PY Notecards 6

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  1. Relation between Dissociative, Somatoform and Anxiety disorders
    Used to be classified together in DSM as neuroses.
  2. Dissociative and Somatoform Disorders Similarities
    • Onset is both related to a stressful experience.
    • Least understood and most controversial of disorders.
    • People rarely given these diagnoses.
  3. Dissociative Disorder is sudden disruption in continuity of:
    • Consciousness
    • Memory
    • Identity
  4. Dissociation
    • Some aspect of cognition or experience becomes inaccessible to consciousness.
    • Repression and avoidance.
  5. Amnesia
    • Memory loss, typically of a stressful experience.
    • Not due to physical injury and may last hours or years.
    • Usually returns spontaneously and in spurts.
  6. Prevalence
    The number of people who currently have a condition.
  7. Incidence
    The annual number of people who are diagnosed with a condition.
  8. Problems with prevalence vs. incidence:
    • An incurable disease can have low incidence, but high prevalence.
    • A short-lived curable condition like a cold can have a high incidence, but low prevalence.
  9. Memory recall deficits of trauma:
    • People focus on weapon and not the face of the person giving them trauma.
    • High levels of stress hormones might interfere with memory formation.
    • Emotional content might have vividness, but not accuracy.
    • Deficits are in explicit memory.
  10. Explicit memory
    Involves conscious recall of experiences.
  11. Implicit memory
    Underlies behaviors based on experiences that cannot be consciously recalled. (riding a bike)
  12. Two other causes of memory loss from dissociation:
    • Degenerative brain disorders
    • Substance abuse
  13. Degenerative Brain Disorders
    • Alzheimer's Disease
    • Not linked to stress
    • Involves gradual decline over time
    • Accompanied by other cognitive deficits - can't learn new info
  14. Fugue
    • Memory loss accompanied by leaving home and making new identity.
    • Sudden, unexpected travel with inability to recall one�s past and create a new identity.
    • Memory comes back spontaneously and in spurts.
    • 0.2% prevalence rate.
  15. Depersonalization disorder
    • Alteration in experience of self.
    • Feelings of detachment or disconnection from self.
    • Unusual sensory experiences - limbs enlarged or voice distant.
    • No psychosis or loss of memory.
    • Based on one symptom - criticized for this.
  16. Dissociative Identity Disorder
    • At least two distinct personalities that act independently of each other.
    • Other symptoms: headaches, hallucinations, self harm, suicide attempts.
    • Most severe dissociative disorder and more common in women.
  17. Two Major Theories of Causes of DID
    • Posttraumatic Model - results from severe psychological and/or sexual abuse in childhood.
    • Sociocognitive Model - a form of role-play in suggestible individuals. Response to therapists or media.
  18. Evidence raised in theory debate
    • DID can be role-played.
    • DID patients show only partial implicit memory deficits.
    • DID diagnosis differs by clinician.
    • For many, symptoms emerge after therapy begins.
  19. DID Treatments
    • Empathic and supportive therapist.
    • Integration of alters into one individual.
    • Improvement of coping skills.
    • Psychoanalytic - reexperience traumatic event
    • Poor outcomes.
  20. Somatoform Disorders
    • Psychological problems take a physiological form.
    • Bodily symptoms have no cause and are involuntary.
    • Individuals seek medical treatment.
  21. Pain Disorder
    • Severe, prolonged pain.
    • Can't be accounted for by organic pathology.
    • Caused by conflict and stress.
    • Individual unaware of psychological origins.
  22. Body Dysmorphic Disorder
    • Preoccupation with and extreme distress over imagined or exaggerated defect in appearance.
    • Constant examination of self in mirror or avoids mirrors.
    • Housebound or plastic surgery or suicidal thoughts.
    • Women. Late adolescence. High comorbidity.
  23. Hypochondriasis
    • Fears of having a serious disease.
    • Critical of medical professionals.
    • Early adulthood.
  24. Somatization Disorder or Briquet's Syndrome
    • Multiple, recurrent pain complaints with no apparent physical cause.
    • Seeks treatment from multiple physicians.
    • Exaggerated presentation of symptoms and complaints.
    • Higher in South Am. and Puerto Rico.
  25. Conversion Disorder
    • Sensory or motor function impaired but no neurological cause.
    • Vision impairment, paralysis of arms/legs, seizures or coordination problems. Anesthesia, aphonia, anosmia.
    • Can't be explained by medical condition.
  26. Anesthesia
    Loss of sensation.
  27. Aphonia
    Whispered speech.
  28. Anosmia
    Loss of smell.
  29. Hippocrates & Conversion Disorder
    Believed it only occured in women and attributed to wandering uterus. Hysteria.
  30. Freud & Conversion Disorder
    • Coined term conversion.
    • Thought that anxiety and conflict converted into physical symptoms.
  31. Conversion Disorder Onset
    • Adolescence to early adulthood.
    • Prevalence less than 1%.
    • Comorbid with depressive disorder, substance abuse, personality disorders.
  32. Conversion Disorder Cause
    • Distressing event that is unexpressed and pushed to unconscious.
    • In women, linked to sexual Electra Complex.
  33. Conversion Disorder Cause: Social and Cultural Factors
    • Decrease in incidence since last half of 19th century. Less repressed sexual attitudes and higher tolerance for anxiety symptoms.
    • Prevalent in rural areas, people of lower SES, non-western.
  34. Body Dysmorphic Disorder co-occurs with:
    Obsessive-Compulsive Disorder
  35. Treatment of Somatoform Disorders
    • Cognitive Behavioral Treatment
    • Not many studies about this.
  36. Cognitive Behavioral Treatment - Somatoform Disorders (3)
    • Identify & change triggering emotions.
    • Change thinking about symptoms.
    • Replace sick role behaviors with more appropriate social interactions.
  37. Treatment of Pain Disorder
    • Antidepressants (Tofranil)
    • Components of psychotherapy for pain disorder
  38. Four Components of psychotherapy for pain disorder
    • Validation of patient�s pain
    • Relaxation training
    • Reinforce shift of focus away from pain
    • Help patient develop ability to cope with stress and gain sense of control over pain
  39. Treatment of Body Dysmorphic Disorder
    • Cognitive Behavioral Therapy
    • Exposure plus response prevention (Prevent individual from checking appearance)
    • Antidepressants (Fluoxetine & Clomipramine)
  40. Treatment of Hypochondriasis
    • Cognitive Behavioral Therapy:
    • Reduce attention to bodily sensations.
    • Challenge negative perceptions about sensations.
    • Discourage reassurance seeking from medical professionals.
  41. Treatment of Somatization Disorder
    • Medical professionals don�t dismiss physical complaints.
    • Minimize use of diagnostic tests and medication.
    • Avoid providing attention only when patient is complaining (reinforcing symptoms).
    • Treat underlying depression and anxiety when present.
  42. Treatment of Conversion Disorder
    • No controlled studies to date.
    • Psychoanalytic treatments have not demonstrated usefulness.
    • Reinforcement of high functioning behavior may help.
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PY Notecards 6
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