Somatoform, Dissociative, Personality, Mood, and Thought Disorders

Modules 42 and 43

Learning Objectives

l What are somatoform disorders and how do they differ from psychosomatic disorders?

l Describe the different dissociative disorders and why DID appears to be on the rise.

l What are the features and causes of mood disorders: depression and bipolar disorder?

l What are the five major symptoms of schizophrenia and what are its causes?

l What are the different types of personality disorders and what common features do they share?

Somatoform Disorders

l Physical ailments that cannot be explained by organic conditions and are mostly due to psychological causes

l The patient is not consciously faking or “malingering”

l Different from psychosomatic disorders

– True physical ailments, caused in part by psychological factors like stress

– Ulcers, high blood pressure

Somatoform Disorders

l Hypochondriasis

– Preoccupation with one’s health that is unwarranted

– Hop from MD to MD

– Overly sensitive to normal bodily sensations

– Also more physiologically reactive

– Reinforced by attention and sympathy from others

Somatoform Disorders

l Conversion Disorder

– Loss of function in a particular organ without a physical cause

– Loss of vision, paralysis of limb

– Freud – “anxiety converted into physical ailment”

– Glove anesthesia- ailment is not anatomically possible

– Expressed lack of concern about illness rather than defensiveness (seen in malingerers)

Etiology of somatoform disorders

l Histrionic personality

– Self-centered, excitable, dramatic

– Thrive on attention

l Cognitive factors

– Excessive attention on physiological processes

– Exaggerated sense of normal body function

Dissociative disorders

l Disorders in which people lose contact with conscious awareness or memory

l Dissociative amnesia

– Sudden loss of memory for important events that is too large to be normal

– Differs from organic amnesia due to traumatic brain injury

l Fugue state

– entire life and identity are forgotten

– May last for hours or years before awakening

Dissociative disorders

l Dissociative identity disorder

– Formerly, multiple personality disorder

– Existence of two or more distinct personalities

– More common among women than men

– Often, one alter does not know about the others

– Seems to be on the rise. Why?

l Savvy people faking for personal gain (the Hillside Strangler, Kenneth Bianchi)

l perhaps due to differences in how therapists diagnose

Etiology of dissociative disorders

l An extreme case of normal behavior?

– Dissociation when driving

l Dissociative fugues and amnesia are related to stress

l Is DID caused by therapists?

– Small number of therapists diagnose overwhelming majority of cases

l Is DID caused by sexual abuse?

Mood disorders

l Episodic emotional disturbances that disrupt physical, perceptual, social and thought processes

l Major depression

l Persistent feelings of sadness/despair

l Anhedonia - loss of interest in pleasure

l Feelings of worthlessness

l Problems sleeping and concentrating, restlessness

l Fatigue and slowness

l Suicidal ideation

– Age of onset is variable, women more likely

– Median = 4 depressive episodes

Mood Disorders

l Bipolar disorder

– Formerly called manic-depression

– Periods of mania and depression

– Mania includes

l Racing thoughts

l Delusions of grandeur

l Increased impulsivity (sex, gambling)

– Age of onset is 20’s

Etiology of Mood Disorders

l Genetic predisposition (twin studies), especially strong for bipolar disorder

l Neurochemical imbalances

– Norepinephrine and serotonin

– Deficit leads to depression, surplus leads to mania

l Cognitive explanations

– Learned helplessness

– Hopelessness caused by a pessimistic explanatory style

– Rumination about depression

– Are cognitions the cause or the effect?

l Poor social skills

Schizophrenic disorders

l Disturbed thought rather than mood

l Positive symptoms

– Delusions (false beliefs)

– Hallucinations (sensory experiences in the absence of external stimuli)

– Disorganized speech (word salad)

– Maladaptive behavior (personal hygiene)

l Negative symptoms

– Sometimes blunted or flat affect

Types of Schizophrenia

l Paranoid

– Delusions of persecution and grandeur

l Catatonic

– Motor disturbances (rigidity to random activity)

l Disorganized

– Disorganized thought and speech

– Severe deterioration of adaptive behavior

– Delusions about body functions

l Undifferentiated

Etiology of schizophrenia

l Genetic vulnerability (48% IT, 17% FT)

l Excess dopamine (positive symptoms)

– Antipsychotic drugs that block dopamine

– Amphetamines increase dopamine and symptoms

– Autopsies reveal excess dopamine receptors

l Neurological defects (negative symptoms)

– Lead to an inability to screen out unimportant sensory information

– Enlarged brain ventricles or small thalamus

l Diathesis-stress model (disposition + stress = S)

Personality disorders

l Extreme, inflexible personality that causes distress or impaired functioning

l Narcissistic personality disorder

– Exaggerated sense of self-importance

– Preoccupied with success

– Entitlement issues

l Borderline personality disorder

– Unstable self-image and relationships

– Fear of abandonment

– Boundary issues and splitting

Personality Disorders

l Antisocial personality

– Lack of concern with rights of others

– Rejection of social norms

– Manipulative and aggressive

– No remorse for transgressions

– Criminal behavior

– More likely in men

Abnormal behavior and the law

l Insanity and mental illness

– Insanity is a legal term, not psychological

l Does mental illness prevent the defendant from understanding the wrongfulness of his/her actions or conforming to the law

– Most mental disorders do not meet the legal definition of insanity

– Insanity defense is rarely used

l Involuntary commitment

– Dangerous to self or others