Modules in Abnormal Psychology First Semester S.Y.

2023-2024

ABNORMAL
PSYCHOLOGY
UNIT THREE
This chapter deals with the somatic symptoms related
CHAPTER 2 disorders and dissociative disorders. The chapter
Objectives commences with a definition and conceptualization
Self-Assessment # 10 of the disorders and presents the characteristic features of
Lesson Two: Somatic Symptoms somatic symptoms related disorder. This is followed by
Related and Dissociative Disorders types of somatoform disorders and causes of this disorder.
The type of treatment interventions are then taken up
and the v a r i o u s t r e a t m e n t i n t e r v e n t i o n s s u
Somatic Symptoms Related c h a s psychotherapy, cognitive behavior therapy etc. are
Disorders discussed. This is followed by detailed presentation of
Dissociative Disorders dissociative disorders and the types of these disorders, the
Self-Test # 12 causes and the various treatment interventions.

Learning Insights
Chapter Questions After completing this part you should be able to:
Suggested Readings 1. Define somatoform and dissociative disorders;
2. Describe the different types of these disorders;
3. Explain the etiology (causes) of these disorders; and
4. Describe the different types of treatment for these
disorders.

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2.2 Self-Assessment # 10
Somatic and Dissociative Disorders
Read the following account and reflect on the questions below.

Case 6
You are asked to see Conchita, a woman on a
general medical ward who has been an in-patient
for 5 days undergoing investigation for pain in her
loin. This was initially thought to be renal in origin,
but an IVU was negative for stones and no other
cause for her continued pain can be identified. In
addition, it has been noted that she has presented
to the hospital on a number of occasions over the
past year or so complaining of a wide variety of
symptoms and different pains for which no physical
cause has been identified. The medical team have
discussed these findings with the patient and told
her that they want to get a psychiatric opinion.

Thought Questions:
1. Based on what has been stated above, what must be your preferred diagnosis of
Conchita’s case?
2. What could be your treatment options?
3. What do you think would be the best predictors of a good case outcome
(prognosis)?

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2.3 LESSON 2: Somatic

Symptoms Related and

Somatic symptom and related disorders are mental health disorders

characterized by an intense focus on physical (somatic) symptoms that causes significant distress
and/or interferes with daily functioning. Most mental health disorders are characterized by mental
symptoms. However, in somatic symptom disorders, mental factors are expressed as physical
symptoms—a process called somatization—and the person's main concern is with physical
(somatic—from soma, the Greek word for body) symptoms, such as pain, weakness, fatigue,
nausea, or other bodily sensations.

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2.3.1 Somatic Symptoms and Related Disorders

The latest edition of DSM 5 has moved away from the need to have no medical
explanation in order to make the diagnosis of ‘medically unexplained symptoms’ and gain
access to appropriate treatment. The emphasis now is on symptoms that are substantially more
severe than expected in association with distress and impairment. The diagnosis includes
conditions with no medical explanation and conditions where there is some underlying pathology
but an exaggerated response.

A new category has therefore been created under the heading ‘Somatic Symptom
and Related Disorders’. This includes diagnoses of Somatic Symptom Disorder,
Illness Anxiety Disorder, Conversion Disorder, Factitious Disorder, and a variety of other
related conditions. The term ‘Hypochondriasis’ is no longer included. In two of the conditions
the absence of any medical pathophysiology is a criteria for diagnosis; these are Conversion
Disorder and Other Specified Somatic Symptom and Related Disorder (which includes
Pseudocyesis, a false belief of being pregnant that is associated with objective signs and
reported symptoms of pregnancy).

Somatic symptom and related disorders is the name for a group of conditions in
which the physical pain and symptoms a person feels are related to psychological factors. These
symptoms can’t be traced to a specific physical cause. In people who have a somatic
symptom and related disorders, medical test results are either normal or don’t explain the person’s
symptoms.

People who have this disorder may have several medical evaluations and tests to be sure
that they
don’t have another
illness. They often
become very worried
about their health
because they don’t
know what’s causing
their health problems.
Their symptoms are s
i m i l a r t o t h e
symptoms of other
illnesses and may last
for several years.
People who have a s
o m a t o f o r md
isorder are not
f a k i n g t h e i r
symptoms. The pain
that they feel is real.

