1. Other Disorders (Module 69)
By: Ruby Gary, Michela Marchini, Eelia Shaw, Connie Walden, Jacqueline Xu

2. Somatic Symptom Disorder
A psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause
aka “somatoform disorder”
Patient displays physiological symptoms that cannot be scientifically explained by any known physical or mental illness.
Pain, stomach problems, headaches, etc. Besides pain, extremely varied
They are not faking it: their experiences are legitimate!
Diagnoses are made based on cognitive symptoms, including:
Anxiety, rumination, worry about death
Often co-morbid with anxiety & mood disorders
May be caused by excess stress or over-sensitivity to regular bodily function

3. Conversion Disorder
A disorder in which a person experiences very specific [neurological] genuine physical symptoms for which no physiological basis can be found
Related to SSD
Neurological symptoms without apparent neurological cause
Blindness, numbness, paralysis, non-epileptic seizures
Indifference to symptoms
More common in the past than today
Thought to be caused by psychological stressors, though no longer a diagnostic criteria

4. Illness Anxiety Disorder (aka hypochondriasis)
A disorder in which a person interprets normal physical sensations as symptoms of a disease
Reinforced by sympathy and temporary relief from everyday demands
Reassurance by physician cannot convince the patient that he/she does not have a serious illness

5. Dissociative Disorders
Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings
Dissociation itself is pretty common
May protect people from being overwhelmed by emotion
presumes repression
i.e. Dissociative Identity Disorder
Person appears to experience a sudden loss of memory or change in identity, usually because of a stressful situation
Vietnam veteran who worked at the World Trade Center, left his office shortly before 9/11 attack, one day disappeared on his way to work, discovered 6mo later in Chicago, with no memory of identity or family
Feeling separated from their body or having an out-of-body experience
Feeling like you aren’t acting yourself
Multitasking: performing an action while thinking about something else

6. Dissociative Identity Disorder (DID)
A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities
Formerly known as “multiple personality disorder”
Person displays dissociative amnesia
Original personality denies awareness of others
Believed to be due to childhood trauma
In 90% of cases, there is history of abuse in childhood
These personalities alternately control behavior - each with its own voice and mannerisms. EX quiet/serious one moment, loud/bantery the next. Typically: Each personality denies awareness of others, and the person also displays dissociative amnesia -- cannot remember certain events that occurred while in a diff personality state, beyond wht can be explained by forgetfulness

7. Controversy: Dissociative Identity Disorder (DID)
Skeptics question whether DID is a genuine disorder, or just an extension of our normal capacity for personality shifts
Studies by Nicholas Spanos (1986, 1994, 1996) on college students
DID is very localized in time and space
: 2 diagnoses per decade
1980s (post-DSM listing): 20,000 reported cases
Almost only in North America
“Role playing” for fantasy-prone people?
DSM - The Diagnostic and Statistical Manual of Mental Disorders -- the same phenomenon in an earlier module of giving a disorder a name
“possessed” by an alien spirit in other cultures
Very rare in Britain “wacky american fad”
In India and Japan, it is essentially nonexistent (or at least unreported).
SAME ISSUE - SOME CULTURES DONT RECOGNIZE PSYCH DISORDERS!!!

8. Controversy: Dissociative Identity Disorder (DID)
Other researchers and clinicians believe DID is a legitimate disorder
Distinct brain and body states with differing personalities
Handedness
Shifting visual acuity and eye-muscle balance
Heightened brain activity in areas associated with control/inhibition of traumatic memories
Possibly method to cope with anxiety or under the umbrella of PTSD
“A natural protective response” to the histories of childhood trauma
The distinct states did NOT occur with simulation of DID

9. Eating Disorders Anorexia nervosa Bulimia nervosa
an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly (15 percent or more) underweight
Bulimia nervosa
an eating disorder in which a person alternates binge eating (usually of high-calorie foods) with purging (by vomiting or laxative use), excessive exercise, or fasting
Binge-eating disorder
significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa
Anorexia - characterized by an obsession with losing weight and a fear of gaining weight or getting fat, see themselves as fat no matter how much weight they lose
Bulimia - binge-purge cycle, purge can be in form of fast, purge or excessive exercise, often have bouts of anxiety and depression during/after binges, easier to hide because weight fluctuations are often within/above normal range

10. Eating Disorders Causes and Stats
Influences of the family environment
Genetic influences
Societal influences
Statistics
9 out of 10 people who have anorexia are female
At some point in their lifetime:
0.6 percent of people meet the criteria for anorexia
1 percent of people meet the criteria for bulimia
2.8 percent of people meet the criteria for binge-eating disorder
Family - mothers of ppl with eating disorders focus on own/child’s weight, families of bulimia patients have higher than usual childhood obesity/low self image, families of anorexia patients v competative/high-achieving
Genetic - identical twins more likely to both have an eating disorder than fraternal
Cultures have different standards of beauty, Western countries that idealize thinness are much more prone to eating disorders, gay men and women are also most likely to have eating disorders--they also have lowest body satisfaction

