comer, abnormal psychology, 8th edition_33608：来的人，心理异常，第八edition_33608

Comer, Abnormal PsychologyDSM-5 Update, 8e,Disorders Focusing on Somatic and Dissociative Symptoms,Chapter 7,Slides & Handouts by Karen Clay Rhines, Ph.D.American Public University System,2,Comer, Abnormal Psychology,8e DSM-5 Update,Disorders Focusing on Somatic and Dissociative Symptoms,In addition to disorders covered earlier, stress and anxiety also contribute to several other kinds of disorder, particularly disorders that focus on somatic and dissociative symptoms,3,Comer, Abnormal Psychology,8e DSM-5 Update,Disorders Focusing on Somatic Symptoms,In these disorders, the somatic symptoms are primarily caused by psychosocial factors or the symptoms trigger excessive anxiety and concernThese disorders are different than psychophysiological disorders, in which psychosocial factors interact with genuine physical ailments,4,Comer, Abnormal Psychology,8e DSM-5 Update,Disorders Focusing on Dissociative Symptoms,Dissociative disorders are each characterized by significant memory loss or identity disruption,5,Comer, Abnormal Psychology,8e DSM-5 Update,Disorders Focusing on Somatic and Dissociative Symptoms,Disorders that focus on somatic symptoms and those that focus on dissociative symptoms have much in common:Both may occur in response to severe stressBoth have traditionally been viewed as forms of escape from stressA number of individuals suffer from both a somatic-related and a dissociative disorderTheorists and clinicians often explain and treat the two groups of disorders in similar ways,Disorders Focusing on Somatic Symptoms,DSM-5 lists a number of disorders in which bodily symptoms or concerns are the primary features,6,Comer, Abnormal Psychology,8e DSM-5 Update,Factitious Disorder,Sometimes when physicians cannot find a medical cause for a patients symptoms, he or she may suspect other factors are involved. Patients may malinger, intentionally fake illness to achieve external gain (e.g., financial compensation, military deferment)Patients may be manifesting a factitious disorder - intentionally producing or faking symptoms simply out of a wish to be a patient,7,Comer, Abnormal Psychology,8e DSM-5 Update,Factitious Disorder,Known popularly as Munchausen syndrome, people with a factitious disorder often go to extremes to create the appearance of illnessMany secretly give themselves medications to produce symptomsPatients often research their supposed ailments and are impressively knowledgeable about medicine,8,Comer, Abnormal Psychology,8e DSM-5 Update,Factitious Disorder,Clinical researchers have a hard time determining the prevalence of this disorder as patients hide the true nature of their problemOverall, the pattern appears to be more common in women than men and the disorder usually begins during early adulthood,9,Comer, Abnormal Psychology,8e DSM-5 Update,Factitious Disorder,Factitious disorder seems to be particularly common among people who (a) received extensive medical treatment as children, (2) carry a grudge against the medical profession, or (3) have worked as a nurse, lab technician, or medical aide,10,Comer, Abnormal Psychology,8e DSM-5 Update,Factitious Disorder,The precise causes of factitious disorder are not understood, although clinical reports have pointed to factors such as depression unsupportive parental relationships, and an extreme need for social support,11,Comer, Abnormal Psychology,8e DSM-5 Update,Factitious Disorder,Psychotherapists and medical practitioners often become angry at people with a factitious disorder, feeling that they are wasting their timePeople with the disorder, however, feel they have no control over their problems and often experience great distress,12,Comer, Abnormal Psychology,8e DSM-5 Update,13,Comer, Abnormal Psychology,8e DSM-5 Update,Factitious Disorder,In a related pattern, factitious disorder imposed on another, known popularly as Munchausen syndrome by proxy, parents make up or produce physical illnesses in their children,Conversion Disorder,Conversion disorderPeople with this disorder display physical symptoms that affect voluntary motor or sensory functioning, but the symptoms are inconsistent with known medical diseasesIn short, the individuals experience neurological-like symptoms blindness, paralysis, or loss of feeling that have no neurological basis,14,Comer, Abnormal Psychology,8e DSM-5 Update,Conversion Disorder,Conversion disorder often is hard to distinguish from genuine medical problemsIt is always possible that a diagnosis of conversion disorder is a mistake and the patients problem has an undetected medical causePhysicians sometimes rely on oddities in the patients medical picture to help distinguish the twoFor example, conversion symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesia,15,Comer, Abnormal Psychology,8e DSM-5 Update,Conversion Disorder,Unlike people with factitious disorder, those with conversion disorder dont consciously want or produce their symptomsThis pattern is called “conversion” disorder because clinical theorists used to believe that individuals with the disorders are converting psychological needs into neurological symptoms,16,Comer, Abnormal Psychology,8e DSM-5 Update,Conversion Disorder,Conversion disorder usually begins between late childhood and young adulthoodIt is diagnosed in women twice as often as in menIt typically appears suddenly, at times of stressIt is thought to be rare, occurring in at most 5 of every 1,000 persons,17,Comer, Abnormal Psychology,8e DSM-5 Update,Somatic Symptom Disorder,People with somatic symptom disorder