Solution Manual For Abnormal Psychology 18th Edition Jill M Hooley Matthew Nock James Butcher

Solution Manual for Abnormal Psychology, 18th
Edition, Jill M Hooley, Matthew Nock, James Butcher
To download the complete and accurate content document, go to:

https://testbankbell.com/download/solution-manual-for-abnormal-psychology-18th-edit
ion-jill-m-hooley-matthew-nock-james-butcher/
Solution Manual for Abnormal Psychology, 18th Edition, Jill M Hooley, Matthew Nock, James Bu
Abnormal Psychology 18e, Hooley/Butcher
Chapter 8: Somatic Symptom and

Dissociative Disorders
Learning Objectives
8.1 List four disorders included in the DSM-5 category of somatic symptom and related
disorders.
8.2 Explain the causes of and treatments for somatic symptom disorder.
8.3 Identify the key difference between illness anxiety disorder and somatic symptom disorder.
8.4 Summarize the clinical features of conversion disorder, also noting its prevalence, causes,
and treatment.
8.5 Explain the difference between factitious disorder and malingering.
8.6 List three DSM-5 dissociative disorders.
8.7 Summarize the clinical features of depersonalization/derealization disorder.
8.8 Describe the clinical features of dissociative amnesia.
8.9 Describe the clinical features of dissociative identity disorder and explain why this disorder
is so controversial.
8.10 Describe the cultural factors, treatments, and outcomes in dissociative disorders.
Chapter Overview/Summary
Somatic symptom disorder and related disorders lie at the interface of abnormal psychology and
medicine. These are disorders in which psychological problems are manifested in physical
symptoms. In response to the symptoms the person also experiences abnormal thoughts, feelings,
and behaviors. Included in the category of somatic symptom and related disorders are somatic
symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder. Somatic
symptom disorder occurs in individuals who have multiple somatic complaints lasting at least 6
months. Even if the symptoms do not seem to have a medical explanation, the person’s suffering
is regarded as authentic.
The psychoanalytic perspective on somatic symptom disorder views physical symptoms as
resulting from unresolved or unacceptable unconscious conflicts. Instead of being expressed
directly, psychic energy is channeled into physical problems, which are more socially acceptable.
A more current perspective is cognitive-behavioral. According to this formulation, people with
somatic symptom disorder are hypervigilant, focusing a great deal of attention on their bodies
and on bodily changes. They also have a tendency to label bodily sensations as somatic
symptoms, attributing physical sensations to illness. This is combined with excessive worry about
1
Copyright © 2020, 2017, 2014 Pearson Education, Inc. All rights reserved.
Visit TestBankBell.com to get complete for all chapters

