psy310 nevid ch07 lecture ppt

7/28/2019 Psy310 Nevid Ch07 Lecture Ppt

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Chapter 7

Dissociative andSomatoform Disorders

Sheila K. Grant, Ph.D.

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Dissociative Disorders

Dissociative disorder - A disorder characterized bydisruption, or dissociation, of identity, memory, orconsciousness.

The major dissociative disorders include dissociativeidentity disorder, dissociative amnesia,dissociative fugue, and depersonalizationdisorder.

In each case, there is a disruption or dissociation(splitting off ) of the functions of identity, memory, orconsciousness that normally make us whole.

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Overview of Dissociative Disorders


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Dr. Holiday Milby

Dissociative Identity Disorder

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Dissociative Disorders

Dissociative identity disorder - A dissociativedisorder in which a person has two or more distinct, oralter, personalities.

In dissociative identity disorder, two or morepersonalitieseach with well-defined traits andmemoriesoccupy one person.

In the film, The Three Faces of Eve , Eve White is atimid housewife who harbors two other personalities: EveBlack, a sexually provocative, antisocial personality, andJane, a balanced, developing personality who could

balance her sexual needs with the demands of socialacceptability.

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Features

In some cases, the host (main) personality is unaware ofthe existence of the other identities, whereas the otheridentities are aware of the existence of the host.

In other cases, the different personalities are completelyunaware of one another.

Sometimes two personalities vie for control of theperson.


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Controversies

Although multiple personality is generally considered

rare, the very existence of the disorder continues toarouse debate.

Many professionals express profound doubts about thediagnosis.

Only a handful of cases worldwide were reported from1920 to 1970, but since then the number of reportedcases has skyrocketed into the thousands.

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Dissociative Amnesia

Amnesia derives from the Greek roots a-, meaning not,and mnasthai, meaning to remember.

Dissociative amnesia - A dissociative disorder inwhich a person experiences memory loss without anyidentifiable organic cause.

Unlike some progressive forms of memory impairment,the memory loss in dissociative amnesia is reversible,although it may last for days, weeks, or even years.


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Jane Doe.

This woman, called Jane

Doe by rescue workers, wasfound wandering in aFlorida park in a dazedstate. She reported she hadno memory of her

background or even who shewas. Her parents recognizedher after she appeared on anational TV program. Shereportedly never regainedher memory.

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Dissociative Amnesia

Dissociative amnesia is divided into five distinct types ofmemory problems:

1.Localized amnesia.2.Selective amnesia.3.Generalized amnesia.4.Continuous amnesia.5.Systematized amnesia.

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Dissociative Fugue

Fugue derives from the Latin fugere, meaning flight.The word fugitive has the same origin.

Fugue is like amnesia on the run.

Dissociative fugue - A dissociative disorder in which

one suddenly flees from ones life situation, travels to anew location, assumes a new identity, and has amnesiafor personal material.


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Elizabeth Loftus.

Research by Loftus and others has demonstrated that false memoriesof events that never actually occurred can be induced experimentally.This research calls into question the credibility of reports ofrecovered memories.

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Depersonalization Disorder

Depersonalization - Feelings of unreality ordetachment from ones self or ones body.

Derealization - A sense of unreality about the outsideworld.

Depersonalization disorder - A disordercharacterized by persistent or recurrent episodes ofdepersonalization.

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Depersonalization Disorder

Depersonalization - Feelings of unreality ordetachment from ones self or ones body.

Derealization - A sense of unreality about the outsideworld.

Depersonalization disorder - A disordercharacterized by persistent or recurrent episodes ofdepersonalization.


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Culture-Bound DissociativeSyndromes

Similarities exist between the Western concept ofdissociative disorder and certain culture-boundsyndromes found in other parts of the world.

For example, amok is a culture-bound syndromeoccurring primarily in southeast Asian and Pacific Islandcultures that describes a trancelike state in which aperson suddenly becomes highly excited and violentlyattacks other people or destroys objects.