become excessively distressed, concerned, and anxious about bodily symptoms that they are experiencingTwo patterns of somatic symptom disorder have received particular attention:Somatization patternPredominant pain pattern,18,Comer, Abnormal Psychology,8e DSM-5 Update,Somatic Symptom Disorder,People with a somatization pattern experience many long-lasting physical ailments that have little or no organic basisAlso known as Briquets syndromeA sufferers ailments often include pain symptoms, gastrointestinal symptoms, sexual symptoms, and neurological symptomsPatients usually go from doctor to doctor in search of relief,19,Comer, Abnormal Psychology,8e DSM-5 Update,Somatic Symptom Disorder,Somatization patternPatients with this pattern often describe their symptoms in dramatic and exaggerated termsMost also feel anxious and depressedThe pattern typically lasts for many yearsSymptoms may fluctuate over time but rarely disappear completely without therapy,20,Comer, Abnormal Psychology,8e DSM-5 Update,21,Comer, Abnormal Psychology,8e DSM-5 Update,Somatic Symptom Disorder,Somatization patternBetween 0.2% and 2% of all women in the U.S. experience a somatization pattern in any given year (compared with less than 0.2% of men)The pattern often runs in families and begins between adolescence and young adulthood,Somatic Symptom Disorder,Predominant pain patternIf the primary feature of somatic symptom disorder is pain, the individual is said to have a predominant pain patternAlthough the precise prevalence has not been determined, this pattern appears to be fairly commonThe pattern often develops after an accident or illness that has caused genuine painThe pattern may begin at any age, and more women than men seem to experience it,22,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,For many years, conversion and somatic symptom disorders were referred to as hysterical disordersThis label was to convey the prevailing belief that excessive and uncontrolled emotions underlie the bodily symptomsTodays leading explanations come from the psychodynamic, behavioral, cognitive, and multicultural modelsNone has received much research support, and the disorders are still poorly understood,23,Comer, Abnormal Psychology,8e DSM-5 Update,24,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,The psychodynamic viewFreud believed that hysterical disorders represented a conversion of underlying emotional conflicts into physical symptomsBecause most of his patients were women, Freud centered his explanation on the psychosexual development of girls and focused on the phallic stage (ages 3 to 5),What Causes Conversion and Somatic Symptom Disorders?,The psychodynamic view During this stage, girls develop a pattern of sexual desires for their fathers (the Electra complex) and recognize that they must compete with their mothers for his attentionBecause of the mothers more powerful position, however, girls repress these sexual feelingsFreud believed that if parents overreact to such feelings, the Electra complex would remain unresolved and the child might re-experience sexual anxiety throughout her lifeFreud concluded that some women unconciously hide their sexual feelings in adulthood by converting them into physical symptoms,25,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,The psychodynamic viewTodays psychodynamic theorists take issues with parts of Freuds explanationThey continue to believe that sufferers of these disorders have unconscious conflicts carried from childhood,26,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,The psychodynamic view Psychodynamic theorists propose that two mechanisms are at work in hysterical disorders:Primary gain: bodily symptoms keep internal conflicts out of conscious awarenessSecondary gain: bodily symptoms further enable people to avoid unpleasant activities or receive sympathy from others,27,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,The behavioral viewBehavioral theorists propose that the physical symptoms of hysterical disorders bring rewards to sufferersMay remove individual from an unpleasant situationMay bring attention from other people,28,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,In response to such rewards, people learn to display symptoms more and moreThis focus on rewards is similar to the psychodynamic idea of secondary gain, but behaviorists view the gains as the primary cause of the development of the disorderLike the psychodynamic explanation, the behavioral view of these disorders has received little research support,29,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,The cognitive viewSome cognitive theorists propose that hysterical disorders are a form of conversion and somatic symptom disorder, providing a means for people to express difficult emotions,30,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,Like psychodynamic theorists, cognitive theorists hold that emotions are being converted into physical symptomsThis conversion is not to defend against anxiety but to communicate extreme feelingsLike the other explanations, this cognitive view has not been widely tested or supported by research,31,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,The multicultural viewSome theorists believe that Western clinicians hold a bias that sees somatic symptoms as an inferior way of dealing with emotionsThe transformation of personal distress into somatic complaints is the norm is many non-Western culturesThe lesson to be learned from multicultural findings is that both bodily and psychological reactions to life events are often influenced