what the symptoms mean, leading to catastrophizing cognitions. Because of their worries, people
become very distressed and seek medical attention for their perceived physical problems.
Cognitive-behavioral therapy is helpful for patients with somatic symptom disorder and
related disorders. Cognitive aspects of the treatment focus on assessing beliefs about illness and
modifying misinterpretations of bodily sensations. Behavioral techniques might include having
the patient induce innocuous symptoms by intentionally focusing on parts of the body to learn
the role that selective perception and hypervigilance play. Patients might also be directed to
engage in response prevention and told not to check their bodies as they usually do. In addition
to CBT, medical management may provide some further benefits. Having one physician who
integrates the patient’s care, sees the patient regularly, and accepts all symptoms as valid, but
who also avoids unnecessary diagnostic testing can be helpful in some cases. For somatic
symptom disorder that involves pain, treatment generally includes relaxation training, support
and validation that the pain is real, scheduling of daily activities, cognitive restructuring, and
reinforcement of “no-pain” behaviors. Antidepressant medications are also sometimes used.
Illness anxiety disorder and somatic symptom disorder are similar in many ways. However,
in somatic symptom disorder symptoms must be present. In contrast, illness anxiety disorder is a
diagnosis that can be used for individuals who are very anxious about having an illness even
though they may have no symptoms.
Conversion disorder involves patterns of symptoms or deficits (such as loss of vision or
paralysis) that affect sensory or voluntary motor functions. Although the clinical problem
suggests a medical or neurological condition, medical examination reveals no physical basis for
the symptoms. Approximately 20 percent of patients with conversion disorder show very little of
the anxiety or concern that might be expected given their symptoms. This is known as la belle
indifférence. Conversion disorders are found in approximately 5 percent of people treated at
neurology clinics. The prevalence in the general population is thought to be very low (no more
than 0.005 percent), although the exact prevalence is unknown. Conversion disorders are thought
to develop in response to extreme stress that the person is unable to cope with. They are more
prevalent in women, and most commonly occur between early adolescence and early adulthood.
The physical problems often resolve if the stressor is removed and the person receives support
and encouragement, although recurrence is quite typical.
Individuals with factitious disorder intentionally produce medical or psychological symptoms
(or both). They do this in the absence of external rewards in order to take on an illness role.
Malingering involves the intentional production of symptoms or the exaggeration of symptoms.
This is motivated by external factors such as a wish to claim insurance money, avoid work or
military service, or to get leniency in a criminal prosecution.
Dissociative disorders occur when the processes that normally regulate awareness and the
multichannel capacities of the mind apparently become disorganized, leading to various
anomalies of consciousness and personal identity. Three dissociative disorders included in DSM-
5 are depersonalization/derealization, dissociative amnesia, and dissociative identity disorder.
Depersonalization/derealization disorder occurs in people who experience persistent and
recurrent episodes of derealization (losing one’s sense of reality of the outside world) and/or
depersonalization (losing one’s sense of oneself and one’s own reality). Despite this, reality
testing overall remains intact and the person has good awareness of what is happening to her or
him. In DSM-IV, derealization and depersonalization were treated as two distinct conditions. In
DSM-5 they have been combined. The lifetime prevalence of depersonalization/derealization
disorder is 1 to 2 percent. Equal numbers of males and females are affected. The disorder can
2
start in childhood. However, the typical age of onset is around age 16 with only a minority of
people over age 25 developing the disorder. There are no established and effective treatments for
depersonalization/derealization disorder. The disorder usually has a fairly chronic course with
little or no fluctuation in intensity. Comorbid conditions include mood or anxiety disorders.
Rates of avoidant, borderline, and obsessive-compulsive personality disorders are also higher in
people with depersonalization and derealization experiences.
Dissociative amnesia involves an inability to recall previously stored information that cannot
be accounted for by ordinary forgetting. It is thought to be a reaction to extremely stressful
circumstances. The memory loss is primarily for episodic or autobiographical memory. Other
aspects of memory generally remain intact. In rare cases a person may retreat from real-life
problems by going into an amnesic state called a dissociative fugue, in which a person is not only
amnesic for some or all aspects of his or her past but also departs from home surroundings.
Dissociative fugue is a subtype of dissociative amnesia.
In dissociative identity disorder, the person manifests at least two or more distinct identities
that alternate in some way in taking control of behavior. Alter identities may differ in many ways
from the host identity. DID is controversial for many reasons. Not everyone believes it is a real
disorder. Some famous cases of DID have been faked and the disorder has been used as a
defense by people accused of serious crimes. Currently, there is no way of detecting “true” DID
from simulated DID. Of course, this does not mean we can conclude that genuine cases of DID
do not exist. There is also controversy about how DID develops. According to posttraumatic
theory, DID develops as a result of severe childhood trauma. Sociocultural theory, in contrast,
maintains that the disorder gets shaped by clinicians who inadvertently encourage patients to
adopt multiple different roles. These then become reinforced with increased attention.
By adding pathological possession to the diagnostic criteria for DID, DSM-5 now
acknowledges the role of cultural factors more explicitly. It is recognized that culture may shape
how DID presents clinically. Including possession and nonpossession forms of DID makes the
diagnosis more culturally inclusive. Other culturally influenced conditions, such as amok, also
have a dissociative component.
The treatment for DID is typically psychodynamic and insight oriented. Hypnosis is also
often used. The focus is on uncovering and working through the trauma and other conflicts that
are thought to have led to the disorder. Little is known about how to treat
derealization/depersonalization disorders. In the case of dissociative amnesia, removing the
person from what he or she perceives as a threatening situation sometimes allows for
spontaneous recovery of memory.
3
Detailed Chapter Outline

