Transcript Lecture 5
Dissociative Disorders Persistent, maladaptive disruptions in memory, consciousness, or identity Dissociative Identity Disorder A. presence of two or more distinct identities or personality states B. at least two of these identities recurrently take control C. inability to recall important personal information Possible Causes: Biological Severe vulnerability abuse/trauma history Suggestibility Treatment: identify cues or triggers that provoke memories or dissociation try to help person integrate personalities hypnosis sometimes used antidepressants may be helpful Depersonalization Disorder depersonalization disorder: severe feelings of unreality - dominates the person’s life depersonalization derealization Depersonalization Disorder: Causes Causes Cognitive deficits Attention Short-term memory Spatial reasoning Easily distracted Decreased emotional response Dissociative Amnesia: generalized amnesia: can’t remember anything- even identity localized or selective amnesia: failure to recall specific events (often traumatic) dissociative flight dissociative fugue: memory loss combined with trance disorder: dissociative phenomena that appears as a trance or “possession” Somatic Symptom and Related Disorders Historical Roots hysteria: “wandering uterus” physical symptoms without a known cause term dates back to Hippocrates and Egyptians neurosis: emotional distress due to underlying unconscious conflicts, anxiety, and implementation of defense mechanisms Illness Anxiety Disorder Preoccupation with fears of having a serious disease based on a misinterpretation of bodily symptoms Persists despite appropriate medical evaluation and reassurance Causes distress or impairment in functioning Disturbance lasts at least 6 months Cultural Variations Africa Sensation of something crawling in one’s head India and Pakistan Sensation of burning in hands or feet dhat – concern about losing semen accompanied by feelings of weakness and exhaustion China, East Asia koro – sudden intense anxiety that one’s genitals will recede into one’s body and possibly cause death Somatic Symptom Disorder A disorder in which persons become excessively distressed, concerned, and anxious about the bodily symptoms that they are experiencing. Their lives are greatly and disproportionately disrupted by the symptoms. Somatic Symptom Disorder and Antisocial Personality Disorder Run in the same families Gender differences Common features Conversion Disorder • Presence of one or more symptoms or deficits that affect voluntary or sensory functioning • paralysis • blindness • difficulty speaking • loss of sense of touch Causes of Somatic Symptom and Related Disorders Cognitive behavioral view Psychodynamic view Tends to run in families (genetic and environmental contributions) Often develops in context of stressful life event Reviewed Treatment (Kroenke, 2007) 34 randomized controlled studies of treatment of somotaform disorders (3,922 patients) Concluded that the most effective treatment for somatoform disorders was cognitivebehavioral therapy (CBT). some evidence that antidepressants and a consultation letter to primary care physician can help. Factitious Disorder A disorder in which an individual feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person. Different from Malingering Specifiers of imposed on self vs. imposed on another (formerly factitious disorder by proxy) http://abcnews.go.com/Health/arizona-mother- accused-poisoning-baby-munchausen-syndromeproxy/story?id=13308998