Psychology
Somatic and Dissociative Disorders
Somatic disorders involve physical symptoms that cannot be fully explained by a general medical condition, often linked to psychological factors. Dissociative disorders involve disruptions in memory, identity, consciousness, or perception of the environment. Both types of disorders are characterized by a significant impact on an individual's functioning and well-being.
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11 Key excerpts on "Somatic and Dissociative Disorders"
No longer available |Learn more- David Sue, Derald Wing Sue, Stanley Sue, Diane Sue, David Sue, Derald Wing Sue, Diane Sue, Stanley Sue(Authors)
- 2020(Publication Date)
- Cengage Learning EMEA(Publisher)
These disorders, and the distress they cause, often occur because of underlying biological, psychological, cognitive, or social factors. We discuss somatic symptom and dissociative disorders together because research shows they have common etiological roots (Baslet & Hill, 2011). Those with somatic symptom dis-orders often express stress through physical symptoms, while dissociative disorders involve psychological mechanisms for coping with overwhelm-ing stress (Cloninger & Dokucu, 2008). We begin with a discussion of the somatic symptom disorders. Somatic and Dissociative Disorders 197 Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 198 | CHAPTER 7 Somatic and Dissociative Disorders Somatic Symptom and Related Disorders The somatic symptom and related disorders are a disparate group of disorders that include somatic symptom disorder; illness anxiety disorder; conversion disorder (func-tional neurological symptom disorder); and factitious disorder (see Table 7.1). DSM-5 groups these disorders together because they all have prominent somatic symptoms (physical or bodily symptoms) that are associated with significant impairment or dis-tress. According to the DSM-5, actual physical illnesses may or may not be present. However, these diagnoses emphasize the presence of “distressing somatic symptoms plus abnormal thoughts, feelings and behaviors in response to these symptoms” (APA, 2013, p. 309).
- David Sue, Derald Wing Sue, Diane Sue, Stanley Sue(Authors)
- 2016(Publication Date)
- Cengage Learning EMEA(Publisher)
These disorders, and the distress they cause, often occur because of un-derlying biological, psychological, cognitive, or social factors. We discuss somatic symptom and dissociative disorders together because research shows they have common etiological roots (Baslet & Hill, 2011). Those with somatic symptom disor-ders often express stress through physical symptoms, while dissociative disorders involve psychological mechanisms for coping with overwhelming stress (Cloninger & Dokucu, 2008). We begin with a discussion of the somatic symptom disorders. Focus Questions 1. What are the somatic symptom and related disorders and what do they have in common? What causes these conditions and how are they treated? 2. What are dissociations? Why do they occur, and how are they treated? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 148 CHAPTER 6 Somatic Symptom and Dissociative Disorders The somatic symptom and related disorders are a disparate group of disorders that include somatic symptom disorder; illness anxiety disorder; conversion disorder (functional neurological symptom disorder) ; and factitious disorder (see Table 6.1). DSM-5 groups these disorders together because they all have prominent somatic symptoms (physical or bodily symptoms) that are associated with sig-nificant impairment or distress. According to the DSM-5, actual physical ill-nesses may or may not be present (APA, 2013).
eBook - PDF- V. Durand, David Barlow, Stefan Hofmann, , V. Durand, David Barlow, Stefan Hofmann(Authors)
- 2018(Publication Date)
- Cengage Learning EMEA(Publisher)
172 5 Somatic Symptom and Related Disorders and Dissociative Disorders CHAPTER OUTLINE Somatic Symptom and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Psychological Factors Affecting Medical Condition Conversion Disorder (Functional Neurological Symptom Disorder) Dissociative Disorders Depersonalization-Derealization Disorder Dissociative Amnesia Dissociative Identity Disorder Tinxi/Shutterstock.com Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. CHAPTER 5 Somatic Symptom and Related Disorders and Dissociative Disorders • 173 Engage in innovative and integrative thinking and problem solving: c Describe problems operationally to study them empirically [APA SLO 2.3a] (see textbook pages 176–178, 175, 182–185, 186–189, 191–192) Describe applications that employ discipline- based problem solving: c Correctly identify antecedents and consequences of behavior and mental processes [APA SLO 1.3b] (see textbook pages 179–180, 185–186) Describe examples of relevant and practical applications of psychological principles to everyday life [APA SLO 1.3a] (see textbook pages 176, 179–181) * Portions of this chapter cover learning outcomes suggested by the American Psychological Association (2013) in their guidelines for the undergraduate psychology major. Chapter coverage of these outcomes is identified above by APA Goal and APA Suggested Learning Outcome (SLO). D o you know somebody who’s a hypochondriac? Most of us do.
