B E H Chapter 7 A V I O Dissociative and R Somatoform Disorders D I S O R Sheila K. Grant, Ph.D. D E R S

B E Dissociative Disorders H A - A disorder characterized by V disruption, or dissociation, of identity, , or I consciousness. O R The major dissociative disorders include dissociative identity disorder, dissociative , D dissociative fugue, and depersonalization I disorder. S O In each case, there is a disruption or dissociation R (“splitting off ”) of the functions of identity, memory, or D consciousness that normally make us whole. E R S

B Overview of Dissociative Disorders E H A V I O R

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1 B E Dissociative Disorders H A Dissociative identity disorder - A dissociative V disorder in which a person has two or more distinct, or I alter, personalities. O R In dissociative identity disorder, two or more personalities—each with well-defined traits and D —“occupy” one person. I S In the film, The Three Faces of Eve , Eve White is a O timid housewife who harbors two other personalities: Eve R Black, a sexually provocative, antisocial personality, and D Jane, a balanced, developing personality who could E balance her sexual needs with the demands of social R acceptability. S

B E The Three Faces of Eve H A V I O R

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B E The Three Faces of Eve H A V I O R

D I S O R D E R “Let us hear the various personalities speak…” S

2 B E Dr. Holiday Milby H A V I O R

D I S O R D E R Dissociative Identity Disorder S

B E Dissociative Disorders H A Dissociative identity disorder - A dissociative V disorder in which a person has two or more distinct, or I alter, personalities. O R In dissociative identity disorder, two or more personalities—each with well-defined traits and D memories—“occupy” one person. I S In the film, The Three Faces of Eve , Eve White is a O timid housewife who harbors two other personalities: Eve R Black, a sexually provocative, antisocial personality, and D Jane, a balanced, developing personality who could E balance her sexual needs with the demands of social R acceptability. S

B E Features H A In some cases, the host (main) personality is unaware of V the existence of the other identities, whereas the other I identities are aware of the existence of the host. O R In other cases, the different personalities are completely unaware of one another. D I Sometimes two personalities vie for control of the S person. O R D E R S

3 B E Controversies H A Although multiple personality is generally considered V rare, the very existence of the disorder continues to I arouse debate. O R Many professionals express profound doubts about the diagnosis. D I Only a handful of cases worldwide were reported from S 1920 to 1970, but since then the number of reported O cases has skyrocketed into the thousands. R D E R S

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B E Dissociative Amnesia H A Amnesia derives from the Greek roots a-, meaning “not,” V and mnasthai, meaning “to remember.” I O Dissociative amnesia - A dissociative disorder in R which a person experiences memory loss without any identifiable organic cause. D I Unlike some progressive forms of memory impairment, S the memory loss in dissociative amnesia is reversible, O although it may last for days, weeks, or even years. R D E R S

4 B “Jane Doe.” E H A This woman, called “Jane V Doe” by rescue workers, was I found in a O Florida park in a dazed R state. She reported she had no memory of her D background or even who she I was. Her parents recognized S her after she appeared on a O national TV program. She R reportedly never regained D her memory. E R S

B E Dissociative Amnesia H A Dissociative amnesia is divided into five distinct types of V memory problems: I O 1. Localized amnesia. R 2. Selective amnesia. 3. Generalized amnesia. D 4. Continuous amnesia. I 5. Systematized amnesia. S O R D E R S

B E Dissociative Fugue H A Fugue derives from the Latin fugere, meaning “flight.” V The word fugitive has the same origin. I O Fugue is like amnesia “on the run.” R Dissociative fugue - A dissociative disorder in which D one suddenly flees from one’s life situation, travels to a I new location, assumes a new identity, and has amnesia S for personal material. O R D E R S

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D I S O R Research by Loftus and others has demonstrated that false memories D of events that never actually occurred can be induced experimentally. E This research calls into question the credibility of reports of R recovered memories. S

B E Depersonalization Disorder H A Depersonalization - Feelings of unreality or V detachment from one’s self or one’s body. I O Derealization - A sense of unreality about the outside R world.

D Depersonalization disorder - A disorder I characterized by persistent or recurrent episodes of S depersonalization. O R D E R S

B E Depersonalization Disorder H A Depersonalization - Feelings of unreality or V detachment from one’s self or one’s body. I O Derealization - A sense of unreality about the outside R world.