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Somatic Symptom Disorder

1. Somatic Symptom Disorder (SSD) involves a person having a s i
g n i fi c a n t f o c u s o n p h y s i c a l
symptoms, such as pain, weakness or
shortness of breath, that results in
major distress and/or problems functioning. The individual has excessive thoughts, feelings and
behaviors relating to the physical symptoms. The physical symptoms may or may not be
associated with a diagnosed medical condition, but the person is experiencing symptoms and
believes they are sick (that is, not faking the illness).

A person is not diagnosed with somatic symptom disorder solely because a medical cause
can’t be identified for a physical symptom. The emphasis is on the extent to which the thoughts,
feelings and behaviors related to the illness are excessive or out of proportion.

Symptoms

◦ One or more physical symptoms that are

distressing or cause disruption in daily life
◦ Excessive thoughts, feelings or behaviors
related to the physical symptoms or health
concerns with at least one of the following:
• Ongoing thoughts that are out of
proportion with the seriousness of
symptoms
• Ongoing high level of anxiety about
health or symptoms
• Excessive time and energy spent on the
symptoms or health concerns
◦ At least one symptom is constantly present, although there may be different symptoms and
symptoms may come and go

People with SSD typically go to a primary care provider rather than psychiatrist or other
mental health professional. Sometimes it can be difficult for individuals with somatic symptom
disorder to understand that their concerns about their symptoms are excessive. They may continue
to be fearful and worried even when they are shown evidence that they do not have a serious
condition. SSD usually begins by age 30.

Treatment

Treatment for SSD is intended to help control symptoms and help the person function as
normally as possible. Treatment typically involves the person having regular visits with a trusted
health care provider. The provider can offer support and reassurance, monitor heath and symptoms
and avoid unnecessary tests and treatments. Psychotherapy (talk therapy) can help the individual
change their thinking and behavior, and learn ways to cope with pain or other symptoms, deal with
stress and improve functioning.

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Illness anxiety disorder

2. Illness Anxiety Disorder ( IAD ) i s a n e w t e r m f o r
hypochondriasis or hypochondria.
People diagnosed with IAD often believe
that despite having no, or just
moderate, symptoms, they have a severe or life-threatening disorder. And the worries of the IAD
patients are very important to them. Also if they go to doctors and there are no problems, they are
usually not convinced and their obsessions are not identified. IAD can also trigger worries in
people who do have a physical illness that they are sicker than they really are. The disorder is
not about the presence or absence of illness, but the psychological reaction.

Symptoms and Causes

Symptoms of IAD may include:

• Excessive worry over having or getting a serious

illness.
• Physical symptoms are not present or if present,
only mild. If another illness is present, or there is a
high risk for developing an illness, the person’s
concern is out of proportion.
• High level of anxiety and alarm over personal
health status.
• Excessive health-related behaviors (e.g., repeatedly
checking body for signs of illness) or shows
abnormal avoidance (e.g., avoiding doctors’
appointments and hospitals).
• Fear of illness is present for at least six months (but
the specific disease that is feared may change over
that time).
• Fear of illness is not due to another mental disorder.

The cause is not known, but certain factors may increase the risk of developing
IAD:

• Major life stress

• A severe symptom believed to threaten one’s health (e.g., chest pain, memory issues)
• History of childhood abuse (physical, sexual, emotional) or neglect
• History of childhood illness
• Having another mental disorder (e.g., major depression, anxiety, obsessive compulsive
disorders, psychotic disorders)

Treatments

The three goals of treatment for people with IAD are to:

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1. Continue to function as normally as possible

2. Ease mental distress
3. Stop overuse of medical services

The best way to achieve these goals depends a lot on

the patient’s preferences, and on the presence or absence of
other illnesses commonly associated with IAD. Cognitive-
behavioral therapy (a type of talk therapy) can help patients
learn to cope with IAD and lead more productive lives. For
some, medications for anxiety, depression, or other mental
disorders may help.