People who run amuck may later claim to have nomemory of the episode or recall feeling as if they wereacting like a robot.

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Psychodynamic Views

To psychodynamic theorists, dissociative disordersinvolve the massive use of repression, resulting in thesplitting off from consciousness of unacceptableimpulses and painful memories.

Dissociative amnesia may serve an adaptive function ofdisconnecting or dissociating ones conscious self fromawareness of traumatic experiences or other sources ofpsychological pain or conflict.

In dissociative amnesia and fugue, the ego protects itselffrom anxiety by blotting out disturbing memories or bydissociating threatening impulses of a sexual oraggressive nature.


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Social-Cognitive Theory

From the standpoint ofsocial-cognitive theory, we

can conceptualize dissociation in the form of dissociativeamnesia or dissociative fugue as a learned responseinvolving the behavior of psychologically distancingoneself from disturbing memories or emotions.

Some social-cognitive theorists, such as the lateNicholas Spanos, believe that dissociative identitydisorder is a form of role-playing acquired throughobservational learning and reinforcement.

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Brain Dysfunction

Might dissociative behavior be connected withunderlying brain dysfunction?

Research along these lines is still in i ts infancy, butpreliminary evidence shows structural differences in

brain areas involved in memory and emotion betweenpatients with dissociative identity disorder (DID) andhealthy controls (Vermetten et al., 2006).

Another study showed differences in brain metabolicactivity between people with depersonalization disorderand healthy subjects (Simeon et al.,2000).

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DiathesisStress Model

Despite widespread evidence of severe physical or sexualabuse in childhood in the great majority of cases ofdissociative identity disorder, very few severely abusedchildren develop multiple personalities.

Consistent with the diathesisstress model, certain

personality traits, such as proneness to fantasize, highability to be hypnotized, and openness to altered statesof consciousness, may predispose individuals to developdissociative experiences in the face of extreme stress,such as traumatic abuse in childhood.


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Treatment ofDissociative Disorders

Dissociative amnesia and fugue are usually fleeting

experiences that end abruptly.

Episodes of depersonalization can be recurrent andpersistent, and they are most likely to occur when peopleare undergoing periods of mild anxiety or depression.

Psychoanalysts seek to help people with dissociativeidentity disorder uncover and learn to cope with earlychildhood traumas.

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Diathesisstress model ofdissociative identity disorder.

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Somatoform Disorders

The word somatoform derives from the Greeksoma,meaning body.

Somatoform disorders - A disorder characterized bycomplaints of physical problems or symptoms thatcannot be explained by physical causes.

The concept of somatoform disorder presumes that thephysical symptoms reflect psychological factors orconflicts.


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Conversion Disorder

Conversion disorder - A somatoform disorder

characterized by loss or impairment of physical functionin the absence of any apparent organic cause.

The person is not malingering. The physical symptomsusually come on suddenly in stressful situations.

A soldiers hand may become paralyzed during intensecombat, for example.

The fact that conversion symptoms first appear in thecontext of, or are aggravated by, conflicts or stressorssuggest a psychological connection (APA, 2000).

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Hypochondriasis

Hypochondriasis - A somatoform disordercharacterized by misinterpretation of physical symptomsas signs of underlying serious disease.

The fear persists despite medical reassurances that i t isgroundless.

Hypochondriasis is believed to affect about 1% to 5% ofthe general population and about 5% of patients seekingmedical care (APA, 2000; Barksy & Ahern, 2004).

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Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) - A somatoform

disorder characterized by preoccupation with animagined or exaggerated physical defect of appearance.

They may spend hours examining themselves in themirror and go to extreme measures to correct theperceived defect, even undergoing invasive or unpleasantmedical procedures, including unnecessary plasticsurgery (Crerand et al., 2005).

Others remove all mirrors from their homes so as not tobe eminded of the glaring flaw in their appearance.

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Pain Disorder

Pain disorder - A somatoform disorder in whichpsychological factors are presumed to play a significantrole in the development, severity, or course of chronicpain.