D Depersonalization disorder - A disorder I characterized by persistent or recurrent episodes of S depersonalization. O R D E R S

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B Culture-Bound Dissociative E H Syndromes A Similarities exist between the Western concept of V dissociative disorder and certain culture-bound I syndromes found in other parts of the world. O R For example, amok is a culture-bound syndrome occurring primarily in southeast Asian and Pacific Island D cultures that describes a trancelike state in which a I person suddenly becomes highly excited and violently S attacks other people or destroys objects. O R People who “run amuck” may later claim to have no D memory of the episode or feeling as if they were E acting like a robot. R S

B E Psychodynamic Views H A V To psychodynamic theorists, dissociative disorders I involve the massive use of repression, resulting in the O “splitting off” from consciousness of unacceptable R impulses and painful memories.

D Dissociative amnesia may serve an adaptive function of I disconnecting or dissociating one’s conscious self from S awareness of traumatic experiences or other sources of O psychological pain or conflict. R D In dissociative amnesia and fugue, the ego protects itself E from anxiety by blotting out disturbing memories or by R dissociating threatening impulses of a sexual or S aggressive nature.

7 B E Social-Cognitive Theory H A V From the standpoint of social-cognitive theory, we I can conceptualize dissociation in the form of dissociative O amnesia or dissociative fugue as a learned response R involving the behavior of psychologically distancing oneself from disturbing memories or emotions.

D I Some social-cognitive theorists, such as the late S Nicholas Spanos, believe that dissociative identity O disorder is a form of role-playing acquired through R observational learning and reinforcement. D E R S

B E Brain Dysfunction H A Might dissociative behavior be connected with V underlying brain dysfunction? I O Research along these lines is still in its infancy, but R preliminary evidence shows structural differences in brain areas involved in memory and emotion between D patients with dissociative identity disorder (DID) and I healthy controls (Vermetten et al., 2006). S O Another study showed differences in brain metabolic R activity between people with depersonalization disorder D and healthy subjects (Simeon et al.,2000). E R S

B E Diathesis– Model H A Despite widespread evidence of severe physical or sexual V abuse in childhood in the great majority of cases of I dissociative identity disorder, very few severely abused O children develop multiple personalities. R Consistent with the diathesis–stress model, certain D personality traits, such as proneness to fantasize, high I ability to be hypnotized, and openness to altered states S of consciousness, may predispose individuals to develop O dissociative experiences in the face of extreme stress, R such as traumatic abuse in childhood. D E R S

8 B Treatment of E H Dissociative Disorders A Dissociative amnesia and fugue are usually fleeting V experiences that end abruptly. I O Episodes of depersonalization can be recurrent and R persistent, and they are most likely to occur when people are undergoing periods of mild anxiety or . D I Psychoanalysts seek to help people with dissociative S identity disorder uncover and learn to cope with early O childhood traumas. R D E R S

B Diathesis–stress model of E H dissociative identity disorder. A V I O R

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B E Somatoform Disorders H A V The word somatoform derives from the Greek soma, I meaning “body.” O R Somatoform disorders - A disorder characterized by complaints of physical problems or symptoms that

D cannot be explained by physical causes. I S The concept of somatoform disorder presumes that the O physical symptoms reflect psychological factors or R conflicts. D E R S

9 B Overview of Somatoform Disorders E H A V I O R

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B E Somatoform Disorders H A Malingering - Faking illness in order to avoid work or V duty. I O - A disorder characterized by R intentional fabrication of psychological or physical symptoms for no apparent gain. D I Münchausen syndrome - A type of factitious S disorder characterized by the fabrication of medical O symptoms. R D E R S

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10 B E H A Conversion disorder - A somatoform disorder V characterized by loss or impairment of physical function I in the absence of any apparent organic cause. O R The person is not malingering. The physical symptoms usually come on suddenly in stressful situations. D I A soldier’s hand may become “paralyzed” during intense S combat, for example. O R The fact that conversion symptoms first appear in the D context of, or are aggravated by, conflicts or stressors E suggest a psychological connection (APA, 2000). R S

B E H A Hypochondriasis - A somatoform disorder V characterized by misinterpretation of physical symptoms I as signs of underlying serious disease. O R The fear persists despite medical reassurances that it is groundless. D I Hypochondriasis is believed to affect about 1% to 5% of S the general population and about 5% of patients seeking O medical care (APA, 2000; Barksy & Ahern, 2004). R D E R S

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11 B E Body Dysmorphic Disorder H A Body dysmorphic disorder (BDD) - A somatoform V disorder characterized by preoccupation with an I imagined or exaggerated physical defect of appearance. O R They may spend hours examining themselves in the mirror and go to extreme measures to correct the D perceived defect, even undergoing invasive or unpleasant I medical procedures, including unnecessary plastic S surgery (Crerand et al., 2005). O R Others remove all mirrors from their homes so as not to D be eminded of the glaring flaw in their appearance. E R S