Functional neurologic
3. Functional Neurologic Disorders disorders — a newer and
broader term that includes what some
people call conversion
disorder — feature nervous
system (neurological) symptoms that can't be explained by a neurological disease or other
medical condition. However, the symptoms are real and cause significant distress or problems
functioning.

Signs and symptoms vary, depending on the type of functional neurologic disorder, and
may include specific patterns. Typically these disorders affect your movement or your senses,
such as the ability to walk, swallow, see or hear. Symptoms can vary in severity and may come
and go or be persistent. However, you can't intentionally produce or control your symptoms.

Symptoms

Symptoms of functional neurologic

disorders may vary, depending on the type of
functional neurologic disorder, and they're
significant enough to cause impairment and
warrant medical evaluation. Symptoms can affect
body movement and function and the senses
.
Signs and symptoms that affect body
movement and function may include:
• Weakness or paralysis
• Abnormal movement, such as tremors or
difficulty walking
• Loss of balance
• Difficulty swallowing or feeling "a lump in the
throat"

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• Seizures or episodes of shaking and apparent loss of consciousness (nonepileptic seizures)

• Episodes of unresponsiveness

Signs and symptoms that affect the senses may include:

• Numbness or loss of the touch sensation
• Speech problems, such as inability to speak or slurred
speech
• Vision problems, such as double vision or blindness
• Hearing problems or deafness

Treatments

There are a number of different treatments available to treat

and manage conversion syndrome. Treatments for conversion
syndrome include hypnosis, psychotherapy, physical therapy, stress
management, and transcranial magnetic stimulation. Treatment plans
will consider duration and presentation of symptoms and may
include one or multiple of the above treatments. This may include the
following:

1. Explanation. This must be clear and coherent as attributing physical symptoms to a

psychological cause is not accepted by many educated people in Western cultures. It must
emphasize the genuineness of the condition, that it is common, potentially reversible and
does not mean the sufferer is psychotic. Taking a neutral-cause- based stance by describing
the symptoms as functional may be helpful, but further studies are required. Ideally, the
patient should be followed up neurologically for a while to ensure the diagnosis has been
understood.
2. Physiotherapy where appropriate;
3. Occupational Therapy to maintain autonomy in activities of daily living;
4. Treatment of comorbid depression or anxiety if present.

Factitious disorder is a
4. Factitious Disorders mental disorder in which a person acts as
if he or she has a physical or mental illness.
People with factitious disorder deliberately
create or exaggerate
symptoms of an illness. They have an inner need to be seen as ill or injured. Factitious disorder is
considered a mental illness because it is associated with severe emotional difficulties and stressful
situations.

Factitious disorders are of two types:

• Factitious disorder imposed on self includes the falsifying of psychological or physical signs
or symptoms, as described above. An example of a psychological factitious disorder is
mimicking behavior that is typical of a mental illness, such as schizophrenia. The person may
appear confused, make absurd statements, and report hallucinations (the experience of
sensing things that are not there; for example, hearing voices).

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• Factitious disorder imposed on another: People with this disorder produce or fabricate
symptoms of illness in others under their care: children, elderly adults, disabled persons, or
pets. It most often occurs in mothers (although it can occur in fathers) who intentionally
harm their children in order to receive attention. The diagnosis is not given to the victim, but
rather to the perpetrator.

Possible warning signs of factitious

disorder include:

• Dramatic but inconsistent

medical history
• Unclear symptoms that are not
controllable, become more s e
v e r e , o r c h a n g e o n c e
treatment has begun
• Predictable relapses following
improvement in the condition
• E x t e n s i v e k n o w l e d g e of h
ospitalsand/ormedical
terminology, as well as the textbook
descriptions of illness
• Presence of many surgical scars
• Appearance of new or additional symptoms following negative test results
• Presence of symptoms only when the patient is alone or not being observed
• Willingness or eagerness to have medical tests, operations, or other procedures
• History of seeking treatment at many hospitals, clinics, and doctors’ offices, possibly even
in different cities
• Reluctance by the patient to allow healthcare professionals to meet with or talk to family
members, friends, and prior healthcare providers
• Refusal of psychiatric or psychological evaluation
• Forecasting negative medical outcomes despite no evidence of this
• Sabotaging discharge plans or suddenly becoming more ill as one is about to be
discharged from the hospital setting

Symptoms and Causes

People with factitious disorder may:

• Lie about or mimic symptoms

• Hurt themselves to bring on symptoms
• Alter diagnostic tests (such as contaminating a
urine sample or tampering with a wound to prevent
healing)
• Be willing to undergo painful or risky tests and
operations in order to obtain the sympathy and
special attention given to people who are truly medically ill.