eBook - PDFAbnormal Psychology
The Science and Treatment of Psychological Disorders, DSM-5-TR Update
- Ann M. Kring, Sheri L. Johnson(Authors)
- 2022(Publication Date)
- Wiley(Publisher)
A year after the start of therapy, a synthesis of Gina and Mary began to emerge. At first it seemed that Gina had taken over entirely, but then Dr. Jeans noticed that Gina was not as serious as 212 CHAPTER 8 Dissociative Disorders and Somatic Symptom and Related Disorders In this chapter, we discuss the dissociative disorders and the somatic symptom and related disorders. We cover these disorders together because both types are hypothesized to be trig- gered by stressful experiences yet do not involve direct expressions of anxiety. In the dissocia- tive disorders, the person experiences disruptions of consciousness—he or she loses track of self-awareness, memory, and identity. In the somatic symptom and related disorders, the per- son complains of bodily symptoms that suggest a physical dysfunction, sometimes dramatic in nature. For some of these disorders, no physiological basis can be found; for others, the psycho- logical reaction to the symptoms appears excessive. In addition to both being related to stress, dissociative disorders and somatic symptom and related disorders are often comorbid. Patients with dissociative disorders often meet the criteria for somatic symptom and related disorders, and those with somatic symptom and related disorders are somewhat more likely than those in the general population to meet the diagnostic criteria for dissociative disorders (Akyüz, Gökalp, et al., 2017; Brown, Cardena, et al., 2007; Dell, 2006). Functional neurological symptom disorder, one of the somatic symptom– related disorders, is particularly likely to be comorbid with dissociative disorders. Clinical Descriptions and Epidemiology of the Dissociative Disorders The DSM-5-TR includes three major dissociative disorders: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder (formerly known as multiple personality disorder). Table 8.1 summarizes the key clinical features of the dissociative dis- orders.
eBook - PDFDiscovering Psychology
The Science of Mind
- John Cacioppo, Laura Freberg(Authors)
- 2015(Publication Date)
- Cengage Learning EMEA(Publisher)
Responses to extreme stress frequently include detachment, numbness, or altered memory and cognitions, but this is quite different from the development of additional identities. Well-meaning thera-pists can misinterpret these stress symptoms as dissociative identity disorder and, worse yet, suggest this possibility to their clients. People diagnosed with dissociative identity disorder, like those with other dissociative disorders, score very high on tests of suggestibility that pre-dict a person’s susceptibility to hypnosis and in measures of being likely to fantasize (Gies-brecht, Lynn, Lilienfeld, & Merckelbach, 2010). These findings imply that these people may have difficulty distinguishing between reality and fantasy and might accept a therapist’s sug-gestion without considering it critically. What Are Somatic Symptom and Related Disorders? Historically, somatic symptom disorder involved physical symptoms that do not have an underlying medical cause (APA, 2013). The DSM-5 notes that these patients spend excessive amounts of time thinking about the seriousness of their symptoms, which is accompanied by a high level of anxiety. To the patient, the somatic symptoms appear quite serious and often disabling. Among the different symptoms are vague pain complaints, gastrointestinal upset, sexual problems, amnesia, breathing problems, or unexplained sensory or motor problems. People with somatic symptoms usually visit physicians frequently, report high numbers of physical complaints, and are at risk of becoming dependent on pain medications. They can become preoccupied with their health and often insist on unnecessary medical tests and procedures. What Are Personality Disorders? Several types of personality disorders are recognized in the DSM-5 (APA, 2013). A personal-ity disorder is characterized by impairments in identity, in personality traits, and in establish-ment of empathy or intimacy. Personality disorders cannot be diagnosed in people under the age of 18.
eBook - PDFEssentials of Psychology
Concepts and Applications
- Jeffrey Nevid(Author)
- 2021(Publication Date)
- Cengage Learning EMEA(Publisher)
In these cases, there is a dissociation or “splitting off”—basically a crack or a break—in the processes of identity, memory, or consciousness upon which our cohe- sive sense of self depends (Spiegel, 2018). Normally we know who we are and where we’ve been. We may forget how we spent last weekend, but we don’t suddenly lose the capacity to remember whole 5 Identify and describe types of dissociative and somatic symptom and related disorders and underlying causal factors in these disorders. Dissociative and Somatic Symptom and Related Disorders MODULE 13.3 dissociative disorders A class of psychological disorders involving changes in consciousness, memory, or self-identity. Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. MODULE 13.3 507 chunks of our lives or abruptly shift back and forth between very different personal- ities. Dissociative disorders, however, affect the ability to maintain a cohesive sense of self or unity of consciousness, resulting in unusual, even bizarre behavior. Here we consider two major types of dissociative disorders: dissociative identity disorder and dissociative amnesia. Dissociative Identity Disorder Consider the following case history: [Margaret explained that] she often “heard a voice telling her to say things and do things.” It was, she said, “a terrible voice” that sometimes threatened to “take over completely.” When it was finally suggested to [Margaret] that she let the voice “take over,” she closed her eyes, clenched her fists, and grimaced for a few moments during which she was out of contact with those around her.
