Study Guide

Somatic and Dissociative Disorders

o Malingering- Intentional production or exaggeration
of symptoms to receive tangible rewards
Fraudulent workers or military compensation
Avoiding military service or work.
o When someone is faking
Factitious disorder- Intentional production of
symptoms to receive benefits of playing the
sick role
No other tangible roles
o Factitious disorder imposed on another
Munchausens syndrome by proxy
Person seeking medical care has
intentionally produced medical/
psychiatric illness in someone under
his/her care.
Somatic Symptom Disorders
o Soma= body
o Have bodily symptoms suggesting a medical
problem, but no obvious medical explanation is
available.
o No control over symptoms
o Not faking

o Hypochondriasis(Hypochondria)
Preoccupation with disease
In the future
Current and undiagnosed
Misinterpretation of bodily signs
Ex. Headache= Brain tumor
Epidemiology
2% of general medical patients M=F
Early adult onset, Chronic course w/
fluctuating severity
Comorbid mood disorders, panic disorders,
other somatic disorders.
o Somatization Disorder
Many physical complaints before age 30 and
lasting for several years, no physical
explanation
4 pain symptoms
1 sexual symptom
2 gastrointestinal
1 neurological type
Arbitrary long list
Treatment: Medical management-- regular
visits with a physician, conservative medical
testing and treatments fewer healthcare
costs

o Pain Disorder
Persistent, severe pain in 1+ areas, not feigned
or intentionally produced
Medical condition can contribute, but
psychological factors are more important
Acute (<6 mos.) or chronic
F>M, comorbid anxiety/mood disorders
Vicious cycle! Inactivity, withdrawal
depressionloss of endurance and physical
strength
Prevalence-no estimates, rare
Easier to Treat-Relaxation, Validation,
Scheduling activities, cognitive restructuring.
o Illness Anxiety Disorder
Mildest forms of DSM-IV hypochondriasis would
now be diagnosed as this in DSM 5
Preoccupation with having/ acquiring a serious
illness-disproportionate to risk
Somatic symptoms mild/not present
Performs excessive health-related behaviors
(checking) or maladaptive avoidance
Persistent- at least 6 mnths

o Conversion Disorder
One or more symptoms: Altered sensory
functioning, voluntary motor functioning
Ex: Numbness, blindness, paralysis,
fainting, fits
No medical basis on examination
Not better explained by another disorder
Distress/ Impairment La Belle indifference
Freud: Anxiety converted into physical
symptoms
RARE: .005%, higher in neurology clinics
Declining in prevalence Education
Ex: Glove Paralysis
Loss of feeling (and motor control) from
the wrist down
Does not match function of cranial (spinal)
nerves.

 Dissociative Disorders
o Disruption in normally integrated functions of
Consciousness
Memory
Identity or
Perception
o 3 Disorders
Depersonalization/ De-realization Disorder
Persistent, Recurrent experience of 1:
o Depersonalization- Unreality with
respect to self (Ex: out of body
experience, distorted sense of time)
o De-realization- Unreality or
detachment with respect to
surroundings
(Ex: other people/objects feel
unreal, dreamlike, foggy)
Other reality testing remains in
tact
o Dissociative Amnesia
Inability to recall
acutobiographical info usually of
stressful or traumatic nature, not
normal forgetting.
Two presentations: Selective
amnesia for specific events or
general amnesia for identity
Includes cases of dissociative
fugue

 Running away and forming a

new identity

o Dissociative Identity Disorder

Formerly known as MPD
(multiple personality disorder)
Identity disruption- 2+
personality states (identities)
cause discontinuity in sense of
self
Not normal forgetting, recurrent
gaps in
Recall of everyday events
Important personal
information
And/or traumatic events
DID models and Controversies
Post traumatic model: Some
prone to dissociate in
trauma- thought to be a key
factor in the development of
alters following trauma.
Sociocultural model: DID
results from learning to
enact social roles; Alters
appear in response to
therapists suggestions
(iatrogenic) Exposure to
media reports of DID, etc.
These patients are impaired
but symptoms emerge after
treatment begins

o Increases in DID
overtime
o DID symptoms can be
role played
o Detection differs by
clinician

 Personality Disorders
o Among the most difficutl to treat and to get people
into treatment
o Controversies
Personality disorders in DSM 5
DSM 5 personality disorders almost looked
very different
Provides diagnoses for 6 PDs and Drops 4
PDs
American psychiatric Assoc. Board of
trustees vetoed it.
o Made the new plan an alternative
model
Old DSM-IV Axis II
DSM-IVs 5 axis system no longer in DSM 5
o Clinical Disorders
o MR- personality disorders
o Medical conditions
o Psychosocial stressors
o Rating of Global Effective Functioning
IN DSM-IV- Axis II
o PDs diagnosed separately from major
mental disorders
o Not in DSM 5

o Personality Traits vs. Disorders

Traits- Characteristic patterns of thinking
feeling and behaving; fairly stable across time
and context
Disorders- When traits are inflexible and
maladaptive (i.e., causes significant
impairment/ distress)
o Trait Model
Negativity affectivity vs emotional stability
Interpersonal detachment vs extraversion
Antagonism vs Agreeableness
Disinhibition vs. Conscientiousness
Psychoticism vs lucidity
o Personality Disorders: DSM 5 Criteria
Essential features
Enduring pattern of inner experience and
behavior markedly deviant from the
individuals culture.
Pattern is inflexible and pervasive
Impairment/distress
Stable and of long duration
o Personality Disorder Clusters
Based on descriptive similarity
Not empirically validated
Co-morbidity is common
2 or 3 PDs is more common that 1 PD