INTRODUCTION
1. When concern about somatic symptoms is severe and leads to significant distress
or impairment, a somatic symptom disorder may be diagnosed.
2. When feelings of “being out of it” become so persistent and recurrent that the
person has profound and unusual memory deficits, the diagnosis of dissociative
disorder may be warranted.
3. In the past, somatic symptom disorders (formerly somatoform disorders) and

dissociative disorders were considered to be forms of neurosis.
I. SOMATIC SYMPTOM AND RELATED DISORDERS: AN OVERVIEW
Learning Objective 8.1: List four disorders included in the DSM-5 category of somatic
symptom and related disorders.
1. The category of somatic symptom and related disorders is new to DSM-5.
2. Soma means body. People with somatic symptom disorders experience bodily
symptoms that cause them significant psychological distress and impairment.
3. The four most important disorders in the somatic symptom and related
disorders category are (1) somatic symptom disorder, (2) illness anxiety disorder,
(3) conversion disorder, and (4) factitious disorder.
II. SOMATIC SYMPTOM DISORDER
Learning Objective 8.2: Explain the causes of and treatments for somatic symptom
disorder.
1. Somatic symptom disorder is regarded as the most major diagnosis in its category.
2. The new diagnosis includes several disorders that were previously considered to
be separate in DSM-IV. The old disorders of hypochondriasis, somatization
disorder, and pain disorder are gone. Most people who would have previously
been diagnosed with one of these disorders will now be diagnosed with somatic
symptom disorder.
3. For the diagnosis to be made, individuals must be experiencing chronic somatic

symptoms that are distressing to them. They must also be experiencing
dysfunctional thoughts, feelings, and/or behaviors; this is a new psychological
component. In DSM-5, only one somatic symptom is required.
4
4. Estimates are that the prevalence of somatic symptom disorder in the general
population will be around 5 to 7 percent.
5. It is very likely that the diagnostic criteria for somatic symptom disorder will be
modified over time.
A. Causes of Somatic Symptom Disorder
1. It was long thought that symptoms developed as a defense mechanism against

unresolved or unacceptable unconscious conflicts. Current views take a much
more cognitive-behavioral approach.
2. Several different models exist, but their core features tend to be quite similar: (1)
There is a focus of attention on the body. In other words, the person is
hypervigilant and has an increased awareness of bodily changes. (2) The person
tends to see bodily sensations as somatic symptoms, meaning that physical
sensations are attributed to illness. (3) The person tends to worry excessively
about what the symptoms mean and has catastrophizing cognitions. (4) Because
of this worry, the person is very distressed and seeks medical attention for their
perceived physical problems.
3. Experimental studies show that these individuals have an attentional bias for
illness-related information. In other words, top-down (cognitive) processes, rather
than bottom-up processes (such as differences in bodily sensations), seem to
account for the problems that they have
4. An individual’s past experiences with illness contribute to the development of a

set of dysfunctional assumptions about symptoms and diseases that may
predispose a person to developing a somatic symptom disorder.
5. Negative affect is regarded as a risk factor. Other characteristics that may be

important are absorption and alexithymia.
6. Research shows that when people who report a lot of physical problems are put
into a negative mood, their reporting of physical symptoms increases.
7. Patients are more likely to be female and to have high levels of comorbid
depression and anxiety.
8. Somatic symptom disorders may be maintained to some degree by secondary

reinforcements.
9. People with somatic symptom disorders are not malingering (consciously faking
symptoms to achieve a specific goal such as winning a personal injury lawsuit).
5
B. Treatment of Somatic Symptom Disorder
1. The cognitive-behavioral model provides a good explanation of the causes of

somatic symptom disorders. Unsurprisingly, then, cognitive-behavioral treatments
are widely used to treat these disorders.
2. Treatment would focus on assessing the patient’s beliefs about illness and
modifying misinterpretations of bodily sensations.
3. Techniques might include having the patient induce innocuous symptoms by

