Psychopathology PSY311

Somatic Disorders:

Malingering: Intentionally faking illness to achieve some external gains, such as financial compensation,
lack of cooperation during the diagnostic process, marked discrepancy between the individual's
"claimed stress or disability" and "objective finding and observation“, lack of compliance with diagnostic
evaluation, treatment regimen and follow up care

Factitious Disorder (Munchausen Syndrome) a disorder in which a person feigns or induces physical
symptoms, typically for the purpose of assuming the role of a sick person

- Factitious Disorder Imposed on Self:

1. False creation of physical or psychological symptoms, or deceptive production of injury or
disease, even without external rewards for such ailments
2. Presentation of oneself as ill, damaged, or hurt
- Factitious Disorder Imposed on Another:
1. False creation of physical or psychological symptoms, or deceptive production of injury or
disease, in another person (victim) as ill, damaged, or hurt
2. Presentation of another person (victim) as ill, damaged, or hurt

Conversion Disorder: disorder in which a person’s bodily symptoms affect their voluntary motor and
sensory functions, but the symptoms are inconsistent with known medical diseases

1. Presence of at least one symptom or deficit that affects voluntary or sensory function
2. Symptoms are found to be inconsistent with known neurological or medical disease
3. Significant distress or impairment

Somatic Symptom Disorder: disorder in which people become excessively distressed, concerned, and
anxious about bodily symptoms they are experiencing, and their lives are disproportionately disrupted
by the symptoms

1. Person experiences at least one upsetting or repeatedly disruptive physical (somatic) symptom
2. Person experiences an unreasonable number of thoughts, feelings, and behaviour regarding the
nature or implications of the physical symptoms, including one of the following
a) Repeated, excessive thoughts about their seriousness
b) Continual high anxiety about their nature of health implications
c) Disproportionate amounts of time and energy spent on the symptoms on their health
implications
3. Physical symptoms usually continue to some degree for more than 6 months

Somatization Pattern: the individual experiences a large and varied number of bodily symptoms
(patients often go from doctor to doctor in search of relief, describe their symptoms in dramatic and
exaggerated terms, feelings of anxiety)

Predominant Pain Pattern: the individual’s primary bodily problem is the experience of pain (source of
pain may be known or unknown, concerns and disruption produced by the pain are disproportionate to
its severity and seriousness, often develops after an accident or illness that causes genuine pain)

Psychodynamic Theory Perspective:

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- Primary Gain: derived when their somatic symptoms keep their internal conflicts out of
awareness
- Secondary Gain: derived when their somatic symptoms elicit kindness from others or provide an
excuse to avoid unpleasant activities

Cognitive-Behavioural Theory Perspective: physical symptoms of these disorders yield important

benefits to sufferers (relationships, attention), in response to such rewards, the sufferers learn to display
the bodily symptoms more and more prominently

Disorder Voluntary Control of Symptoms Linked to Apparent Goal

Symptoms Psychosocial Factor
Malingering Yes Maybe Yes
Factitious Disorder Yes Yes No, except for medical
attention
Conversion Disorder No Yes Maybe
Somatic Symptom No Yes Maybe
Disorder
Illness Anxiety Disorder No Yes No
Psychophysiological No Yes No
Disorder
Physical Illness No Maybe No

Multicultural View: inappropriate to produce or focus excessively on somatic symptoms in response to

personal distress, inferior way of dealing with emotions

Treatment (Conversion & Somatic Symptom Disorder): psychotherapy, psychotropic drug therapy, or
both, may focus on the underlying causes of these disorders, use of exposure treatment, antidepressant
drugs, education, reinforcement, cognitive restructuring

Illness Anxiety Disorder: (hypochondriacs), a disorder in which people are chronically anxious about and
preoccupied with the notion that they have or are developing a serious medical illness, despite the
absence of somatic symptoms

1. Person is preoccupied with thoughts about having or getting a significant illness, person has no,
or mild somatic symptoms
2. Person has easily triggered high anxiety about health
3. Person displays unduly high number of health-related behaviours or dysfunctional health-
avoidance behaviours
4. Person’s concern continues to some degree for at least 6 months

Psychophysiological Disorders: (psychological factors affecting other medical conditions) disorders in

which biological, psychological, and sociocultural factors interact to cause or worsen a physical illness

1. Presence of a medical condition

2. Psychological factors negatively affect the medical condition by
- Affecting the course of the medical condition
- Providing obstacles for the treatment of the medical condition
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- Posing new health risks

