CHAPTER 6: SOMATIC SYMPTOM AND RELATED SOMATIC SYMPTOM AND RELATED DISORDERS threatening

DISORDERS AND DISSOCIATIVE DISORDERS 1. Somatic Symptom Disorder (SSD)  Focusing causes increases arousal and intensity of
--------------------------------------------------------  was formerly called Briquet’s Syndrome (named after sensations
Somatic Symptom and Dissociative Disorders Pierre Briquet due to his patients having multiple
 Believe that health is symptom-free
 are strongly linked historically, and evidence indicates physical symptoms without medical basis)
 Modest genetic component, may be nonspecific
they share common features (Kihlstrom, Glisky, &  runs in a families; probably heritable basis
Anguilo, 1994; Prelior, Yutzy, Dean, & Wetzel, 1993)  rare-most prevalent among unmarried women in low (traits inherited such as tendency to over-respond to
 they used to be categorized under one general socioeconomic groups stress), may also be due to learning from family to
heading, <hysterical neurosis=  onset usually in adolescence; often persist into old focus anxiety on specific physical conditions
 are not well understood, but they have intrigued age  Seem to develop in stressful events and people
psychopathologists and the public for centuries Treatments for SSD tend to have disproportionate incidence of disease
 a fuller understanding provides a rich perspective on the  Antidepressants (SSRIs and tricyclics) in their family
extent to which normal, everyday traits found in all of  Psychotherapy 3 reassuring supportive therapy,  Social and interpersonal: ill person gets a lot of
us can evolve into distorted, strange, and incapacitating  catharsis attention
disorders  CBT 3 focus on identifying and changing
 Severe form is strongly linked to antisocial
Hysteria maladaptive thoughts about illness and
personality disorder in similar qualities and
 term that dates back to the Greek physician misperceptions of physical symptoms, reassurance,
normalizing symptoms, decreasing help-seeking possibly share neurobiologically based
Hippocrates, and the Egyptians before him
behaviors and reinforcements disinhibition syndrome characterized by impulsive
 suggests that the cause of these disorders, which were
thought to occur primarily in women, can be traced to a 2.Illness Anxiety Disorder (IAD) behavior
<wandering uterus=  formerly hypochondriasis Treatments for IAD
Hysterical 3 refer more generally to physical symptoms without
 anxiety is due to possibility of being sick instead of the  Ongoing reassurance and education effective in
known organic cause or to dramatic or <histrionic= behavior symptom itself some cases, reducing stress and frequency of
thought to be c haracteristic of women.  physical symptoms are either not experienced at the help-seeking behaviors
Sigmund Freud (1894–1962) suggested that in a condition present time or are very mild, but severe anxiety is
 CBT focused on identifying and challenging
called conversion hysteria, unexplained physical symptoms focused on the possibility of having a serious
illnessr elated misinterpretations of physical
indicated the conversion of unconscious emotional conflicts disease
sensations, shows patients that they have control
into a more acceptable form.  idea of being sick instead of the physical
and can create symptoms by focusing attention
Neurosis symptoms itself
 if one or more physical symptoms are relatively  Personal gatekeeper physician to screen physical
 as defined in psychoanalytic theory, suggests a specific
severe and are associated with anxiety and complaints
cause for certain disorders
 specifically, neurotic disorders resulted from distress, the diagnosis would be SSD  Therapeutic attention direction at reducing
underlying unconscious conflicts, anxiety that resulted Causes of IAD supporting consequence of relating to significant
from those conflicts, and the implementation of ego  Faulty interpretations of physical signs and others based on symptoms
defense mechanisms sensations (cognition and perception based and 3. Conversion Disorder (Functional Neurologicalv
strong emotional contributions) Symptom Disorder)
 Tend to interpret ambiguous stimuli as
  the term conversion has been used off and on  when an individual deliberately makes someone
since the Middle Ages (Mace, 1992) but was else sick, the condition is called Factitious Depersonalization
popularized by Freud, who believed the anxiety Disorder Imposed on Another (previously known
resulting from unconscious conflicts somehow was as Munchausen syndrome by proxy)  your perception alters so that you temporarily lose
<converted= into physical symptoms to find the sense of your own reality as if you were in a
Causes of FD dream and you were watching yourself
expression.
