic memory and procedural memory remain intact
Explicit memories may be forgotten
Implicit memories are still intact and continue to
influence behavior
Onset of memory loss is typically gradual and remits gradually
Amnesia and Crime
Amnesia has created difficulties for legal system
Many people accused of crime cannot remember event; some are
faking
Dissociative Fugue
Dissociative fugue involves forgetting past and sudden
travel away from home; traveling amnesia
Show purposeful activity; may create identity
Length and elaborateness of fugues vary considerably
Individual's memory remits suddenly and is amnesic for events
while in fugue state
Dissociative Identity Disorder
Dissociative identity disorder (formerly multiple personality
disorder) characterized by personality breaking up into 2 or more
distinct, well-integrated identities
One of more identities is amnesic
Host is original personality, and alters are later
developing personalities
Host and alters often have complex patterns of consciousness
Types of Personalities
Personalities often are polar opposites and include internal
homicide
Personalities may divide up emotional life and other areas
of functioning
Child personality is common
Childhood Abuse
Most common trauma is sexual abuse and incest
Disorder may be way that children use to distance themselves
from abuse since most cases begin in childhood
Not clear if abused children are more likely to develop DID
than nonabused children
Mechanism underlying DID is not known
Problems in Diagnosis
DID, once rare, reported more frequently and in North America
Some argue that DID is more a fad than legitimate syndrome
Rise in numbers could reflect better recognition of DID and
increased awareness and reporting of childhood sexual abuse
Concern expressed over false cases; criteria is used to distinguish
false cases
Physiology of DID patients changes depending on which personality
is in charge
Depersonalization Disorder
Depersonalization disorder involves disruption of personal
identity without amnesia
Central feature is a sense of strangeness or unreality in oneself
Often accompanied by derealization, feeling of strangeness
about world
May involve déja vu
May involve jamais vu
Depersonalization can occur in course of normal life, as part
of other psychological disorders, and near-death experience
Depersonalization is diagnosed when it interferes with person's
life
Groups at Risk for Dissociative Disorders
Prevalence as high as 3% in general population
DID more common in females, and these tend to be already troubled
Depersonalization is rare and more common in females; it is seen
worldwide and is sometimes regarded as a legitimate trance or a spirit
possession
Dissociative Disorders: Theory and Therapy
The Psychodynamic Perspective: Defense Against Anxiety
Pierre Janet originated idea of mental dissociation
Dissociation as Defense
Freud argued dissociation disorders were neuroses that were
extreme and maladaptive defenses
Research supports anxiety-relief hypothesis
Treating Dissociation
Psychodynamic therapy most common treatment for dissociative
disorders
Treatment involves three stages
In dissociative disorders, material is protected from exposure
Repressed memory may be revealed through hypnosis
Hypnosis may bring on or exacerbate symptoms
Memory-retrieval may be retraumatized, especially when
it takes form of abreaction
Memory is retrieved gradually, which may be long process,
especially in DID
The Behavioral and Sociocultural Perspectives: Dissociation as
a Social Role
Dissociative disorders seen as form of learned coping response
with production of symptoms in order to obtain rewards or relief from
stress
Results of person adopting a social role that is reinforced by
its consequences
Sociocultural perspective views symptoms as product of social
reinforcement
Seen as strategy to evoke sympathy and escape responsibility
for certain actions performed by nonresponsible part of self
Patient, hypnosis, and therapist's attention help to create
disorder and come to believe in its existence
Research reveals that when situation demands it and appropriate
cues are given, personalities can be manufactured
Nonreinforcement
Way to treat dissociative symptoms is to stop reinforcing
them
Treatment involves expressing no interest in alters and expecting
patient to take responsibility for actions committed by alters
The Cognitive Perspective: Memory Dysfunction
Dissociative disorders seen as disorders of memory, namely explicit
memory for dissociated material
Retrieval Failure
State-dependent memory established in extreme emotional state
may be lost
Control elements can activate or inhibit retrieval information
Improving Memory Retrieval
Therapists use cognitive mechanism in treatment
Therapists may improve implicit memory
The Neuroscience Perspective: Brain Dysfunction
Some dissociative disorders may be neurological disorders
May be by-products of undiagnosed epilepsy
Hippocampus may be involved since it is involved in memory
integration, which stress can affect
Abnormality in serotonin functioning may be involved
None of neurological hypotheses rules out psychological causes
Drug Treatment
Not many drug treatments developed
The barbiturate sodium amytal and SSRIs have been used
Somatoform Disorders
Somatoform Disorders
1. Involve psychological conflicts that take on a somatic form
and may involve complaints or actual loss or impairment of normal
physiological function
Body Dysmorphic Disorder
Body dysmorphic disorder consists of extreme distress over
physical appearance