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 Suggests invalidity of distinct categories

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 Cluster A: Odd/ Eccentric

o Paranoid, Schizoid, Schizotypal
o Paranoid PD
Distrustful and suspicious of others
Interpret others motives as malevolent
Hostile, feel victimized, alienated
Perceive threats in a very benign event
Potentially violent if paranoid ideas
threatened.
E.g., survivalists, cult members,
totalitarian dictators
<2.5% of population, M>F
o Schizoid PD
Lack of interest in social relationships and
restricted range of affect
Appear cold and aloof
Dont desire or enjoy close relationships
(loner)
Lack of interest in sex or most activities
Indifferent to what others think of them
Similar to negative symptoms of
schizophrenia
o <1% ; M>F

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o Schizotypal PD
Pervasive social and interpersonal deficit and
cognitive/ perceptual distortions, eccentricities
Superstitious or magical thinking
Ideas (not full delusions) of reference
Unusual perceptual experiences
Odd speech/ behavior/ appearance
Excessive social anxiety
Strong familial (15%) in 1st degree relatives of
schizophrenics (3% in general pop)
Schizophrenia spectrum
Cluster B- Dramatic & Erratic
o Borderline PD- Pattern of instability in interpersonal
relationships, self-image, affect and marked
impulsivity
Frantic efforts to avoid abandonment
Unstable, intense relationships
Idealization devaluation
Identity disturbance
Impulsivity (self-damaging)
Suicidality; self mutilating behavior
Affective labiality; anger problems
Feelings of emptiness
Dissociated symptoms
2% of population, 20% in psychiatric settings

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 Sex ratio: Predominantly female (75%)

Familial Patterns
Increased risk of substance use disorders,
mood disorders and ASPD
Treatment
Dialectal behavior therapy (emotion
regulation)
Research
Marsha Linehan-DBT
Cognitive behavior therapy to harsh and
judgmental
New a dialectal (parallel ideas): seems
to contradict but balances out
o Histrionic PD
Patter of excessive emotionally and attentionseeking needs to be center of attention
Dramatic and theatrical behavior
Rapidly shifting and shallow emotions
Sexually provocative and seductive
Uses appearance to draw attention
Constantly searching for compliments
o Narcissistic PD-Grandiosity, need for admiration,
and lack of empathy
Grandiose sense of self-importance
Sense of entitlement
Interpersonally exploitative (ego centric)

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 May become violent if achievements are

unnoticed
Narcissistic range
Envious of others success
One hypothesized etiology
Psychodynamic theory/Freudian
Person harbors deep self-consciousness
Vanity is a defense mechanism to protect
a fragile psych (one group)
Another group does not seem to do so
o The Anti social personalities
Best researched PDs
Only disorders where research appreciably predates DSM-III
Terminology
Anti-social personality Disorder (ASPD)
o In DSM-IV
Psychopathic personality (Psychopathy)
o Not in DSM-IV
Sociopath
o Not in DSM-IV
o Often used as a synonym for ASPD or
psychopath

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o ASPD
Must be 18 for a diagnosis
Not exclusively during psychotic or manic
episodes
Especially linked to early-onset conduct
disorder
Late onset tends to desist
Prevalence
Males (3%)
Females (1%)
o Psychopathy
Harvey Cleckly (1941): The mask of Sanity
Good reasoning abilities (not psychotic or
low IQ)
Well adjusted (not depressed, anxious or
suicidal)
Charming, entertaining
Unemotional, callous
Psychopath vs ASPD (unemotional vs rule
breaking)
Not currently an official DSM disorder
Psychopathys focus on personal traits and
emotional deficits
o Difficult to diagnose reliably deal with
motivations and internal states
Since DSM III

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o Akin to common criminality

o More reliably measured, less valid
o Implemented behavioral
o Criteria of ASPD
o Examples of Psychopaths
Ted Bundy
John Wayne Gacy
o Prevalence
Prison vs general pop
o Successful psychopaths
Possess core personality traits but avoid
arrest and conviction
Protective factors (e.g., Intelligence)
Might have psychopathic traits but to a
lesser degree than others
2 main concepts
Emotional detachment
Antisocial behavior
o High on factor 1 but low on 2
Endowed with core benefits better socialized.
Low fear hypothesis
Lykken (1957): Psychopaths are
individuals low in trait fear who are poorly
socialized while growing up
o Low fear and poorly socialized:
Psychopath

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o Low fear and socialized: heroes,

leaders

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 Cluster C: Anxious, Fearful

o Avoidant PD
Pattern of social inhibition, feelings of
inadequacy and hypersensitivity to negative
evaluation
Low self esteem
Avoid jobs, relationships (unless secure)
Huge fears of rejection
Few close relationships
o Experience loneliness and longing for
interaction
Essentially social phobia.
o Dependent PD
Key feature-pervasive and excessive need to
be taken care of
Submissive and clingy
Need others to make decisions
Feelings of inadequacy when alone
Goes to extreme lengths to obtain
nurturance and maintain relationships
Frequently encountered in mental clinics.

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 Obsessive Compulsive PD (OCPD)

Preoccupation with orderliness,
perfectionism and control
Preoccupied with details, rules, lists
Perfectionism interferes with task
completion
Excessively devoted to work
Over conscientious
Hoarding possibility
Need control
Stingy with $
Not the same as OCD as these are not true
obsessions and compulsions
PD Diagnostic issues
o Reliability and Validity
Poor reliability
Validity research limited
Clinically: sometimes tough to diagnose until
after multiple sessions
o High co morbidity: Several PD diagnoses more
common than just one.
Gender Bias: Some personality disorders may
be extreme versions of negative gender
stereotypes

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