 is often part of a serious set of conditions in which
 allowed the individual to discharge some anxiety  Four basic processes in the development (Freud):
reality, experience, and even identity seem to
without actually experiencing it  Experience traumatic event and unconscious
disintegrate
 as in phobic disorders, the anxiety resulting from conflict
unconscious conflicts might be <displaced= onto  Can’t cope with conflict and anxiety, make it Derealization
another object unconscious
 your sense of the reality of the external world is
 physical malfunctioning such as paralysis, Anxiety escalates and threatens to emerge into
lost
blindness, or difficulty speaking (aphonia), consciousness, individual converts it to physical
 things may seem to change shape or size; people
without any physical or organic pathology to symptoms to relieve pressure of having to cope
may seem dead or mechanical
account for the malfunction with the conflict (primary gain)
 these sensations of unreality are characteristic of
4.Functional Neurological Symptom Disorder 3  Sympathy and attention from loved ones and may
the dissociative disorders because, in a sense,
is a subtitle to conversion disorder because the term be excused from difficult situations or tasks
they are a psychological mechanism whereby one
is more often used by neurologists who see the (secondary gain)
<dissociates= from reality
majority of patients receiving a conversion disorder
Treatments for FD
diagnosis, and because the term is more acceptable Disintegrated Experience
to patients.  Identify and attend to the traumatic or stressful
 there are alterations in relationship to the self, to
 <Functional= refers to a symptom without an organic cause event if still present
the world, or to memory processes
(Stone, LaFrance, Levenson, & Sharpe, 2010).  Catharsis: re-experiencing the event is a good first
5. Factitious Disorders  can’t remember why a person is in a certain place
step
or even who they are
 a set of conditions that fall somewhere  Therapist must reduce reinforcing or supportive
 an individual loses his sense that his
between malingering and conversion disorders consequences
surroundings are real
 the symptoms are under voluntary control, as  CBT holds promise, hypnosis does not
 he forgets who he is but also begin thinking
with malingering, but there is no obvious that he’s somebody else4somebody who has a
reason for voluntarily producing the symptoms different personality, different memories, and even
except, possibly, to assume the sick role and DISSOCIATIVE DISORDERS
different physical reactions, such as allergies he
receive increased attention Dissociative Experiences 3 when individuals feel never had
 may tragically extend to other members of the detached from themselves or their surroundings, almost as
family if they are dreaming or living in slow motion. 1. Depersonalization-Derealization Disorder
  feelings of unreality are so severe and frightening  previously known as <Multiple Personality Disorder=  reflects that these episodes represent a state of
that they dominate an individual’s life and prevent  people with DID may adopt as many as 100 new low positive affect and not just high negative affect
identities, average number is 15
normal functioning  in some cases, the identities are complete, each with Mania
its own behavior, tone of voice, and physical gestures
Treatments for DDD
 but in many cases, only a few characteristics are  individuals find extreme pleasure in every activity;
distinct, because the identities are only partially
 Psychological treatment similar to those for panic independent, so it is not true that there are
some patients compare their daily experience of
disorder <multiple= complete personalities mania with a continuous sexual orgasm
 Stresses associated with onset of disorder should Alters 3 separate identities, different personality  they become extraordinarily active (hyperactive),
be addressed Host 3 usually attempts to hold various fragments of identity require little sleep, and may develop grandiose
 Tends to be lifelong together but end up being overwhelmed plans, believing they can accomplish anything
they desire
Switch 3 transition from one personality to another
2. Dissociative Amnesia  DSM-5 highlights this feature by adding criteria
Treatments for DID <persistently increased goal-directed activity or
 easiest severe dissociative disorder to understand
 Longterm psychotherapy may reintegrate energy=
 is common during war separate personalities
 Treatment of associated trauma similar to PTSD,  speech is typically rapid and may become
Generalized Amnesia 3 unable to remember anything, incoherent, because the individual is attempting to
 lifelong condition without treatment
including who they are express so many exciting ideas at once; this
Localized or Selective Amnesia 3 failure to recall specific feature is typically referred to as flight of ideas
4. Dissociative Trance 3 altered state of consciousness in
events, usually traumatic, that occur during a specific which people firmly believe they are possessed by spirits;  DSM-5 criteria for a manic episode require a