eBook - PDFAbnormal Psychology in Context
The Australian and New Zealand Handbook
- Nadine Pelling, Lorelle Burton(Authors)
- 2017(Publication Date)
- Cambridge University Press(Publisher)
The first study in Australia that explored somatoform dissociation (dissociative symptoms that manifest in the body) in adolescents noted a high percentage of somatoform dissociation and that participants with more than one mental health condition had higher levels of somatoform dissociation (Pullin et al., 2014 ). The few studies conducted in Australia show that somatic disorders reflect significant psychological problems and lead to distress for patients, as well as diagnostic and treatment concerns for practitioners. New Zealand There is little epidemiological literature on somatoform disorders in NZ. A somewhat related epidemiological study explored the effects of various adverse life events like childhood and adult physical abuse in the possible causation of medical conditions in a large community sample. Various medical conditions emerged as significantly increased including migraine, heart disease, and diabetes (Romans et al., 2002 ). A case example noted a shipping accident resulting from the ship’s pilot experiencing a conversion disorder in the form of sudden vision loss. It is difficult to anticipate such an occurrence, even from regular medical screening (Griffiths & Ellis, 2007 ). 166 Section III Disorders and psychological practice related items Management The key feature in managing somatic symptom and related disorders is arriving at a diagnosis by taking a thorough history, including any stressors or conflicts. A thorough review of various tests, investigations, and liaison with the treating physicians is imperative to have a thorough view of the ongoing difficulties. Assessing the psychosocial world of the individual encourages exploring possible perpetuating and precipitating factors, which could be useful in future management. A comorbid psychiatric condition should be also considered and treated assertively. An open stance towards the condition should be present with a non-judgemental view on the illness and the possible causative factors.
eBook - PDFAbnormal Psychology
The Science and Treatment of Psychological Disorders
- Ann M. Kring, Sheri L. Johnson(Authors)
- 2021(Publication Date)
- Wiley(Publisher)
• Psychodynamic treatment is perhaps the most commonly used treatment for dissociative disorders, but some of the techniques involved, such as hypnosis and age regression, may make symp- toms worse. Somatic Symptom and Related Disorders • Somatic symptom and related disorders share a common focus on physical symptoms. As shown in Table 8.2, the major somatic symptom and related disorders include somatic symptom disor- der, illness anxiety disorder, and conversion disorder. • Health anxiety is moderately heritable. • Neurobiological models suggest that key brain regions involved in processing the unpleasantness of bodily sensations may be hyperactive among people with somatic symptom and related disorders. These regions include the anterior cingulate cortex and the rostral anterior insula. Cognitive variables are also important: Some people are overly attentive to physical concerns and make overly negative interpretations of symptoms and their implica- tions. Avoidance may lead to health declines, and behavioral rein- forcement may maintain help-seeking behavior. Safety behaviors may prolong and intensify health anxiety. • Brain-imaging findings are consistent with the psychodynamic idea that people with conversion disorder may not be conscious of their perceptions (in the case of blindness) or their control of movements (in the case of movement symptoms). Sociocultural influences also appear important in conversion disorder. • People with somatic symptom and related disorders often resent being referred for mental health care. Programs in which primary care physicians are encouraged to address these symptoms by providing warmth and reassurance while limiting medical tests have been shown to be helpful.
