1. Dissociative & Somatoform Disorders DISORDER V. FAKING Malingering = faking bad - symptoms deliberate - for gain - not a disorder

2. Factitious Disorder = psychological need to lie -only for psychological gain -symptoms deliberate -a mental disorder

3. Ex. Munchausen’s Syndrome - lies for medical attention Munchausen by proxy - creating physical problems in another for medical attention

4. Somatoform Disorders = physical symptoms without physical basis -psychological disorder -may be gain -symptoms not deliberate**

5. Undiagnosed physical illness

6. Somatoform Disorders Physical complaints with no physical cause

7. 1. Conversion Disorder Freud: conflicts converted into sxs - women

8. Description Affects voluntary movement/sensation Identifiable stressors Not explained medically Not intentional Distress/impairment Decreasing incidence

9. Signs of conversion Sudden onset after stress La belle indifference Selective symptoms

10. Possible Causes Psychodynamic: 4 processes: 1) traumatic event --> impulse emerges 2) conflict is repressed

11. 3) anxiety increases, is “converted” into physical symptom - avoid anxiety(primary gain) 4) attention/sympathy & avoid tasks (secondary gain)

12. Learning Theory 1) traumatic event => escape/avoid 2) symptom develops 3) environment reinforces symptoms

13. Other: Personality type - histrionic

14. Treatment 1)Deal with stressor 2)Remove secondary gain 3)Teach reuse of body part

15. 2. Hypochondriasis Description -belief of serious illness (anxiety) -illness is long-term -misinterpret body symptoms -symptoms are wide-ranging -agree that reaction is excessive

16. “doctor shopping” distress/impairment men & women

17. Possible Causes Theoretical agreement faulty interpretation of sensations biological hypersensitivity learned focus on illness

18. Treatment Uncover unconscious conflicts Attack illness beliefs via cognitive-behavioral Support groups

19. 3. Somatization Disorder Description Multiple somatic complaints Most major body systems No physical basis

20. Concern = symptoms themselves, not illness Life revolves around symptoms Relating to others = symptoms Lengthy medical history Severe impairment Very rare - women

21. Possible Causes Childhood learning Identifiable stressor

22. Personality traits - insensitive to punishment - impulsive (short-term gains) - irresponsible - aggressive Women - socialization

23. Treatment Very difficult Reduce help-seeking behavior Increase independence No reinforcement for symptoms Teach more appropriate behavior

24. 4. Body Dysmorphic Disorder Description Perceived defect in appearance Imagined/exaggerated Face/head flaws

25. Difficulty controlling obsession Frequently check appearance Requests reassurance Plastic surgery Distress & life impairment

26. Prevalence unknown but probably common Men & women

27. Causes & Treatment Little known Related to OCD? - anxiety Surgery increases complaints

28. Dissociative Disorders Splitting off of a psychological function from rest of conscious mind

29. 1. Dissociative Identity Disorder (DID) Description 2+ distinct personalities Alternate control of body —> NOT INTEGRATED “Core” has amnesia

30. DID vs. Schizophrenia Does DID exist? (iatrogenic effects)

31. Indications of DID Amnestic periods Childhood abuse or trauma Unsuitable nickname Hypnotizability

32. 2. Dissociative Amnesia Loss of memory Traumatic event Lack of distress

33. 3. Dissociative Fugue Amnesia for identity Flight New life & identity Brief duration

34. 4. Depersonalization Disorder Recurrent detachment from self/body Observing self Good reality perception Distress

35. Possible Causes Childhood sexual abuse/trauma Self-hypnosis Biological vulnerability

36. Treatment Amnesia & fugue get better on own Resolve trauma Improve coping

37. Tx for DID Uncover & deal with trauma Hypnosis to remember Goal: integrate personalities