intentionally focusing on parts of the body to learn that selective perception of
bodily sensations could play a major role in symptoms.
4. Sometimes patients are also directed to engage in response prevention by not

checking their bodies as they usually do and by stopping their constant seeking of
reassurance.
5. Cognitive-behavioral techniques are also widely used in the treatment of somatic

symptom disorder that involves pain. Treatment programs generally include
relaxation training, support and validation that the pain is real, scheduling of daily
activities, cognitive restructuring, and reinforcement of “no-pain” behaviors.
III. ILLNESS ANXIETY DISORDER
Learning Objective 8.3: Identify the key difference between illness anxiety disorder and
somatic symptom disorder.
1. Illness anxiety disorder is new to DSM-5. People with this disorder have high
anxiety about having or developing a serious illness.
2. This anxiety is distressing or disruptive, but there are very few (or very mild)
somatic symptoms.
3. The main difference between illness anxiety disorder and somatic symptom
disorder is the severity. People with somatic symptom disorder have more
comorbid conditions and visit doctors more frequently.
IV. CONVERSION DISORDER (FUNCTIONAL NEUROLOGICAL SYMPTOM

DISORDER)
Learning Objective 8.4: Summarize the clinical features of conversion disorder, also
noting its prevalence, causes, and treatment.
1. Conversion disorder is characterized by the presence of neurological symptoms

in the absence of a neurological diagnosis.
6
a. Historically, it was one of the disorders grouped under the term hysteria.
2. Patients have symptoms or deficits affecting the senses or motor behavior that
strongly suggest a medical or neurological condition.
a. Examples include partial paralysis, blindness, deafness, and episodes of limb

shaking accompanied by impairment or loss of consciousness that resemble
seizures.
b. La belle indifférence—French for “the beautiful indifference”—occurs in only

about 20 percent of patients.
A. Range of Conversion Disorder Symptoms
1. There are four categories of symptoms: sensory, motor, seizures, and mixed
presentation of the first three categories.
2. Sensory Symptoms or Deficits
a. Deficits are most common in the visual system (especially blindness and
tunnel vision), the auditory system (especially deafness), and in sensitivity to
feeling (especially the anesthesias).
i. In anesthesias, the person loses feeling in a part of the body. One of the
most common is glove anesthesia, where the person cannot feel anything
on the hand in the area where gloves are worn, although the loss of
sensation usually makes no anatomical sense.
ii. With conversion blindness, the person reports being unable to see.
However, it is not uncommon for the person to be able to navigate around
a room without bumping into furniture or other objects.
iii. With conversion deafness, the person reports not being able to hear and
yet orients appropriately upon “hearing” his or her own name.
3. Motor Symptoms of Deficits
a. Motor conversion reactions cover a wide range of symptoms, including (1)

conversion paralysis, which is usually confined to a single limb; (2) aphonia,
a speech-related conversion disturbance; and (3) globus, the sensation of a
lump in the throat.
7
4. Seizures
a. These resemble epileptic seizures, but they are not true seizures. For example,
patients show no EEG abnormalities and no confusion or memory loss
afterwards.
B. Important Issues in Diagnosing Conversion Disorder
1. Because the symptoms in conversion disorder can mimic a variety of medical

conditions, accurate diagnosis can be extremely difficult.
2. The criteria used for distinguishing between conversion disorders and true
neurological disturbances include:
a. The frequent failure of the dysfunction to conform clearly to the symptoms of

the particular disease or disorder simulated.
b. The nature of the dysfunction is highly selective.
c. Under hypnosis or narcosis, the symptoms can usually be removed, shifted, or

reinduced at the suggestion of the therapist.
C. Prevalence and Demographic Characteristics
1. Conversion disorder was the most frequently diagnosed psychiatric syndrome

among soldiers in World War I, and was also relatively common during World
War II.
2. Conversion disorders are found in approximately 5 percent of people referred for

treatment at neurology clinics.
3. The prevalence in the general population is unknown, but even the highest
estimates are around only 0.005 percent. Decreased prevalence may be closely
related to our growing sophistication about medical and psychological disorders.
4. It is more common among rural populations from lower socioeconomic circles.