eBook - PDFAbnormal Psychology
An Integrative Approach
- David Barlow, V. Durand, Stefan Hofmann, , David Barlow, V. Durand, Stefan Hofmann(Authors)
- 2017(Publication Date)
- Cengage Learning EMEA(Publisher)
Mario Tama/Getty Images Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-208 198 CHAPTER 6 SOMATIC SYMPTOM AND RELATED DISORDERS AND DISSOCIATIVE DISORDERS her time in a room in the back of the house while her mother attended to business out front. Following similar cognitive-behavioral programs, 65% of a group of 45 patients with mostly motor behavior conversions (for example, difficulty walking) responded well to treatment. Inter-estingly, hypnosis, which was administered to approximately half the patients, added little or no benefit to the CBT (Moene et al., 2002, 2003). Dissociative Disorders At the beginning of the chapter, we said that when individu-als feel detached from themselves or their surroundings, almost as if they are dreaming or living in slow motion, they are hav-ing dissociative experiences. Morton Prince, the founder of the Journal of Abnormal Psychology, noted more than 100 years ago that many people experience something like dissociation occa-sionally (Prince, 1906–1907). It might be likely to happen after an extremely stressful event, such as an accident (Spiegel, 2010). It also is more likely to happen when you’re tired or sleep deprived from staying up all night cramming for an exam (Giesbrecht, Smeets, Leppink, Jelicic, & Merckelbach, 2007). If you have had an experi-ence of dissociation, it may not have bothered you much, perhaps because you knew the cause (Barlow, 2002). On the other hand, it may have been extremely frightening. Transient experiences of dissociation will occur in about half of the general population at some point in their lives, and studies suggest that if a person expe-riences a traumatic event, between 31% and 66% will have this feeling at that time (Hunter, Sierra, & David, 2004; Keane, Marx, Sloan & DePrince, 2011).
eBook - PDFAbnormal Psychology
The Science and Treatment of Psychological Disorders
- Ann M. Kring, Sheri L. Johnson(Authors)
- 2019(Publication Date)
- Wiley(Publisher)
In contrast to these common dissociative experiences, dissociative disorders are defined by more severe types of dissociation. Depersonalization/derealization involves a form of dissociation involving detachment, in which the person feels removed from the sense of self and surroundings. The person may feel “spaced out,” numb, or as though in a dream (Holmes, Brown, et al., 2005). Dissociative amnesia and dis- sociative identity disorder involve a more dramatic form of dissociation, in which the person cannot access important aspects of memory. In dissociative identity disorder, the gaps in memory are so extensive that the person loses his or her sense of a unified identity. What causes dissociation? Both psychodynamic and behavioral theorists consider patho- logical dissociation to be an avoidance response that protects the person from consciously experiencing stressful events. Consistent with the idea that this is a coping response, people undergoing very intense stressors, such as advanced military survival training, often report brief moments of mild dissociation (Morgan, Hazlett, et al., 2001). In addition to the idea of dissociation as a coping response, sleep disruptions may contribute to dissociation (Giesbrecht, Smeets, et al., 2013). Recent research jointly considers how trauma and sleep could contribute to dissociation. In one study of preschoolers, abuse led to sleep disturbance, and the sleep disturbance then predicted parental report of child dissociation (Hébert, Langevin, et al., 2016). Researchers know less about dissociative disorders than about other disorders, and considerable controversy surrounds the risk factors for these disorders, as well as the best treatments. To some, this controversy may seem daunting. We find the process of discovery to be fascinating as researchers strive to untangle this complex puzzle.
eBook - PDF- Gordon L. Flett, Nancy L. Kocovski, Gerald C. Davison, John M. Neale(Authors)
- 2018(Publication Date)
- Wiley(Publisher)
DID presumably begins in childhood, but it is rarely diag- nosed until adulthood. The diagnosis is much more common in women than in men. The presence of other diagnoses—in par- ticular, depression, borderline personality disorder, and soma- tization disorder—is frequent (Boon & Draijer, 1993; Oeztuerk & Sar, 2008). DID is often accompanied by headaches, substance abuse, phobias, hallucinations, suicide ideation and attempts, sexual dysfunction, and self-abusive behaviour, as well as by other dissociative symptoms such as amnesia and deperson- alization (Scroppo et al., 1998). A study by Ross et al. (1990) of 102 multiple personality disorder clients, including a sub- set from Winnipeg and Ottawa, used a structured interview to determine that about 90% had a history of suicidal tendencies, depression, recurring headaches, and sexual abuse. A related possibility is that individuals suffering from disso- ciative symptoms have a disorganized or insecure attachment style because they were exposed as young children to the fright- ening and chaotic behaviour of their caregiver (Liotti, 1992; Oeztuerk & Sar, 2008). Indeed, a study of clinically treated ado- lescents from three Canadian cities confirmed that attachment- related trauma was linked significantly with self-reported symptoms of dissociation (West, Adam, Spreng, & Rose, 2001). Cases of DID are often mislabelled as schizophrenia in the media. This diagnostic category derives part of its name from the Greek root schizo, which means “splitting away from,” hence the confusion. A split in the personality, wherein two or more fairly separate and coherent systems of being exist alternately in the same person, is very different from any recognized symptoms of schizophrenia, which involves a splitting away from reality. Controversies in the Diagnosis of DID Although DID is recognized formally as a diagnosis by its inclusion in DSM-IV-TR, its inclusion in the DSM is controversial.
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