- Triggering or worsening the medical condition

Bacterial and viral infections may also be caused by an interaction of psychosocial and physical factors

- Ulcers: lesion that forms in the wall of the stomach or of the duodenum
- Asthma: disease marked by narrowing of the trachea and bronchi, resulting in shortness of
breath, wheezing, coughing, and choking sensation
- Insomnia: difficulty falling or staying asleep
- Muscle Contraction Headache: (tension headache) headache caused by a narrowing of muscles
surrounding the skull
- Migraine Headache: very severe headache that occurs on one side of the head, often preceded
by a warning sensation, and sometimes accompanied by dizziness, nausea or vomiting
- Hypertension: chronic high blood pressure
- Coronary Heart Disease: illness of the heart caused by a blockage in the coronary arteries

Contributing Factors to Psychophysiological Disorders:

- Biological: defects in the autonomic nerve system (ANS)

- Psychological: (attitudes, emotions, or stressors) repressing coping style; reluctance to express
discomfort, anger, or hostility, Type-A personality style; personality pattern characterized by
hostility, cynicism, drivenness, impatience, competitiveness, and ambition, Type-B personality
style; personality pattern in which a person is more relaxed, less aggressive, and less concerned
about time
- Sociocultural: poverty, race, dangerous living environments

Psychoneuroimmunology: study of the connections between stress, the body’s immune system, and
illness

Immune System: the body’s network of activities between stress, the body’s immune system, and illness

Antigen: a foreign invader of the body, such as a bacterium or virus

Lymphocytes: white blood cells that circulate through the lymph system and bloodstream helping the
body identify and destroy antigens and cancer cells

Contributing Factors to Decreases in the Immune System:

- Biochemical: sympathetic nervous system, norepinephrine neurotransmitters, hypothalamic-

pituitary-adrenal pathway, cytokines
- Behavioural: poor sleep patterns or sleep health, poor nutrition, physical wellness, life habits
- Personality: poor responses to stress, hopelessness, poor coping styles, difficulty in emotional
expression
- Social Support: few social supports, feelings of loneliness

Psychological Treatments for Physical Disorders:

- Behavioural Medicine: psychological and physical interventions to treat or prevent medical

problems
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- Relaxation Training: treatment procedure that teaches individuals to relax so they can calm
themselves in stressful situations
- Biofeedback: technique in which a client is given information about physiological reactions as
they occur and learn to control the reactions voluntarily
- Electromyograph: device that provides feedback about the level of muscular tension in the body
- Meditation: technique of turning one’s concentration inward, achieving a slightly changed state
of consciousness, and temporarily ignoring all stressors (mantras, mindfulness meditation
- Hypnosis: guided by a hypnotist into a sleep-like, suggestible state during which they can be
directed to act in unusual ways, feel unusual sensations, remember seemingly forgotten events,
or forget remembered events
- Cognitive-Behavioural Interventions: self-instruction straining, stress inoculation training
- Support Groups: awareness and expression of emotions and needs
- Combination of Treatments

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Sexual Dysfunction: disorder marked by a persistent inability to function normally in some area of the
sexual response cycle (desire, excitement, orgasm, resolution), can be lifelong, acquired, generalized, or
situational

Desire Phase: phase of the sexual response cycle consisting of an urge to have sex, sexual fantasies, and
sexual attraction to others

Male Hypoactive Sexual Desire Disorder: male dysfunction marked by a persistent lack of interest in sex
and hence a low level of sexual activity

1. For at least 6 months, individual repeatedly experiences few or no sexual thoughts, fantasies, or
desires
2. Individual experiences significant distress about this

Female Sexual Interest/Arousal Disorder: female dysfunction marked by a persistent reduction or lack of
interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual
sensations during sexual activity

1. For at least 6 months, individual usually displays reduced or no sexual interest and arousal,
characterized by the reduction or absence of at least three of the following: sexual interest,
sexual thought or fantasies, sexual initiation or receptiveness, excitement or pleasure during
sex, responsiveness to sexual cues, genital or non-genital sensations during sex
2. Individual experiences significant distress about this

Excitement Phase: phase of the sexual response cycle marked by changes in the pelvic region, general
physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing

Erectile Disorder: dysfunction in which an individual with a penis fails to attain or maintain an erection
during sexual activity