And it occurs two to three times more often in women than in men.
5. It generally has a rapid onset after a significant stressor, and often resolves within
two weeks if the stressor is removed.
D. Causes of Conversion Disorders
1. Conversion disorders are thought to develop as a result of stress or internal

conflicts of some kind.
8
2. Freud used the term conversion hysteria for these disorders because he believed
that the symptoms were an expression of repressed sexual energy—that is, the
unconscious conflict that a person felt about his or her repressed sexual desires.
a. In Freud’s view, the repressed anxiety threatens to become conscious, so it is

unconsciously converted into bodily disturbance.
b. Freud also thought that the reduction in anxiety and intrapsychic conflict was
the primary gain that maintained the condition; but he noted that patients
often had many sources of secondary gain as well, such as receiving
sympathy and attention from loved ones.
c. Freud’s theory is no longer accepted outside of psychodynamic circles.

However, many of his clinical observations about primary and secondary gain
are still incorporated into contemporary views of conversion disorder.
3. The greater the negative impact of preceding life events, the greater the severity
of the conversion disorder symptoms.
4. Individuals with depression and individuals with conversion disorder showed

reduced levels of brain-derived neurotrophic factor relative to nondisordered
controls.
E. Treatment of Conversion Disorder
1. Knowledge of how to treat conversion disorder is limited because few well-

controlled studies have been conducted.
2. Some hospitalized patients have been successfully treated with a behavioral

approach in which specific exercises are prescribed in order to increase movement
or walking, and then reinforcements (e.g., praise) are provided when patients
show improvements.
3. Some studies have used hypnosis combined with other problem-solving therapies,
and it has been suggested that hypnosis, or adding hypnosis to other therapeutic
techniques, can be useful.
V. FACTITIOUS DISORDER
Learning Objective 8.5: Explain the difference between factitious disorder and
malingering.
1. In factitious disorder, the person intentionally produces psychological or

physical symptoms (or both).
9
a. The person’s goal is to obtain and maintain the benefits that playing the “sick
role” may provide, including the attention and concern of family and medical
personnel.
b. These disorders have a history of being stigmatized, and many doctors do not
take them very seriously.
A. Identifying Factitious Disorder
1. In factitious disorder, the person receives no tangible external rewards.
2. The person who is malingering is intentionally producing or grossly exaggerating

his or her physical symptoms and is motivated by external incentives such as
avoiding work or military service or evading criminal prosecution.
3. Patients may surreptitiously alter their own physiology in order to simulate real
illnesses.
4. The prevalence is not well established, but it is probably in the region of 0.5 to 0.8
percent of patients in general hospital settings.
5. Factitious disorder imposed on another (sometimes referred to as

Munchausen’s syndrome by proxy) is a dangerous variant of factitious disorder in
which the person seeking medical help has intentionally produced a medical or
psychiatric illness (or its appearance) in another person—usually someone, such
as a child, who is under their care.
B. Distinguishing Between Different Types of Somatic Symptom and Related Disorders
1. It is sometimes difficult to distinguish between disorders and make a correct

diagnosis.
2. Those engaged in malingering and those who have factitious disorder are
consciously perpetrating frauds by faking the symptoms of diseases or disabilities,
and this is often reflected in their demeanor.
3. Individuals with conversion disorders (and other somatic symptom disorders) are
not consciously producing their symptoms; they feel themselves to be “victims of
their symptoms” and are very willing to discuss them. They are usually
unperturbed when inconsistencies in their behavior are pointed out, whereas
individuals feigning symptoms are inclined to be defensive, evasive, and
suspicious when asked about them.
10
VI. DISSOCIATIVE DISORDERS: AN OVERVIEW
Learning Objective 8.6: List three DSM-5 dissociative disorders.
1. Dissociative disorders are a group of conditions involving disruptions in a

person’s normally integrated functions of consciousness, memory, identity, or
perception.
2. Included here are some dramatic clinical presentations: people who cannot recall
who they are or where they may have come from, and people who have two or
more distinct identities or personality states that alternately take control of the
individual’s behavior.
3. Dissociation is “a disruption of and/or discontinuity in the normal, subjective

integration of one or more aspects of psychological functioning, including—but
not limited to—memory, identity, consciousness, perception and motor control.”
4. Dissociation only becomes pathological when the dissociative symptoms are