11. Personality Disorders
→ psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning.
There are 10 types, grouped into three categories:
Suspicious (Paranoid, Schizoid, Schizotypal, *Antisocial*)
Emotional/Impulsive (Borderline, Histrionic, Narcissistic)
Anxious (Avoidant, Dependant, Obsessive Compulsive)

12. Antisocial Personality Disorder
→ A personality disorder in which a person exhibits a lack of conscience for wrongdoing, even toward friends and family members.
The DSM-5 defines it as including three or more of the following traits:
Regularly breaks or flouts the law
Constantly lies and deceives others
Is impulsive and doesn’t plan ahead
Can be prone to fighting/aggression
Little regard for the safety of others
Irresponsible (ex. financially)
Lack of remorse or guilt
One of the most concerning of the ten personality disorders is Antisocial Personality Disorder (referred to as ASPD)
The key here is the lack of remorse towards friends and family members––criminality is not inherently a part of ASPD. What differentiates a lot of criminals, murderers, etc. from people suffering from ASPD is the fact that they still have remorse for people in their lives. People with ASPD do not.

13. Antisocial Personality Disorder
3% men, 1% women
Becomes clear before age 15
Indicators in children:
Little ANS arousal
Lower stress levels
Slow to develop conditioned fears
Unconcerned with social rewards
Lack a sense of social responsibility
“Antisocial”–– what does this mean, and what are the behavioral implications?
Uncommon! Only 0.6% of the population
Firstly, it is usually a male
Behaviors consistent with ASPD in children include…
If one is going to continue to develop it, that is usually clear before age 15
Indicators include…
Little autonomic nervous system arousal as they await aversive events (in one study, this was illustrated through electric shocks)
Lower levels of stress hormones
Slow to develop conditioned fears (**)
Children who are unconcerned with social rewards, and lack a sense of social responsibility
Examples of sensationalized evil characters (ask the class)

14. Antisocial Personality Disorder –– Biopsychosocial
Multiple genes
Hyper-reactive dopamine reward system
Twin and adoptive studies have confirmed genetic link
Genes predispose children to be more sensitive to maltreatment
Those exposed to BOTH a premature birth and an unstable family were twice as likely to commit a crime
Reduced activity in the frontal lobes
11% less frontal lobe tissue
Reduced activity in response to others’ displays of distress
Not a single gene––molecular geneticists have identified a few that are usually present
One of these includes those that upset neurotransmitter balance, including a hyper-reactive dopamine reward system, which predisposes being impulsive
twin/adoptive studies have confirmed the presence of a genetic link
Looking at it from a biopsychosocial perspective, there is the general consensus that genes predispose children to be more sensitive to maltreatment
Thus, abuse of children who are genetically predisposed to ASPD or its symptoms accelerates its development
For example, in one study, compared to either coming from biological risk factors at birth (premature) OR unstable family, those that experienced BOTH were at double the risk of committing a crime
In analyzing the brains of 41 murderers, those who were violent and repeat offenders (more likely falling under the umbrella of ASPD) had 11% less tissue in the frontal lobes and less activity there (What does the frontal lobe do? Organization, decision making, etc)
They also had much less brain activity in response to images/expressions of distress in others
(Mirror neurons!)

15. Psychopathy v. Sociopathy
“Hot headed sociopath, cold hearted psychopath.”
Both suffer from ASPD, lack empathy/remorse/guilt, violent, narcissism
→ Sociopaths are spontaneous, impulsive, erratic; origins are in their nurture 1% of the gen. population Issues with one’s conscience
→ Psychopaths are much more controlled, highly manipulative and calculated 4% of the gen. population, 93% are in the criminal justice system Total lack of a conscience

16. Psychopathy In the Media
When combined with keen intelligence and amorality, we get the sensationalized evil characters common in popular culture.
The Joker (Batman)
Patrick Bateman (American Psycho)
Hannibal Lecter (Manhunter, Silence of the Lambs)
→ All of these, however, are overwhelmingly dramaticized. According to Belgian psychiatry professor Samuel Leistedt, the most accurate representation was Anton Chigurh in No Country for Old Men (show clip!)
Out of the 126 that they found (watching 400 movies from 1950 to 2014), this was the most realistic
Yes, the others are scary and maniacal
But Chigurh embodies it in a terrifyingly realistic way––totally devoid of any emotion or response, completely cold blooded.
→ differences between sociopathy and psychopathy
“Hot headed sociopath, cold hearted psychopath” (impulsive, violent, dramatic v. cold and calculating, manipulative, entirely emotionless)
Both lack empathy and a conscience, but psychopathy is much more intense/extreme