The psychological factors may contribute to the

development, severity, or maintenance of the pain.

The pain is severe enough and persistent enough tointerfere with the persons daily functioning.


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Somatization Disorder

Somatization disorder - A somatoform disorder

characterized by repeated multiple complaints thatcannot be explained by physical causes.

These complaints persist for at least several years, andresult either in the seeking of medical attention or insignificant impairment in fulfilling social or occupationalroles.

Reported rates of somatization disorder vary from 0.2%to 2% in women to less than 0.2% in men (APA, 2000).

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Koro syndrome

Koro syndrome - A culture-bound somatoformdisorder, found primarily in China, in which people fearthat their genitals are shrinking.

Koro is considered a culture-bound syndrome, althoughsome cases have been reported outside China and theFar East.

Koro syndrome has been traced within Chinese cultureas far back as 3000 B.C.E.

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Dhat syndrome

Dhat syndrome - A culture-bound somatoformdisorder, found primarily among Asian Indian males,characterized by excessive fears over the loss of seminalfluid.

Some men with this syndrome also believe (incorrectly)

that semen mixes with urine and is excreted throughurination.

Men with dhatsyndrome may roam from physician tophysician seeking help to prevent nocturnal emissions orthe (imagined) loss of semen mixed with excreted urine.


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Theoretical Perspectives

Conversion disorder, or hysteria, was known to the

great physician of ancient Greece, Hippocrates, whoattributed the strange bodily symptoms to a wanderinguterus (hystera in Greek) creating internal chaos.

Hippocrates noticed that these complaints were lesscommon among married than unmarried women.

He prescribed marriage as a cure on the basis of theseobservations and also on the theoretical assumption thatpregnancy would satisfy uterine needs and fix the organin place.

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The wandering uterus.The ancient GreekphysicianHippocrates

believed that hystericalsymptoms wereexclusively a femaleproblem caused by a

wandering uterus. Mighthe have changed hismind had he the

opportunity to treatmale aviators during

World War II whodeveloped hystericalnight blindness thatprevented them from

carrying out dangerousnighttime missions?

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Psychodynamic Theory

According to psychodynamic theory, hystericalsymptoms are functional:

They allow the person to achieve primary gains andsecondary gains.

The primary gain of the symptoms is to allow theindividual to keep internal conflicts repressed.

Secondary gains from the symptoms are those that allowthe individual to avoid burdensome responsibilities andto gain the supportrather than condemnationofthose around them.


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Learning Theory

Learning theorists focus on the more direct reinforcing

properties of the symptom and its secondary role inhelping the individual avoid or escape anxiety-evokingsituations.

From the learning perspective, the symptoms inconversion and other somatoform disorders may alsocarry the benefits, or reinforcing properties, of the sickrole.

Some learning theorists link hypochondriasis and bodydysmorphic disorder to obsessivecompulsive disorder.

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Cognitive Theory

Cognitive theorists have speculated that some casesof hypochondriasis may represent a type of self-handicapping strategy, a way of blaming poorperformance on failing health (Smith, Snyder, & Perkins,1983).

Cognitive theorists speculate that hypochondriasis andpanic disorder, which often occur together, may share acommon cause: a distorted way of thinking that leads theperson to misinterpret minor changes in bodilysensations as signs of pending catastrophe (Salkovskis &Clark, 1993)

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Treatment ofSomatoform Disorders

The treatment approach that Freud pioneered,psychoanalysis, began with the treatment of hysteria,

which is now termed conversion disorder.

Psychoanalysis seeks to uncover and bring unconsciousconflicts that originated in childhood into conscious

awareness.

Once the conflict is aired and worked through, thesymptom is no longer needed and should disappear.


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Conceptual models of conversiondisorder.

Psychodynamic andlearning theory offer

conceptual models ofconversion disorderthat emphasize therole of conversionsymptoms leading toescape or relief fromanxiety.

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QUESTIONS?

psy310 nevid ch07 lecture ppt

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