period considered a disorder only where there is distress and duration of only 1 week, less if the episode is
dysfunction. severe enough to require hospitalization. Irritability is
Dissociative Fugue often part of a manic episode, usually near the
 is a subtype of dissociative amnesia with fugue end
CHAPTER 7: MOOD DISORDERS AND SUICIDE  paradoxically, being anxious or depressed is also
literally meaning <flight= (fugitive is from the
same root) ----------------------------------------------------------------------------- commonly part of mania
 unexpected trip, memory loss is accompanied by Hypomania
AN OVERVIEW OF DEPRESSION AND MANIA
purposeful travel or bewildered wandering
Anhedonia  Hypo means <below=; thus, the episode is below
Treatments for DA the level of a manic episode
 Usually self-correcting when current life stress is  loss of energy and inability to engage in  a less severe version of a manic episode that
resolved pleasurable activities or have any <fun= does not cause marked impairment in social or
 Therapy focuses on retrieving lost information  is more characteristic of severe episodes of occupational functioning and need last only 4
depression than are, for example, reports of days rather than a full week
3. Dissociative Identity Disorder (DID) sadness or distress (Pizzagalli, 2014)
 is not in itself necessarily problematic, but its the individual was not depressed
presence does contribute to the definition of THE STRUCTURE OF MOOD DISORDERS  This is important with determining the
several mood disorders future course of the disorder
 Unipolar mood disorder- individuals who
experience either depression or mania
2. Persistent Depressive Disorder (Dysthymia)-
 Their mood remains at one <pole= of
Depressive mood that continues at least 2 years, during
the depression-mania continuum
which the patient cannot be symptom free for more than 2
 Many people with this eventually
months
develop depression
 At least 2 symptoms
 Mixed Features: An individual that experience  Depression remains relatively unchanged over
manic symptoms but feel somewhat depressed long periods, 20 to 30 years or more
or anxious at the same time, or be depressed  Double Depression- An individual that suffers
with a few symptoms of mania from major depressive episodes and persistent
 Manic episodes are characterized by dysphoric depression with fewer symptoms
(anxious or depressive) features
 Pattern of occurrence and recovery make a
difference with treatments ADDITIONAL DEFINING CRITERIA FOR DEPRESSIVE
DISORDERS
DEPRESSIVE DISORDERS
 Specifiers- symptoms
 The disorders differ with frequency and severity  Severity of episode- mild, moderate, or severe 8
of when the depressive symptoms occur
 Severity and chronicity are important with basic specifiers to describe depressive disorders
describing mood disorders 1. Psychotic features (mood congruent or mood
Clinical Descriptions incongruent)
Hallucinations: seeing or hearing things that
1. Major Depressive Disorder- A disorder defined by the aren’t real, can be physical (somatic) or voices
presence of depression and the absence of manic (auditory)
or hypomanic episode before or after the disorder Delusions: strongly held but inaccurate beliefs
 Sad mood or loss of pleasure in usual activities 2. Anxious distress (mild to severe)
 With suicidal thoughts 3. Mixed features
 Recurrent: A disorder where 2 or more 4. Melancholic features
depressive episodes occurred and were 5. Atypical features
separated by at least 2 months during which 6. Catatonic features
 Catalepsy: An absence of movement
7. Peripartum onset 4. Premenstrual Dysphoric Disorder (PMDD) 3. Cyclothymic Disorder- A chronic alteration of mood
Just before and just after birth  Depressive or physical symptoms in the week elevation and depression that does not reach the severity
8. Seasonal pattern before menstruation of manic or major depressive episodes
 Marked affective lability  Frequent mild symptoms of depression
3. Seasonal Affective Disorder (SAD)- episodes that  2% to 5% of women suffer from this  alternating with mild symptoms of mania
have occurred for at least 2 years with no evidence of  A combination of of physical symptoms, severe  At least 2 years (1 year for children and
nonseasonal major depressive episodes occurring mood swings, and anxiety Adolescent)
during that period of time  This is a mood disorder  A milder but more chronic version of bipolar
 Winter blues disorder
 Depression during 2 consecutive winters then 5. Disruptive Mood Dysregulation Disorder- intense
clears during summers negative effects that seem to be driving irritability Additional Defining Criteria for Bipolar Disorders
and marked inability to regulate mood
 Specifiers: delusions of grandeur, anxious distress
Onset and Duration  Severe recurrent temper outburst and persistent
 Rapid- Cycling Specifier
negative mood
 Risk is low until early teens  Unique to bipolar disorders
 More children and adolescents are being
 25% of people ages 18 to 29 have already  At least 4 manic or depressive episodes in