Most people with this condition do not believe they have factitious disorder. They may
not be entirely aware of why they are inducing their own illness. Many people with

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factitious disorder may also suffer from other mental disorders, particularly personality or identity
disorders.

Treatments

The first goal of treatment is to change the person’s behavior and reduce his or her
misuse of medical resources. In the case of factitious disorder imposed on another, the main goal
is to ensure the safety and protection of any real or potential victims.

Once the initial goal is met, treatment aims to resolve any underlying psychological issues
that may be causing the person’s behavior.
The primary treatment for factitious disorder is psychotherapy (a type of counseling). Treatment
likely will focus on changing the thinking and behavior of the individual with the disorder
(cognitive-behavioral therapy). Family therapy also may help in teaching family members not to
reward or reinforce the behavior of the person with the disorder.

There are no medications to actually treat factitious disorder. Medication may be used,
however, to treat any related disorder, such as depression or anxiety.

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2.3.2 Dissociative Disorders

Dissociative Disorders can be defined as conditions that involve disruptions or

breakdowns of memory, awareness, identity and/or perception. People with dissociative disorders
use dissociation, a defense mechanism, pathologically and involuntarily. Dissociative disorders are
thought to primarily be caused by psychological trauma.

Dissociative disorders are mental disorders that involve experiencing a disconnection and
lack of continuity between thoughts, memories, surroundings, actions and identity. People with
dissociative disorders escape reality in ways that are involuntary and unhealthy and cause
problems with functioning in everyday life.

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Dissociative disorder could be described and understood using a combination of one

of five core symptoms:

• amnesia r e c u r r e n t m e m o r
y problems, often described as
"losing time", these gaps in memory
can vary from several minutes to
years
• depersonalization a sense of
detachment or disconnection from
one’s self, this can include feeling
like a stranger to yourself, feeling
detached from your emotions, feeling
robotic or like you are on autopilot, or
feeling like a part of your body does
not belong to you. Some people self-
injure when depersonalized, for
example in order to feel "real".
• derealization a s e n s e o f
disconnection from familiar people or
one’s surroundings, for example, close relatives or your own home may seem
unreal or foreign. Episodes of derealization may happen during flashbacks; you may
suddenly feel much younger and feel your present environment is unreal during this
time.
• identity confusion an inner struggle about one’s sense of self/identity, which may
involve uncertainty, puzzlement or conflict. Severe identity confusion regarding sexual
identity has been reported in people who have been sexually abused.
• identity alteration a sense of acting like a different person some of the time
Recognizable signs of identity alteration include using of different names in different
situations, discovering you have items you don't recognize, or having a learned skill which
you have no recollection of learning.

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Dissociative Amnesia.
1. Dissociative Amnesia Disorder The main symptom is memory loss that's
more severe than normal forgetfulness
and that can't be explained by a medical
condition. You
can't recall information about yourself or events and people in your life, especially from a
traumatic time. Dissociative amnesia can be specific to events in a certain time, such as intense
combat, or more rarely, can involve complete loss of memory about yourself.

CASE SAMPLE:

A
29-year-old female experienced the onset of dissociative amnesia during an academic trip to China. She was
found in a hotel bathroom unconscious, with no signs of structural or neurologic abnormalities or alcohol or
chemical consumption. The woman was sent home but could not
remember her name, address, family, or any facts about her home life. The amnesia persisted for nearly 10 months, until
the feeling of blood on the woman's fingers triggered the recollection of events from the night of onset of dissociative
amnesia, and, subsequently, other facts and events. The woman finally remembered having witnessed a murder that night
in China. She recalled being unable to help the victim out of fear for her own safety. She came to remember other
aspects of her life; however, some memories remain unretrievable.