1. For at least 6 months, individual usually finds it very difficult to obtain an erection, maintain an
erection, and/or achieve past levels of erectile rigidity during sex
2. Individual experiences significant distress about this
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Nocturnal Penile Tumescence (NPT): erection during sleep

Performance Anxiety: fear of performing inadequately and a related tension that are experienced during
sex

Spectator Role: state of mind that some people have during sex, focusing on their sexual performance to
such an extent that their performance and enjoyment are reduced

Orgasm Phase: phase of the sexual response cycle during which a person’s sexual pleasure peaks and
sexual tension is released as muscles in the pelvic region contract rhythmically

Premature Ejaculation: (early/rapid ejaculation) dysfunction in which a man persistently reaches orgasm
and ejaculates within 1 minute of beginning sexual activity with a partner and before he wishes to

1. For at least 6 months, individual ejaculates within 1 minute of beginning sex with a partner, and
earlier than they want to
2. Individual experiences significant distress about this

Delayed Ejaculation: dysfunction characterized by persistent inability to ejaculate or very delayed

ejaculations during sexual activity with a partner

1. For at least 6 months, individual usually displays a significant delay, infrequency, or absence of
ejaculation during sexual activity with a partner
2. Individual experiences significant distress about this

Female Orgasmic Disorder: dysfunction in which an individual with a vuvla persistently fails to reach
orgasm, has very low intensity orgasms, or has very delayed orgasms

1. For at least 6 months, individual usually displays a significant delay, infrequency, or absence of
orgasm, and/or is unable to achieve past orgasmic intensity
2. Individual experiences significant distress about this

Sexual Pain/Discomfort Disorders:

Genito-Pelvic Plain/Penetration Disorder: sexual dysfunction characterized by significant discomfort

during intercourse

1. For at least 6 months, individual repeatedly experiences at least one of the following problems:
difficulty having vaginal penetration during intercourse, significant vaginal or pelvic pain when
truing to have intercourse or penetration, significant fear that vaginal penetration will cause
vaginal or pelvic pain, significant tensing of the pelvic muscles during vaginal penetration
2. Individual experiences significant distress about this
- Usually a learned fear response, set off by the expectation that intercourse will be painful and
damaging. Factors that can set the stage for this fear: anxiety and lack of information about
intercourse, trauma caused by an unskilled sexual partner, trauma of childhood sexual abuse or
adult

Dyspareunia: recurrent and persistent genital pain during sexual intercourse but no structural genital
abnormality to account for the pain, individuals typically enjoy sex and experience arousal, however
experience severe pain (can be a result after childbirth, injury to the vagina or pelvic ligaments, scar
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from episiotomy), other factors include penis colliding with remaining parts of the hymen, vaginal
infections, wiry pubic hair rubbing against the labia during intercourse, pelvic diseases, tumors, cysts,
allergic reactions to chemicals in vaginal douches and contraceptive creams, rubber in condoms and
diaphragms, and the protein in semen, and psychological factors; heightened anxiety, overattentiveness
to one’s body

Sexual Dysfunction Therapy/Treatments: assessing and conceptualizing the problem, mutual

responsibility, education about sexuality, emotional identification, attitude change, elimination of
performance anxiety/spectator role, increasing sexual and general communication skills, changing
destructive lifestyles and couple interactions, addressing physical and medical factors

- Desire Disorder: affectual awareness, self-instruction training, hormone treatments

- Erectile Disorder: reducing performance anxiety, increase stimulation, tease technique, sildenafil
(viagra), tadalafil (cialis), vardenafil (levitra)
- Premature Ejaculation: stop-start or pause procedure, SSRI’s
- Delayed Ejaculation: reduce performance anxiety, increase stimulation
- Female Orgasmic Disorder: hormone therapy, directed masturbation training
- Genito-Pelvic Pain/Penetration Disorder: tightening and relaxing vaginal muscles, exposure
treatment, dilators, botox, pain management procedures, sex therapy techniques, medical
interventions

Paraphilias: patterns in which a person has recurrent and intense sexual urges, fantasies, or behaviors
involving nonhuman objects, children, nonconsenting adults, or experiences suffering or humiliation

- Many people with a paraphilia can become aroused only when a paraphilic stimulus is present,
fantasized about, or acted out, others need the stimulus only during times of stress or under
other special circumstances
- Initial pairing of stimulus and arousal (may be accidental or vicarious), lack of alternative sexual
reinforcement opportunities and skills for relating appropriately to others, inappropriate sexual
fantasies, and behaviour, increasing their frequency and intensity, development of paraphilia