Most complain of facial flaws and thinning hair
Individuals are not delusional but do suffer great unhappiness
Onset is usually gradual and may begin with someone's negative
comment; tends to be chronic
Disorder is associated with social phobia and depression, and
is related to obsessive-compulsive disorder (OCD)
Hypochondriasis
Hypochondriasis is gnawing fear of disease
Fear is maintained by misinterpretation of physical signs and
sensations as abnormal
Symptoms are not faked; people truly feel the pains they report
Fears do not have bizarre quality of delusions
Different from obsessive-compulsion disorder where fears are groundless
Developmental factors may predispose person to hypochondriasis
Somatization Disorder
Somatization disorder characterized by numerous and recurrent
physical complaints
Resembles hypochondriasis, but focus differs
Symptoms described as vague, dramatic, and exaggerated
Complaints are many and varied
Often accompanied by depression and anxiety
Pain Disorder
Pain disorder occurs when person has pain that is more
severe or persistent than can be explained by medical causes
Tends to have psychiatric symptoms
Psychological factors may be result or cause of pain
Indications of pain as being psychologically related
Harder time localizing pain
Pain is described in emotional terms
Less likely to specify changes in pain
See pain as the disorder rather than as symptom of a disorder
Conversion Disorder
In conversion disorder, there is actual disability but no organic
pathology
Symptoms vary considerably; most common are blindness, deafness,
paralysis, and anesthesia
Symptoms are not supported by medical evidence, but also are not
faked
Was formerly known as hysteria
Conversion disorder seen as result of some psychological conflict
Blocks person's awareness of internal conflict; primary
gain
Excuses person from responsibilities and attracts sympathy
and attention; secondary gain
Many patients show la belle indifference (beautiful indifference)
Evidence shows that the person's body is capable of functioning
properly and that the person is not consciously refusing to use body
parts
Conversion, Malingering, or Organic Disorder?
Differential diagnosis is difficult
Malingering must be ruled out
Actual organic disorders must be ruled out
Glove anesthesia contradicts structure of nervous system
Symptoms are very similar to true organic disorders
Criteria for differential diagnosis
Rapid appearance of symptoms
La belle indifference
Selective symptoms
Conversion disorder is rare but diagnosis may be rare, symptoms
may go unnoticed
Groups at Risk for Somatoform Disorders
Prevalence for body dysmorphic disorder is not clear
Unmarried; average age of onset is 16
Equally common in males and females
Somatoform disorder common among females (2.8%) and more common
than among males; cultural differences with regard to complaints
Conversion disorder's prevalence questioned; 5 to 14% in general
medical setting involved symptoms
Twice as common in females
SES status is factor
History of childhood trauma increases vulnerability
Somatoform Disorders: Theory and Therapy
The Psychodynamic Perspective: Defense Against Anxiety
Somatizing as Conflict Resolution
Strong emotions not expressed would lead to somatic symptoms
Hostility and anxiety play role
Disorders seen as defense against anxiety produced by unacceptable
wishes
Conflict-resolution theories have been proposed
Uncovering Conflict
Patient is induced to release repression of material
Somatic symptoms will subside
No evidence that psychodynamic treatment is any more effective
than other therapies
Supportive therapy, brief physical exams may be best approaches
The Behavioral and Sociocultural Perspectives: The Sick Role
Somatoform disorders are inappropriate adoptions of sick role
Learning to Adopt the Sick Role
Rewards of sick role more reinforcing than rewards of illness-free
life
Person must have experience with sick role directly or
indirectly
Adoption of sick role must be reinforced
Respondent conditioning of ANS may play role as anxiety riggers
symptoms causing further anxiety
Sociocultural theories focus on large cultural factors in
adoption of sick role such as culture's attitudes toward unexplained
somatic symptoms
Treatment by Nonreinforcement
Therapist withdrawals reinforcement for illness behavior
Therapist tries to build up patient's coping skills involving
social-skills training
Therapist often tries to provide face-saving mechanism so
that patient can give up illness
Other techniques involve relaxation and contingency management
The Cognitive Perspective: Misinterpreting Bodily Sensations
Overattention to the Body
Cognitive style predisposes person to exaggerate normal bodily
sensations and catastrophize minor symptoms
Corresponding high rates of negative affect have been found
in somatizers
Treatment: Challenging Faulty Beliefs
Cognitive therapy and behavior therapy may be effective for
hypochondriasis and pain disorder
Cognitive therapy focuses on patient testing explanations
and confronting beliefs
The Neuroscience Perspective: Brain Dysfunction
Genetic Studies
Somatoform patients tend to have family histories of somatic
complaints
Genetic family patterns have been reported; twins studies
and adoption studies give preliminary support to genetic factor
Brain Dysfunction and Somatoform Disorders
Possible problem lies in processing of sensory signals in
cerebral cortex; appears suppressed
May be dysfunction in right cerebral hemisphere due to lateralization
Abnormality in serotonin functioning has been proposed