“perceived as disruptive, invoking a loss of needed information, as producing
discontinuity of experience,” or as “recurrent, jarring involuntary intrusions into
executive functioning and sense of self.”
5. Implicit memory is remembering things an individual cannot consciously recall.
6. Implicit perception is responding to sights and sounds as if they had been

perceived, even though the individual cannot report that they have seen or heard
them.
7. The normally useful capacity of maintaining ongoing mental activity outside of

awareness appears to be subverted, sometimes for the purpose of managing severe
psychological threat.
8. Symptoms of dissociation are transdiagnostic, meaning that they are associated

with many different forms of psychopathology.
VII. DEPERSONALIZATION/DEREALIZATION DISORDER
Learning Objective 8.7: Summarize the clinical features of depersonalization/

derealization disorder
1. In derealization, one’s sense of the reality of the outside world is temporarily

lost.
2. In depersonalization, one’s sense of one’s self and one’s own reality is

temporarily lost.
11
3. Depersonalization/derealization disorder may be diagnosed when episodes

become consistent and recurrent and interfere with normal functioning.
a. People have persistent or recurrent experiences of feeling detached from, and

like an outside observer of, their own bodies and mental processes. They may
even feel they are, for a time, floating above their physical bodies.
b. Research has shown that emotional experiences are attenuated or reduced

during depersonalization.
c. Individuals have shown higher levels of subjective and objective memory

fragmentation.
4. In DSM-IV, derealization and depersonalization were treated as two distinct

conditions. In DSM-5, they are combined.
5. It is estimated that lifetime prevalence is around 1 to 2 percent of the population,

with equal numbers of males and females being affected.
6. The mean age of onset is around 16, with a minority developing the disorder after
age 25.
7. The disorder has a fairly chronic course in nearly 80 percent of cases.
8. Comorbid conditions can include mood or anxiety disorders. Avoidant,

borderline, and obsessive-compulsive personality disorders are also elevated.
VIII. DISSOCIATIVE AMNESIA
Learning Objective 8.8: Describe the clinical features of dissociative amnesia.
1. Retrograde amnesia is the partial or total inability to recall or identify previously

acquired information or past experiences.
2. Anterograde amnesia is the partial or total inability to retain new information.
3. Dissociative amnesia is usually limited to a failure to recall previously stored

personal information when that failure cannot be accounted for by ordinary
forgetting.
a. Gaps in memory most often occur following intolerably stressful

circumstances (wartime combat conditions, catastrophic events, traumatic
experiences).
b. In typical reactions, individuals cannot remember certain aspects of their

personal life history or important facts about their identity.
12
c. The only tip of memory that is affected is episodic or autobiographical

memory.
4. Dissociative fugue is a defense by actual flight: The person is not only amnesic
for some or all aspects of their past but they also depart from home surroundings.
a. It is accompanied by confusion about personal identity or even by the

assumption of a new identity.
b. Individuals are unaware of the memory loss for prior stages of their life.
c. Memory of what happens during the fugue stage is intact.
d. Behavior is usually quite normal and unlikely to arouse suspicion, but it

reflects a rather different lifestyle from the previous one.
e. In DSM-5, it is considered to be a subtype of dissociative amnesia rather than

a separate disorder.
5. The pattern in dissociative amnesia is essentially similar to that in conversion

symptoms, except that the person unconsciously avoids thoughts about the
situation or, in the extreme, leaves the scene.
6. Little systematic research has been conducted on individuals with dissociative

amnesia and fugue.
a. Individuals’ semantic knowledge seems to be intact. The primary deficit is