Paraphilic Disorder: disorder in which a person’s paraphilia causes great distress, interferes with social
or occupational activities, or places the person or others at risk of harm, either currently or in the past

1. For at least 6 months, individual experiences recurrent and intense sexually arousing fantasies,
urges, or behaviors involving objects or situations outside the usual sexual norms (nonhuman
objects; non-genital body parts; the suffering or humiliation of oneself or one’s partner; or
children or other nonconsenting persons)
2. Individual experiences significant distress or impairment over the fantasies, urges, or behaviors.
(In some paraphilic disorders—pedophilic disorder, exhibitionistic disorder, voyeuristic disorder,
frotteuristic disorder, and sexual sadism disorder—the performance of the paraphilic behaviors
indicates a disorder, even in the absence of distress or impairment.)

Fetishistic Disorder: paraphilic disorder consisting of recurrent and intense sexual urges, fantasies, or
behaviors that involve the use of a nonliving object or non-genital part, often to the exclusion of all
other stimuli, accompanied by clinically significant distress or impairment
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Transvestism/Cross-Dressing: paraphilic disorder consisting of repeated and intense sexual urges,

fantasies, or behaviors that involve dressing in clothes of the opposite sex, accompanied by clinically
significant distress or impairment

Exhibitionistic Disorder: paraphilic disorder in which persons have repeated sexually arousing urges or
fantasies about exposing their genitals to others, and either act on these urges with nonconsenting
individuals or experience clinically significant distress or impairment

Voyeuristic Disorder: paraphilic disorder in which a person has repeated and intense sexual desires to
observe unsuspecting people in secret as they undress or to spy on couples having intercourse, and
either acts on these urges with nonconsenting people or experiences clinically significant distress or
impairment

Frotteuristic Disorder: paraphilic disorder in which a person has repeated and intense sexual urges or
fantasies that involve touching and rubbing against a nonconsenting person, and either acts on these
urges with the nonconsenting person or experiences clinically significant distress or impairment

Pedophilic Disorder: paraphilic disorder in which a person has repeated and intense sexual urges or
fantasies about watching, touching, or engaging in sexual acts with children, and either acts on these
urges or experiences clinically significant distress or impairment (classic type, hebephilic type,
pedohebephilic type)

Sexual Masochism Disorder: paraphilic disorder in which a person has repeated and intense sexual
urges, fantasies, or behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer,
accompanied by clinically significant distress or impairment

Sexual Sadism Disorder: paraphilic disorder in which a person has repeated and intense sexual urges or
fantasies that involve inflicting suffering on others, and either acts on these urges with nonconsenting
individuals or experiences clinically significant distress or impairment

Paraphilic Treatments: aversion therapy, masturbatory satiation, social-skill training, insight therapy

- Electroshock/Ammoniac: administered while the person imagines their object of desire

- Cover Sensitization: people are guided to imagine the pleasurable object and repeatedly pair
this image with an imagined aversive stimulus until the object of sexual desire/pleasure is no
longer desired
- Masturbatory Satiation: person masturbates to orgasm while fantasizing about a sexually
appropriate object, then switches to fantasizing about fetishistic objects while masturbating
again and continues the fetishistic fantasy for an hour, meant to produce a feeling of boredom,
which becomes linked to the fetishistic object

Gender Variations:

Transgender: Individuals who have a strong sense that their gender identity is different from their birth
anatomy

Gender Dysphoria: disorder in which a person persistently feels clinically significant distress or
impairment due to his or her assigned gender and strongly wishes to be a member of another gender
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1. For 6 months or more, an individual’s gender-related feelings and/or behaviors are at odds with
those of his or her assigned gender, as indicated by two or more of the following symptoms:
gender-related feelings and/or behaviors clearly contradict the individual’s primary or secondary
sex characteristics, powerful wish to eliminate one’s sex characteristics, yearning for the sex
characteristics of another gender, powerful wish to be a member of another gender, yearning to
be treated as a member of another gender, firm belief that one’s feelings and reactions are
those that characterize another gender
2. Individual experiences significant distress about this

Gender Affirming Healthcare/Surgery: hormone replacement therapy, face-changing plastic surgery,

breast augmentation, genital reconstruction (MTF), bilateral mastectomy, chest reconstruction,
hysterectomy, genital reconstruction (FTM)