1. Somatization Disorder
    Persons with this disorder present with multiple complaints of physical ailments over a long period. Also known as Briquet's Syndrome.

    • Diagnosis of Somatization Disorder requires reporting of symptoms in four categories:
    • 1.Pain
    • 2. Gastrointestinal
    • 3.Sexual
    • 4. Pseudoneurological (suggestive of a neurological condition but without basis; examples include paralysis, difficulty swallowing, loss of sensation, or dissociation)
  2. Malingering
    Deliberate faking of a physical or psychological disorder motivated by gain. Type of factitious disorder.
  3. Somatization disorder vs Hypochondriasis
    Hypochondriasis: Onset can be at any age. The key feature is an abnormal concern that one has or is developing a serious illness. These persons may not claim particular symptoms but are often preoccupied with health and avoidance of germs.

    Major Differences between Somatization Disorder and Hypochondriasis

    • Characteristic Somatization Disorder Hypochondriasis
    • Focus of complaint Symptoms Implication of symptoms, i.e., hidden disease

    Style of complaint Vague but colorful Precise but affectless

    Interaction with clinician Attentive, seductive, grateful, trusting Demanding, ungrateful, unreassurable

    Age 20s-30s 30s-40s

    Sex ratio Usually female Balanced or slightly more often male

    Physical appearance Often attractive Often unattractive

    Personality style Hysteroid (dramatic, excitable) Obsessive
  4. Pain disorder
    Manifests with significant pain without physical basis or with pain that greatly exceeds what is expected on the basis of injury.
  5. Conversion disorder
    There is sensory/motor dysfunction in the absence of a physical basis. These persons tend to present with numbness of limbs, limb paralysis, speech problems, blindness or hearing loss.
  6. La Belle Indifference
    This refers to the tendency of these persons to appear relatively unconcerned about the physical problem, quite in contrast to the concern shown by persons with similar physical problems that are truly medical. This idea may not be supported.
  7. Pseudoneurologic Manifestation
    The sensory/motor loss does not follow neurological function (e.g., glove anesthesia). The loss may come and go with stress/functional need. For example, when the patient is startled or suddenly awakened, the loss may be briefly gone.
  8. Body Dysmorphic Disorder
    A preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect. For diagnosis, the preoccupation must cause significant impairment in the individual's life, with the person thinking about the defect for at least an hour per day.
  9. Dissociation
    The loss of the ability to access information normally in consciousness.
  10. Amnesia
    Amnesia refers to loss of recall. Retrograde amnesia refers to loss of memory for events prior to onset of amnesia (problems of memory access). Antereograde amnesia refers to inability to form new memories (problem of memory formation).
  11. Psychogenic Amnesia
    Refers to memory loss in the absence of organic cause, essentially always retrograde in form.

    Psychogenic amnesia can vary in specificity of memory lost and in time frame. Types include:

    • -Localized: Can't remember what happened during a specific (usually short) period of time.
    • -Selective: Forgets some, but not all of what happened during a specific period.
    • -Generalized: Loss of memory for entire life.
    • -Continuous: Remembers nothing beyond a certain point.
  12. Fugue
    Involves flight to new surroundings without others knowing. In fugue, individuals may "find" themselves days to years later in a new place wondering how they got there.
  13. Depersonalization and Derealization
    Depersonalization: a sense that you or the world around you is not real

    Derealization: a sense that the world is distorted, unstable, or indistinct.
  14. Dissociative Identity Disorder
    Formerly known as "Multiple Personality Disorder," it was changed to more clearly emphasize the dissociative element and to appease critics who challenged the idea that the "alters" were actually complete personalities (like another being lurking inside a person). The essential idea, however, is that the person presents with a "host" or core personality and "alters" which have important critical differences. Usually the host presents as completely unaware of the alters, who may or may not be aware of the host and each other. As few as one alter can be present, but the average in diagnosed persons is about 15.
  15. Three kinds of alter awareness of it's host
    • 1. Inferential: Most indirect, based solely on inference from "signs" of other personalities.
    • 2. Mnestic: More direct in that one personality has access to another's memory traces.
    • 3. Perceptual: One personality claims to be "co-conscious" of another, i.e., aware and able to observe.
  16. Prominent Symptoms in DID, by Gender
    SYMPTOMS Female% Male%

    Depressions 90 78

    Amnesias 85 64

    Dazed states 83 50

    Nightmares 83 59

    Suicide attempts 81 77

    Multiple phobias 75 59

    Severe anxieties or panics 69 61

    Early sexual abuse 60 27

    Auditory hallucinations 54 45

    Headaches 50 36

    Early physical abuse 40 32
  17. Autobiographical memory
    Memory of:

    • 1. Self (name, address, occupation)
    • 2. People in one's life (names, visual recognition)
    • 3. Personalized past experiences (loss of history)
  18. Primary gain v Secondary gain
    Primary: Freudian notion that anxiety reduction is the principal reinforcement obtained for the display of psychological symptoms.

    Secondary: Additional reinforcers beyond primary gain that a person may obtain by the display of symptoms. These may include attention, sympathy, and avoidance of unwanted responsibilities.
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chapter 9