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39 Cards in this Set

  • Front
  • Back

Dissociative Disorder

(& major diss. disorders)

Dissociative disorder – A disorder characterized by disruption, or dissociation, of identity, memory, or consciousness.

major dissociative disorders include:

1. dissociative identity disorder(DID, formally multiple per. disorder),

2. dissociative amnesia,

3. depersonalization disorder.

• In each case, there is a disruption or dissociation (“splitting off ”) of the functions of identity, memory, or consciousness that normally make us whole.

-Usually brought on by trauma

-maladaptive ways of managing anxiety! (neurosis)

Dissociative identity disorder

A dissociative disorder in which a person has two or more distinct, or alter, personalities.

• two or more personalities—each with well-defined traits and memories—“occupy” one person.

Ex: the film The Three Faces of Eve.

Don't get confused with:

-Schiz - distorting in thought processes, etc (misperceptions in reality, hallucinations(sensory percept.), delusions(maladaptive beliefs)

-DID - alter personality(2 or more)

Features of DID

• In some cases, the host (main) personality is unaware of the existence of the other identities, whereas the other identities are aware of the existence of the host.

-host = legal name, dominant person

-alters can vary in age, gender, sexual orientation, ethincies, eyes, additions, allergies

• In other cases, the different personalities are

completely unaware of one another.

• Sometimes the personalities vie for control of the person.

-goal in treatment is to integrate the alters


• Although multiple personality is generally

considered rare, the very existence of the disorder continues to arouse debate.

• Many professionals express profound doubts about the diagnosis.

• Only a handful of cases worldwide were reported from 1920 to 1970, but since then the number of reported cases has skyrocketed into the thousands.

(higher prevalence rate of DID in the US/ sometimes called culture-bound)


Dissociative Amnesia

A dissociative disorder in which a person experiences memory loss without any identifiable organic cause.

(organic cause ex: brain cancer) (^without cause)

• Unlike some progressive forms of memory

impairment, the memory loss in dissociative amnesia is reversible, although it may last for days, weeks, or even years.

Dissociative amnesia (divided into type of memory problems)

• Dissociative amnesia is divided into five distinct types of memory problems:

1. Localized amnesia: events associated with a specific incident

2. Selective amnesia: particular type around a traumatic event

3. Generalized amnesia: forgetting entire life

4. Continuous amnesia: no memory, from one pt to another

5. Systematized amnesia: forgetting particular categories of information

Malingering: falsely claiming amnesia to get away from something/ some responsibly

Dissociative Fugue

A rare subtype of dissociative amnesia is

characterized by fugue, or “amnesia on the run.”

fugue meaning "flight" (like fugitive)

People in a fugue state may suddenly flee from their life situations, travel to a new location, assume a new identity, and have amnesia for personal information.


A temporary loss or change in the usual sense of reality in which people feel detached from themselves and their surroundings.


A sense of unreality about the external world involving odd changes in the perception of one’s surroundings or in the passage of time.

Depersonalization/derealization disorder

A disorder characterized by persistent or recurrent episodes of depersonalization and/or derealization.

Culture-Bound Dissociative Syndromes

• Similarities exist between the Western concept of dissociative disorder and certain culture-bound syndromes found in other parts of the world.

• example, amok is a culture-bound syndrome primarily in southeast Asian and Pacific Island cultures that describes a trancelike state in which a person suddenly becomes highly excited and violently attacks other people or destroys objects.

• People who “run amuck” may later claim to have no memory of the episode or recall feeling as if they were acting like a robot.

Psychodynamic Views

dissociative disorders involve the use of repression, resulting in the “splitting off” from consciousness of unacceptable impulses and painful memories.

-may be seen as and adaptive function of dissociating conscious self from awareness of traumatic experiences (or other pain/conflict)

-EGO protects itself from anxiety by blotting out disturbing memories

Social-Cognitive Theory

View dissociative disorders as a learned response involving the behavior of psychologically distancing oneself from disturbing memories or emotions.

Some social-cognitive theorists (such as

Nicholas Spanos) believe that dissociative identity disorder is a form of role-playing acquired through observational learning and reinforcement.

Brain Dysfunction

Is dissociative behavior be connected with underlying brain dysfunction?

structural differences in brain areas involved in memory and emotion between patients with dissociative identity disorder (DID) and healthy


differences in brain metabolic activity between people with depersonalization disorder and healthy subjects

irregularity in brain functioning during sleep

Diathesis-Stress Model

certain personality traits, (such as proneness to fantasize, high ability to be hypnotized, and openness to altered states of consciousness,) may predispose individuals to develop dissociative experiences in the face of extreme stress, such as traumatic abuse in childhood.

predisposion ---- stressor --- diss disorder

Treatment of Dissociative Disorders

Dissociative amnesia and fugue are usually fleeting experiences that end abruptly.

Episodes of depersonalization can be recurrent and persistent, and are most likely to occur when people are undergoing periods of mild anxiety or

depression. (must try to calm them down)

treating dissociative identity disorder focuses on integrating the alter personalities into a cohesive personality structure.

The therapists may seek to help patients uncover and work through memories of early childhood trauma.(long term treatment)

Somatic Symptom


Related Disorders

Soma = body

• Somatic symptom and related disorders Disorders characterized by complaints of physical problems or symptoms that cannot be explained by physical causes or have excessive concern about the nature or meaning of the symptoms. (there is no medical explanation!)

• The concept of somatoform disorder presumes that the physical symptoms reflect psychological factors.