diagnosed with bipolar disorder
experienced major depression one year
 At least 1 year
 Persistent depressive disorder lasts 20 to 30 years  Onset and Duration
 Before age 10  Bipolar I average onset age- 15 to 18
From Grief to Depression
years old
BIPOLAR DISORDERS
 Most grieving processes take around 6 months  Bipolar II average onset age- 19 to 22
 Integrated grief- the acute grief most of us would  Tendency of manic episodes to alter with major years old
feel eventually evolves into this, the feeling of depressive episodes  It is rare to develop after the age of 40
positive memories of the person lost  Cyclothymia tends to be chronic and
 Complicated grief- A disorder that includes many 1. Bipolar II Disorder- Major depressive episodes lifelong
psychological and social factors that are related alternate with hypomanic episodes rather than full mania  Average onset age is 12 to 14 years old
to mood disorders, and include a history of episodes
depressive episodes  At least 1 lifetime major depressive episode
MOOD DISORDERS
 Persistent Complex Bereavement Disorder  and one hypomanic episode
 Treatment: therapy where the loved one lost is PREVALENCE OF MOOD DISORDERS
discussed, trying to associate positive memories 2. Bipolar I Disorder- the same as Bipolar II Disorder,
except the individual experiences a full manic episode  16% of world population experience major
with the person
 At least 1 lifetime manic episode depressive disorder over a lifetime
  6% in the last year and agitation heritable
 Persistent depressive disorder and chronic major  ⅓ to ½ of elderly depressed also  Genetic contributions to bipolar disorder are
depression over the past year and lifetime is 3.5% experience generalized anxiety disorder higher than depression
 1% of world population experience bipolar and panic disorder  Depression and Anxiety: Same Genes?
disorder  Early childhood- boys are more likely to  Same genetic factors contribute to both
 0.8% in the past year be depressed than girls anxiety and depression
 Elderly- sex ratio for depression is pretty  Neurotransmitter Systems
Prevalence in Children, Adolescents, and Older Adults
balanced  Mood disorders are caused by low levels of
 Depressive disorders tend to occur less in serotonin
Across Cultures
prepubertal children than in adults, but rises  L-dopa: causes hypomania in bipolar
dramatically in adolescents  Some cultures have their own names for patients
 As many as 20% to 50% of children experience depression  The Endocrine System
some depressive symptoms  Hopi Native Americans call depression-  Adrenal cortex secretes cortisol->
 Major depressive disorders in adolescents occur <heartbreak= depression and anxiety
more in females  Native Americans tend to be more depressed than  Neurohormones
 Occurs less in people over the age of 65 the general population  Sleep and Circadian Rhythms
 Bipolar disorder- 1%  Hallmark of mood disorders
Among Creative Individuals
 Depressed people tend to experience
Life Span Developmental Influences on Mood Disorders  Geniuses tend to be in a state of madness (Ex: REM sleep faster
 Development influences that characteristics of Bipolar disorder)
mood disorders  Mood disorders are seen in artists and writers Additional Studies of Brain Structure and Function
 Infants with depressed mothers may also ■ EEG measures brain waves
experience depression (genetic tendency) CAUSES OF MOOD DISORDERS
 Most mood disorders are the same throughout the Equifinality- the same product resulting from possibly Psychological Dimensions
lifespan different causes
 Social dimensions have a strong connection to
 Comorbidity is affected by development
Biological Dimensions depression
 Age-Based Influences on Older Adults
 Stressful Life Event
 14% to 42% of nursing home residents  Looking at genetic contributions
 Stressful and trauma are unique
may experience major depressive  Family and Genetic Influences
contributions to the etiology of all
episodes. This doubles the chances of  Mood disorders- 2 to 3 times more likely
psychological disorders
dying. for those who have relatives with mood
 Stress and Depression
 Symptoms of late-onset depression: disorders
 Brown’s study of life events
sleep difficulties, illness anxiety disorder,  Twin studies- mood disorders are
 Stressful life events are strongly related
 to the onset of mood disorders  Men were more likely to develop a mood (SSRIs), mixed reuptake inhibitors,
 Gene-environment correlation modes disorder after a divorce tricyclic antidepressants, and monoamine
 Stress and Bipolar Disorder  Depression leads to problems in oxidase (MAO)
 There is a strong relationship between marriages  Have relieved severe depression and
stressful events and the onset of bipolar  Mood Disorders in Women have prevented suicide
disorder  Almost 70% of the population that  Lithium
 A patient usually develops depression experiences major depressive disorder or  An unique antidepressant
and then mania persistent depressive disorder are women  Mood-stabilizing drug: it is effective in