their compromised episodic or autobiographical memory.
b. Individuals show reduced activation in their right frontal and temporal brain
areas relative to normal controls during the same kinds of tasks.
c. Several cases have suggested that implicit memory is intact.
d. Some memory deficits in dissociative amnesia and fugue have been compared
to related deficits in explicit perception that occur in conversion disorders.
IX. DISSOCIATIVE IDENTITY DISORDER
Learning Objective 8.9: Describe the clinical features of dissociative identity disorder
and explain why this disorder is so controversial.
1. Dissociative identity disorder, formerly known as multiple personality disorder,

is a disruption of identity characterized by two or more distinct personality states
as well as recurrent episodes of amnesia. Disruption can be self-reported or
observed by others.
13
2. Another change in DSM-5 is the inclusion of pathological possession in the

diagnostic criteria for DID.
a. A trance occurs when someone experiences a temporary marked alteration in

state of consciousness or identity.
b. In a possession trance, alteration of consciousness or identity is replaced by a

new identity that is attributed to the influence of a spirit, deity, or other power.
c. Pathological possession is a common form of DID.
3. In the prototypical case, there are different personalities that emerge and are
apparent to an outside observer.
4. The one identity that is most frequently encountered and who carries the person’s
real name is known as the host identity.
5. Alter identities represent fragments of a single person; some alters may have
more knowledge than others.
a. Alter identities take control at different points in time, and switches typically
occur very quickly, although gradual switches can also occur.
6. Additional symptoms include depression, self-injurious behavior, frequent

suicidal ideation and attempts, erratic behavior, headaches, hallucinations,
posttraumatic symptoms, and other amnesic and fugue symptoms.
7. It usually starts in childhood, although most patients are in their teens, 20s, or 30s
at the time of diagnosis.
8. Approximately three to nine times as many females as males are diagnosed with
the disorder. Females also tend to have more alters than males.
a. It is believed that this gender difference is due to the greater proportion of

childhood sexual abuse among females, but this is a highly controversial
point.
9. The number of alter identities varies tremendously and has increased over time.
Recent estimates are that about 50 percent now show over 10 identities, with
some respondents claiming as many as 100.
10. Another recent trend is bizarre and unusual identities.
14
A. Causal Factors and Controversies About DID
1. Is DID a Real Disorder or Are People Faking?
a. The possibility that DID is a factitious or malingered disorder has been a

controversial diagnostic issue for at least a century. There are good reasons for
this, as the disorder could be used by defendants and their attorneys to try to
escape punishment for crimes.
2. How Does DID Develop?
a. According to trauma theory, DID starts from early childhood traumatization

and reflects an attempt to cope with an overwhelming sense of hopelessness
and powerlessness in the face of repeated traumatic abuse.
b. According to sociocognitive theory, DID develops when a highly suggestible

person learns to adopt and enact the roles of multiple identities, mostly
because clinicians have inadvertently suggested, legitimized, and reinforced
them and because these different identities are geared to the individual’s own
personal goals.
i. Spanos and colleagues demonstrated that normal college students can be

induced by suggestion under hypnosis to show DID symptoms.
ii. This theory is consistent with evidence of no clear DID symptoms prior to
entering therapy and the fact that the number of alters increases as therapy
progresses.
iii. The theory is also consistent with increased DID as therapists became
more aware of the condition.
3. Are Recovered Memories of Abuse in DID Real or False?
a. Repressed memories may be false, a product of highly leading questions and

suggestion techniques.
b. It is difficult to determine which memories of abuse are real and which are
false.
4. If Abuse Has Occurred, Does It Play a Causal Role in DID?
a. Childhood abuse tends to occur in families with many other sources of

adversity and trauma.
15
b. It may be that people with DID who have experienced childhood abuse are
more likely than those who did not experience childhood abuse to seek
treatment.
c. Childhood abuse is associated with many forms of psychopathology. It may

play a nonspecific causal role.
B. Current Perspectives
1. The current prevalence estimate of DID in community samples is between 1 and