by ones culture,32,Comer, Abnormal Psychology,8e DSM-5 Update,What Causes Conversion and Somatic Symptom Disorders?,A possible role for biologyThe impact of biological processes on somatoform disorders can be understood through research on placebos and the placebo effectPlacebos: substances with no known medicinal valueTreatment with placebos has been shown to bring improvement to many possibly through the power of suggestion but likely because expectation triggers the release of endogenous chemicalsPerhaps traumatic events and related concerns or needs can also trigger our “inner pharmacies” and set in motion the bodily symptoms of hysterical somatoform disorders,33,Comer, Abnormal Psychology,8e DSM-5 Update,How Are Conversion and Somatic Symptom Disorders Treated?,People with these disorders usually seek psychotherapy only as a last resort,34,Comer, Abnormal Psychology,8e DSM-5 Update,How Are Conversion and Somatic Symptom Disorders Treated?,Many therapists focus on the causes of the disorders and apply techniques including:Insight often psychodynamically orientedExposure client thinks about traumatic event(s) that triggered the physical symptomsDrug therapy especially antidepressant medication,35,Comer, Abnormal Psychology,8e DSM-5 Update,How Are Conversion and Somatic Symptom Disorders Treated?,Other therapists try to address the physical symptoms of these disorders, applying techniques such as:Suggestion usually an offering of emotional support that may include hypnosisReinforcement a behavioral attempt to change reward structuresConfrontation an overt attempt to force patients out of the sick roleResearchers have not fully evaluated the effects of these particular approaches on these disorders,36,Comer, Abnormal Psychology,8e DSM-5 Update,37,Comer, Abnormal Psychology,8e DSM-5 Update,Illness Anxiety Disorder,People with illness anxiety disorder, previously known as hypochondriasis, experience chronic anxiety about their health and are concerned that they are developing a serious medical illness, despite the absence of somatic symptoms,38,Comer, Abnormal Psychology,8e DSM-5 Update,Illness Anxiety Disorder,They repeatedly check their bodies for signs of illness and misinterpret bodily symptoms as signs of a serious illnessOften their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweatingAlthough some patients recognize that their concerns are excessive, many do not,Illness Anxiety Disorder,Although this disorder can begin at any age, it starts most often in early adulthood, among men and women in equal numbersBetween 1% and 5% of all people experience the disorderFor most patients, symptoms rise and fall over the years,39,Comer, Abnormal Psychology,8e DSM-5 Update,Illness Anxiety Disorder,Theorists explain this disorder much as they explain various anxiety disorders:Behaviorists: classical conditioning or modelingCognitive theorists: oversensitivity to bodily cues,40,Comer, Abnormal Psychology,8e DSM-5 Update,Illness Anxiety Disorder,Individuals with illness anxiety disorder typically receive the kinds of treatments applied to OCD:Antidepressant medicationExposure and response prevention (ERP)Cognitive-behavioral therapies,41,Comer, Abnormal Psychology,8e DSM-5 Update,Body Dysmorphic Disorder,People with this disorder, also known as dysmorphobia, become deeply concerned about some imagined or minor defect in their appearance Most often they focus on wrinkles, spots, facial hair, swelling, or misshapen facial features (nose, jaw, or eyebrows),42,Comer, Abnormal Psychology,8e DSM-5 Update,Body Dysmorphic Disorder,As many as half of people with this disorder seek plastic surgery or dermatology treatment, and often they feel worse rather than better afterwardMost cases of the disorder begin in adolescence but are often not revealed until adulthoodUp to 5 percent of people in the United States experience BDD, and it appears to be equally common among women and men,43,Comer, Abnormal Psychology,8e DSM-5 Update,Body Dysmorphic Disorder,Theorists typically account for BDD by using the same kinds of explanations both physical and psychological that have been applied to anxiety disorders and OCDSimilarly, clinicians typically treat clients with this disorder by applying the kinds of treatment used with OCD, particularly anti-depressant drugs, exposure and response prevention, and cognitive therapy,44,Comer, Abnormal Psychology,8e DSM-5 Update,Dissociative Disorders,The key to our identity the sense of who we are and where we fit in our environment is memoryOur recall of past experiences helps us to react to present events and guides us in making decisions about the futurePeople sometimes experience a major disruption of their memory,45,Comer, Abnormal Psychology,8e DSM-5 Update,Dissociative Disorders,When such changes in memory lack a clear physical cause, they are called “dissociative” disordersIn such disorders, one part of the persons memory typically seems to be dissociated, or separated, from the rest,46,Comer, Abnormal Psychology,8e DSM-5 Update,Dissociative Disorders,There are several kinds of dissociative disorders, including:Dissociative amnesiaDissociative identity disorder (multiple personality disorder)Depersonalization-derealization disorderThese disorders are often memorably portrayed in books, movies, and television programs,47,Comer, Abnormal Psychology,8e DSM-5 Update,Dissociative Amnesia,People with dissociative amnesia are unable to recall important information, usually of an upsetting nature, about their livesThe loss of memory is much more extensive than normal forgetting and is not cause