Learning Objectives for:

Somatic and Dissociative Disorders

Readings for this topic include pages 152-160 (Somatic Symptoms Disorders) and pages 160-166, 169-171 (Dissociative Disorders) of chapter 6. Remember, information in addition to what is on the pages listed will be discussed in class for some of the objectives.

1) What types of thoughts and behaviors fall under the category of Somatic Symptom Disorders? (Note that you should be familiar with the behaviors associated with specific disorders, such as Conversion Disorders & Factitious Disorders, but you will only be responsible for knowing that these behaviors fall under the umbrella of Somatic Symptom Disorders, not knowing the specific diagnosis associated with a given behavior)

i) Real or imagined somatic (physical) symptoms

ii) Related abnormal thoughts, feelings, or behaviors

a) Biopsychosocial Model

i) Biological Factors

1) Physical symptom may be present

ii) Social Factors

1) Greater cultural acceptance of physical than psychological problems

2) “Sick role” reinforcers

3) Social support

b) Treatment

i) Cogntivie Behavioral Therapy

1) Identify reinforcers and elimate or replace them

2) Change catastrophic thoughts

3) Identify and challenge misinterpretations

ii) Biological

1) Antidepressants

2) Can Somatic Symptom Disorders include real bodily symptoms or do they have to be imagined?

3) How do fears and beliefs about illness play into Somatic Symptom Disorders? What about reinforcement of the “sick role?”

4) What kinds of symptoms does Cognitive-Behavioral Therapy for Somatic Symptom Disorders target? Are there any biological treatments for it?

5) What is dissociation? What differentiates “everyday” dissociative events from dissociative disorder symptoms?

a) Disturbances in memory, identity, or consciousness

i) Dissociative Identity disorder

ii) Dissociative Amnesia

iii) Depersonalization/Derealization disorder

b) Dissociation on a continuum

i) Mild dissociation is common

1) Daydreaming

2) Forgetting a conversation you had

ii) More extreme end:

1) Frequently forgetting important events

2) Depersonalization

3) Derealization

6) What are the key features of Dissociative Identity Disorder (DID)?

a) Presence of 2 or more distinct personalities

b) Each identity has its own memories, attitudes, and perceptions

c) Identities alternate control

d) Common Features of DID

i) People who have been abused in their childhood/experienced a trauma are more likely to report DID

ii) Extremely hypnotizable

iii) Much more likely to occur within women (more than 3 times more likely)

7) Why is DID a controversial diagnosis? (about 25% of psychiatrics believe that it exists)

a) Prevalence rate is shifting very rapidly

i) 1970 – 79 cases

ii) 1986 – 6,000 cases

iii) 1998 – 40,000 cases

b) Average number of personalities also increased from 3-12

c) Folks with DID tend to be more suggestible/hypnotizable

d) Nearly everyone with DID symptoms has been exposed to information about DID before symptoms developed

e) Therapist-induced symptoms (iatrogenic) (meaning being in a medical disorder induced the disorder.

f) (BE AWARE of both sides of the arguments/the arguments all about this; read!!!)

8) Biopsychosocial Factors

a) Little is known, but evidence suggests:

i) Stress Response => Dissociative Symptoms (as with PTSD)

ii) Psychological: Natural Processes

1) State Dependent Learning - the principle that one is likely to recall information when you are in a physiological state similar to where you learned the information

2) Selective Attention

3) Suggestibility/Hypnotizability

iii) Social:

1) Severe past stress or trauma

2) Can be reinforced through selective social support

3) Psychological treatment may worsen symptoms

9) What role does reinforcement play in the development of DID?

10) What types of psychological treatments may be helpful for DID? Hurtful?

a) Very little known

b) General Principles:

i) Resolve precipitating stressors

ii) DON’T focus on remembering forgotten info