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B E Pain Disorder H A Pain disorder - A somatoform disorder in which V psychological factors are presumed to play a significant I role in the development, severity, or course of chronic O pain. R The psychological factors may contribute to the D development, severity, or maintenance of the pain. I S The pain is severe enough and persistent enough to O interfere with the person’s daily functioning. R D E R S

12 B E H A Somatization disorder - A somatoform disorder V characterized by repeated multiple complaints that I cannot be explained by physical causes. O R These complaints persist for at least several years, and result either in the seeking of medical or in D significant impairment in fulfilling social or occupational I roles. S O Reported rates of somatization disorder vary from 0.2% R to 2% in women to less than 0.2% in men (APA, 2000). D E R S

B E syndrome H A V Koro syndrome - A culture-bound somatoform I disorder, found primarily in China, in which people fear O that their genitals are shrinking. R Koro is considered a culture-bound syndrome, although

D some cases have been reported outside China and the I Far East. S O Koro syndrome has been traced within Chinese culture R as far back as 3000 B.C.E. D E R S

B E Dhat syndrome H A Dhat syndrome - A culture-bound somatoform V disorder, found primarily among Asian Indian males, I characterized by excessive fears over the loss of seminal O fluid. R Some men with this syndrome also believe (incorrectly) D that semen mixes with urine and is excreted through I urination. S O Men with dhat syndrome may roam from physician to R physician seeking help to prevent nocturnal emissions or D the (imagined) loss of semen mixed with excreted urine. E R S

13 B E Theoretical Perspectives H A Conversion disorder, or “hysteria,” was known to the V great physician of ancient Greece, Hippocrates, who I attributed the strange bodily symptoms to a wandering O uterus (hystera in Greek) creating internal chaos. R Hippocrates noticed that these complaints were less D common among married than unmarried women. I S He prescribed marriage as a “cure” on the basis of these O observations and also on the theoretical assumption that R pregnancy would satisfy uterine needs and fix the organ D in place. E R S

B The wandering uterus. E H The ancient Greek A physician Hippocrates V believed that hysterical symptoms were I exclusively a female O problem caused by a R wandering uterus. Might he have changed his D mind had he the I opportunity to treat S male aviators during O World War II who R developed “hysterical D night blindness” that E prevented them from carrying out dangerous R nighttime missions? S

B E Psychodynamic Theory H A According to psychodynamic theory, hysterical V symptoms are functional: I O They allow the person to achieve primary gains and R secondary gains.

D The primary gain of the symptoms is to allow the I individual to keep internal conflicts repressed. S O Secondary gains from the symptoms are those that allow R the individual to avoid burdensome responsibilities and D to gain the support—rather than condemnation—of E those around them. R S

14 B E Learning Theory H A Learning theorists focus on the more direct reinforcing V properties of the symptom and its secondary role in I helping the individual avoid or escape anxiety-evoking O situations. R From the learning perspective, the symptoms in D conversion and other somatoform disorders may also I carry the benefits, or reinforcing properties, of the “sick S role.” O R Some learning theorists link hypochondriasis and body D dysmorphic disorder to obsessive–compulsive disorder. E R S

B E Cognitive Theory H A Cognitive theorists have speculated that some cases V of hypochondriasis may represent a type of self- I handicapping strategy, a way of blaming poor O performance on failing health (Smith, Snyder, & Perkins, R 1983).

D Cognitive theorists speculate that hypochondriasis and I , which often occur together, may share a S common cause: a distorted way of thinking that leads the O person to misinterpret minor changes in bodily R sensations as signs of pending catastrophe (Salkovskis & D Clark, 1993) E R S

B E Treatment of H Somatoform Disorders A The treatment approach that Freud pioneered, V psychoanalysis, began with the treatment of hysteria, I which is now termed conversion disorder. O R Psychoanalysis seeks to uncover and bring unconscious conflicts that originated in childhood into conscious D awareness. I S Once the conflict is aired and worked through, the O symptom is no longer needed and should disappear. R D E R S

15 B Conceptual models of conversion E H disorder. A V Psychodynamic and I learning theory offer O conceptual models of R conversion disorder that emphasize the

D role of conversion symptoms leading to I escape or relief from S anxiety. O R D E R S

B E H A V I O R QUESTIONS?

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