It may sometimes involve travel or confused wandering away from your life
(dissociative fugue). An episode of amnesia usually occurs suddenly and may last minutes,
hours, or rarely, months or years.

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CASE SAMPLE:

C
ommonly, individuals who experience the onset of dissociative fugue are found wandering in a dazed or
confused state, unable to recall their own identity or recognize their own relatives or daily surroundings. Often,
they have suffered from some post-traumatic stress, as in the case of a 35-year-
old businessman who disappeared more than 2 years after narrowly escaping from the World Trade Center attack in
2001, leaving behind his wife and children. The man was missing for more than 6 months when an anonymous tip
helped police in Virginia identify him.

2. Dissociative Identity Disorder Dissociative Identity disorder.

Formerly known as multiple personality
disorder, this disorder is characterized by
"switching" to alternate identities. You
may feel the presence of two or more people talking or living inside your head, and you may feel
as though you're possessed by other identities. Each identity may have a unique name,
personal history and characteristics, including obvious differences in voice, gender, mannerisms
and even such physical qualities as the need for eyeglasses. There also are differences in how
familiar each identity is with the others. People with dissociative identity disorder typically also
have dissociative amnesia and often have dissociative fugue.

CASE SAMPLE:

I
n a case of dissociative identity disorder, a
woman who had been physically and sexually
abused by her father throughout her childhood
and adolescence exhibited at least 4
personalities as an adult. Each personality was
of a different age, representing the phases of
the woman's experience – a fearful child, a
rebellious teenager, a protective adult, and the
woman's primary personality. Only one of the
personalities, the protective adult, was
consciously aware of the others, and during
therapy sessions was realized to have been
developed to protect the woman during the
abusive experiences.
When one of the secondary personalities took
over, it often led to episodic dissociative
amnesia, during which the woman acted out
according to the nature of the dominating
personality. During intensive therapy sessions,
each personality was called upon as necessary
to facilitate their integration.

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3. Depersonalization-Derealization Depersonalization-Derealization
disorder. This involves an ongoing or
episodic sense of detachment or being
outside yourself — observing your
actions, feelings, thoughts and self from a distance as though watching a movie
(depersonalization). Other people and things around you may feel detached and foggy or
dreamlike, time may be slowed down or sped up, and the world may seem unreal
(derealization). You may experience depersonalization, derealization or both. Symptoms, which
can be profoundly distressing, may last only a few moments or come and go over many years.

CASE SAMPLE:

D
epersonalization disorder generally leads to observable distress in the affected individual. It often occurs in
individuals who are also affected by some other psychological nondissociative disorder, as in the case of a 19-
year-old college student who was suffering from sleep deprivation at the onset of
depersonalization disorder. The young man experienced increased anxiety as he struggled to meet his responsibilities as
a scholarship-dependent student athlete. Teammates expressed concern about his apparent distress to their coach who
arranged for the young man to speak with a therapist. The young man described feeling as though he were observing the
interactions of others as if it were a film. The young man's anxiety was determined to contribute to severe sleep
deprivation, which triggered episodes of depersonalization.

Causes

Dissociative disorders usually develop as a way to cope with

trauma. The disorders most often form in children subjected to
long-term physical, sexual or emotional abuse or, less often, a
home environment that's frightening or highly unpredictable.
The stress of war
or natural disasters also can bring on dissociative disorders.
Personal identity is still forming during childhood. So a
child is more able than an adult to step outside of
himself or herself and observe trauma as though it's
happening to a different person. A child who learns to
dissociate in order to endure a
traumatic experience may use this coping mechanism in
response to stressful situations throughout life.

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Treatments

Dissociative disorders treatment may vary based on the type of disorder you have, but
generally include psychotherapy and medication.

Psychotherapy

Psychotherapy is the primary treatment for

dissociative disorders. This form of therapy, also known
as talk therapy, counseling or psychosocial therapy,
involves talking about your disorder and related issues
with a mental health professional. Look for a therapist
with advanced training or experience in working with
people who have experienced trauma.