 20% to 50% of people who experience a  Women are at a disadvantage in society preventing and treating manic episodes
stressful event do not develop a mood  Social Support
Electroconvulsive therapy and Transcranial Magnetic
disorder  Ex: people who live alone are 80% more
Stimulation
 Learned Helplessness likely to develop depression
Learned helplessness theory of depression-  Having friends they can talk to makes a  Electroconvulsive therapy (ECT)- electric shock is
The theory that people become anxious and difference administered directly through the brain for less
depressed when they decide they have no control than a second, producing a seizure and a
An Integrative Theory
over the stress in their lives series of brief convulsions that usually last for
 Negative Cognitive Styles  Depression and anxiety may share a common, several minutes
 Depressive cognitive triad: the cognitive genetically determined biological vulnerability  A very controversial method only used when
errors in thinking negatively about  People who develop mood disorders have a someone does not respond to medication
themselves, their immediate worlds, and psychological vulnerability
Psychological Treatments for Depression
their future  Difficulty coping
 The self, the world, and the future  Biological vulnerability → Psychological  Cognitive-behavioral therapy
vulnerability →Activation of stress hormones with  Cognitive therapy: the process of
 Cognitive Vulnerability for Depression: An wide-ranging effects on neurotransmitter, changing the negative thoughts seen to
Integration Depression, and Problems in interpersonal cause depression into more positive or
 Some people are predisposed to view relationships and lack of social support → realistic thoughts
situations in a negative way Mood Disorder  Interpersonal psychotherapy
Social and Cultural Dimensions  Interpersonal psychotherapy: (IPT)
TREATMENT OF MOOD DISORDERS focuses on resolving problems in existing
 Social and cultural factors contribute to relationships and learning to form
Medication
depression important new interpersonal relationships
 Marital Relations  to alter neurotransmitter levels  Negotiation, Impasse, and Resolution
 Interpersonal stress influences  Antidepressants stage
depression and bipolar disorders  Selective-serotonin reuptake inhibitors
  Prevention himself on a sword.  Approximately 12% of college students have had
 Universal programs, Selected thoughts of suicide
Egoistic Suicide- low social integration.
interventions, and Indicated interventions
Causes
 CBT prevention program  e.g., older adults who kill themselves after losing
Combined Treatments for Depression touch with their friends or family fit into this  Past Conceptions
category.  Formalized suicide- occurs after
 Antidepressant medication, CBT treatment, or both
disrespecting one’s family
 Combined treatment provides an advantage Anomic suicides are the result of marked disruptions or
 Anomic suicide- result from marked
disappointments, such as the sudden loss of a high-
Preventing Relapse of Depression disturbances
prestige job. (Anomie is feeling lost and confused.)
 Fatalistic suicides- result from the loss of
 Medication tends to help faster when it does work Fatalistic Suicides- result from a loss of control over one’s
control over one’s destiny
 Antidepressant medication own destiny. The mass suicide of 39 Heaven’s Gate cult
 Freud- considered suicide to indicate
 Maintenance treatment- used to prevent relapse or members in 1997 is an example of this type because
unconscious hostility towards oneself
recurrence over the long term the lives of those people were largely in the hands of
 Cognitive-behavioral therapy has also been seen to Marshall Applewhite, a supreme and charismatic Risk Factors
be effective leader.
Psychological autopsy- the methods used to study
Statistics
Psychological Treatments for Bipolar Disorder conditions and events that make a person vulnerable
 The 11th leading cause for death in the US
 Medication- Lithium Family History
 Is mostly a white phenomenon
 Interpersonal and social rhythm therapy (IPSRT)  High rate of suicide for Native Americans  Increased chance if someone in the family had
has been seen to reduce manic episodes  High rate of suicide in adolescents and the elderly committed suicide (6x more likely)
 CBT is effective with people suffering from bipolar  Even young children ages 2 to 5 have
who have a Repic-cycling feature tried
 Males are 4x more likely to commit suicide
SUICIDE
than females
 Approximately 40,000 people commit suicide a year  Females attempt suicide more often than males
in the US  China- women in rural areas commit suicide more
often than males
Types of Suicides
Suicidal ideation- thinking severely about suicide
Altruistic Suicide - for the benefit of the community
Suicidal plans- the formulation of a specific method for
 e.g., as the ancient custom of hara-kiri in Japan, in killing oneself
which an individual who brought dishonor to
himself or his family was expected to impale Suicidal attempts- An attempt where the person survives