-underlying psychological issue!



-6 or more months

-ass. with personal distress

-interference with day to day functioning

-physical pain

Somatic symptom disorder (SSD)

Troubling physical symptoms and excessive concern about the symptoms to the extent that it affects thoughts, feelings, and behaviors in daily life.

• Diagnosis emphasizes psychological features, not whether the underlying cause or causes of the symptoms can be medically explained.

• People with SSD may have concerns that last for

years and become a source of continuing frustration for themselves, their families, and their physicians

-doctor shopping: you can't figure it to, so I'm going to another doc


people with physical complaints who believe their symptoms are due to a serious, undetected illness despite medical reassurance to the contrary.

-no longer a distinct diagnosis in DSM-5.

-believed to affect about 1% to 5% of the general population, and about 5% of patients seeking medical care

illness anxiety disorder (IAD)

The DSM-5 introduced a new diagnostic category of illness anxiety disorder (IAD) to apply to a

subgroup of people with hypochondriasis who

complain of relatively minor or mild symptoms they take to be signs of a serious undiagnosed illness.

(place emphasis on the anxiety they have)

• The emphasis is placed on the anxiety associated with illness rather than the distress the symptoms cause.

• Two general subtypes of the disorder are the care-avoidant subtype(don't go to hospital) and the care-seeking subtype(always going to hospital)

Conversion disorder

characterized by symptoms or deficits that affect the ability to control voluntary movements or that impair sensory functions, such as an inability to see, hear, or feel tactile stimulation.

(ex: fantom limb)

AKA: functional neurological symptom disorder in the DSM-5

-Believed to involve the conversion or transformation of emotional distress into significant symptoms in the motor or sensory domain

-Physical symptoms usually come on suddenly in stressful situations, suggesting a psychological connection

Factitious disorder (AKA

Münchausen syndrome)

characterized by intentional fabrication of psychological or physical symptoms for no apparent gain.

(diff from malingering)


The faking of illness motivated by external rewards or incentives.

​(trying to get out of responsibility)

Factitious disorder imposed on another (popularly referred to as Münchausen syndrome by proxy)

The inducing of physical or emotional illness in another person, typically a child or dependent person.

-without trying to get any type of gain

Koro syndrome (on test!)

A culture-bound somatoform disorder, found primarily in China, in which people

fear that their genitals are shrinking.

• Koro is considered a culture-bound syndrome,

although some cases have been reported outside China and the Far East.

Dhat syndrome

A culture-bound somatoform disorder, found primarily among Asian Indian males, characterized by excessive fears over the loss of seminal fluid.

-Some men with this syndrome also believe (incorrectly) that semen mixes with urine and is excreted through urination.

Psychodynamic Theory (know diff between primary & secondary gains)

According to psychodynamic theory, hysterical symptoms are functional:

– They allow the person to achieve primary gains and secondary gains:

– The primary gain of the symptoms is to allow the individual to keep internal conflicts repressed.

Secondary gains from the symptoms are those that allow the individual to avoid burdensome responsibilities and to gain the support—rather than condemnation—of those around them.

Learning Theory

• Learning theorists focus on the more direct reinforcing properties of the symptom and its secondary role in helping the individual avoid or escape anxiety-evoking situations.

(usually positive reinforcement: adding something to increase behavior. Ex: attention)

• From the learning perspective, the symptoms in conversion and other somatoform disorders may also carry the benefits, or reinforcing properties, of the “sick role.”

• Some learning theorists link hypochondriasis and body dysmorphic disorder to obsessive–compulsive disorder.

Cognitive Theory

• Cognitive theorists have speculated that some cases of hypochondriasis may represent a type of self handicapping strategy, a way of blaming poor performance on failing health

• Cognitive theorists speculate that hypochondriasis and panic disorder, which often occur together, may share a common cause: a distorted way of thinking that leads the person to misinterpret minor changes in bodily sensations as signs of pending catastrophe

wandering Uterus


-treatment: get married (calm uterus)

previous belief

Brain Dysfunction

fiill in

Treatment of Somatoform Disorders

• The treatment approach that Freud pioneered,

psychoanalysis, began with the treatment of hysteria, which is now termed conversion disorder.

• Psychoanalysis seeks to uncover and bring

unconscious conflicts that originated in childhood into conscious awareness.

• Once the conflict is aired and worked through, the symptom is no longer needed and should disappear.

-free association


Treatment of Somatoform Disorders

• The behavioral approach to treatment focuses on removing sources of secondary reinforcement (or secondary gain)(the attention you are getting from others) that may become connected with physical complaints.

Cognitive-behavioral therapy has achieved good results in hypochondriasis, which is now classified as a somatic symptom disorder or illness anxiety disorder. (removing thoughts)

Psychological Factors Affecting

Physical Health

fill in

Psychosomatic disorders

Physical disorders in which psychological factors are believed to play a causal or contributing role.


• Headaches are symptoms of many medical disorders.

• When they occur in the absence of other symptoms, however, they may be classified as stress-related.

• By far the most frequent kind of headache is the tension headache.

cause of headaches


tension headaches: may be increased sensitivity of the neural pathways that send pain signals to the brain from the face and head.

Migraines headaches: may involve an underlying central nervous system disorder involving nerves and blood vessels in the brain. (SSRI can be used as treatment)


stay away from certain triggers

fill in

2 Treatments for migrainheadaches

1. idk

2. Biofeedback (BFT)