Your therapist will work to

help you understand the cause of your
condition and to form new ways of
coping with stressful circumstances.
Over time, your therapist may help you
talk more about the trauma you
experienced, but generally only when
you have the coping skills and
relationship with your therapist to
safely have these conversations.

Medication

Although there are no

medications that specifically treat
dissociative disorders, your doctor may
prescribe antidepressants, a n t i - a n
x i e t y m e d i c a t i o n s o r
antipsychotic drugs to help control the
mental health symptoms
associated with dissociative
disorders.

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Name: Year & Section:

IDENTIFY: A. Identify2.3.3 SELF-TEST

the following (7 pts.): # 12
1. Intentionally fake or greatly exaggerate their symptoms for some type of
external gain,

2. The alternation of two or more distinct personality states with impaired recall
among personality states.

3. Their symptoms are “pseudoneurological”, which means they suggest a

neurological cause but no such cause can be found.

4. Physical desertion of familiar surroundings and experience of impaired recall of

the past. This may lead to confusion about actual identity and the assumption of a new identity.

5. Preoccupied with the belief or fear that they have a serious medical condition.
Their belief or fear is triggered by their own misinterpretation of their physical symptoms or
bodily functions.

6. Noticeable impairment of recall resulting from emotional trauma.

7. Periods of detachment from self or surrounding which may be

experienced as "unreal" (lacking in control of or "outside of" self) while retaining
awareness that this is only a feeling and not a reality.

B. CASE STUDY (3pts.)

Dora the Explorer often temporarily loses her sense of personal identity and impulsively
wander or travel away from her home or place of work. She often become confused about who
she is and might even create new identities. Dora the Explorer can be diagnosed as having what
disorder?

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2.4 LEARNING INSIGHTS

Somatic and Dissociative disorders according to this provided algorithm can be
diagnosed:

Somatic and Dissociative Disorders

Presenting symptoms: unexplained neurological symptoms, pain, fear of having
a disease, fear of defect in appearance, intentional feigning of symptoms, and
other symptoms characterized by disruptions or breakdowns of memory,
awareness, identity or perception.

1. If multiple unexplained physical symptoms are present. Somatic Symptom

Disorder

2. If the symptoms include excessive preoccupation

with the fear of having a disease. Illness Anxiety Disorder

3. If the predominant symptom is an unexplained

apparently neurological symptom. Conversion Disorder

4. If psychological factors are playing a role in the onset, Psychological Factors

severity, or exacerbation of a medical symptoms or Affecting Other Medical
condition. Conditions

5. If the physical symptoms are being intentionally feigned

Somatic and
to deceived the clinician. Factitious Disorder

Dissociative
6. If symptoms characterized by at least two distinct and
relatively enduring identities or personality states that
alternately control a person's behavior, and is
accompanied by memory impairment for important Dissociative Identity
information not explained by ordinary forgetfulness. Disorder

7. If one or more episodes of inability to recall important

personal information, usually of a traumatic or stressful
nature and is too extensive to explained by ordinary
Dissociative Amnesia
forgetfulness (including a type of unexpected travel
away from home).

8. If persistent or recurrent experiences of feeling

detached from, and as if one is an outside observer of, Depersonalization/
one’s mental processes or body (e.g., feeling like one is in a Derealization Disorder
dream).

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2.5 CHAPTER QUESTIONS

1) Discuss the somatic symptoms related disorders.

2.) Define various somatoform disorders with their types .And also cite examples.

3) Difference between somatic symptoms related and dissociative disorders.

4) What are the causal factors of dissociative disorders.

2.6 SUGGESTED READINGS

Butcher, James, N. and Mineka, Susan & Hooley, Jill, M. (2006). Abnormal Psychology My
Psych Lab, MI.

Coleman, J.C. (2000). Abnormal Psychology And Modern Life. Allyn & Bacon, NJ

Sharpe, M., and A. C. D. C. Williams. 2002. Treating patients with somatoform pain disorder and
hypochondriasis. In Psychological Approaches to Pain Management: A Practitioner’s Handbook,
edited by D. C. Turk and R. J. Gatchel. New York: Guilford Press.

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