1.5 percent.
2. There are now around 20 studies that have compared the behavior of people
diagnosed with DID with the behavior of people who are asked to simulate DID.
The findings suggest more support for the sociocognitive model than for the
trauma model.
3. Controversies concerning DID are routinely stated in a dichotomous way: Is DID

real or faked? What causes DID—spontaneous social enactments of roles or
repeated childhood trauma?
4. Theorists on both sides acknowledge that multiple different causal pathways are
likely to be involved.
a. The sociocognitive model has evolved into the diathesis-stress model, where
some people are more predisposed than others to develop DID when exposed
to sociocultural influences such as media portrayal, therapist cuing, and the
like.
X. CULTURAL FACTORS, TREATMENTS, AND OUTCOMES IN DISSOCIATIVE

DISORDERS
Learning Objective 8.10: Describe the cultural factors, treatments, and outcomes in
dissociative disorders.
A. Cultural Factors in Dissociative Disorders
1. The prevalence of dissociative disorders, especially their more dramatic forms

(such as DID), is influenced by the degree to which such phenomena are accepted
or tolerated either as normal or as legitimate mental disorders by the surrounding
cultural context.
2. Many related phenomena, such as spirit possession and dissociative trances, occur
frequently in many different parts of the world, where the local cultures sanction
them.
16
3. The inclusion of pathological possession in the diagnostic criteria for DID has
made the diagnoses more applicable to people from a wide range of cultural
backgrounds.
4. There are also cross-cultural variants on dissociative disorders, such as amok,

which is often thought of as a rage disorder.
B. Treatment and Outcomes in Dissociative Disorders
1. Virtually no systematic, controlled research has been conducted on treatment of

depersonalization disorder and dissociative amnesia. Thus little is known about
how to treat these two disorders successfully.
2. Some think that hypnosis—including training in self-hypnosis techniques—may

be useful, because patients with depersonalization disorder can learn to dissociate
and then “reassociate,” thereby gaining some sense of control.
3. Many types of antidepressant, antianxiety, and antipsychotic drugs have been

tried, and some have hade modest effects.
4. Treatment outcome data for large groups of patients with DID are seldom
reported, and control groups are lacking.
5. For people diagnosed with DID, most current therapeutic approaches are based on
the assumption of trauma theory that the disorder was caused by abuse.
a. Most therapists set integration of the previously separate alters, together with
their collective merging into the host personality, as the ultimate goal of
treatment.
b. Typically, the treatment for DID is psychodynamic and insight oriented,

focused on uncovering and working through the trauma and other conflicts
that are thought to have led to the disorder.
c. In general, for treatment to be successful, it must be prolonged, often lasting

for many years. The more severe the case, the longer the treatment.
17
Key Terms
alter identities hysteria
conversion disorder illness anxiety disorder
depersonalization implicit memory
depersonalization/derealization disorder implicit perception
derealization malingering
dissociation primary gain
dissociative amnesia secondary gain
dissociative disorder sociocognitive theory (of DID)
dissociative fugue soma
dissociative identity disorder (DID) somatic symptom disorder
factitious disorder somatoform disorders
factitious disorder imposed on another trauma theory
host identity
Lecture Suggestions and Activities

Learning Objective 8.1: List four disorders included in the DSM-5 category of somatic
symptom and related disorders.
LECTURE SUGGESTION
Was Freud Right the First Time?

Freud’s initial investigations of hysteria suggested that childhood sexual abuse was common.
Later, he dismissed reports of such abuse as fantasies because they started to seem far too
frequent to be plausible. Now, however, there is increasing recognition of high rates of childhood
sexual abuse in society, and its role in somatoform and dissociative disorders has become the
subject of etiological theorizing once again. By some estimates (Cutler & Nolen-Hoeksema,
1991), between 7 and 19 percent of females and between 3 and 7 percent of males were sexually
assaulted in childhood. Even though there is clearly a very high rate of childhood sexual abuse in
the histories of adults with somatoform and dissociative disorders, it is worth emphasizing that
most people who are sexually abused as children do not grow up to suffer from these disorders.
Indeed, childhood sexual assault also increases the risk for depression (Weiss et al., 1999).
Therefore, other factors must be taken into consideration. It is interesting to speculate about how
Freud’s ideas would have developed had he not abandoned his initial ideas about actual sexual
abuse.
18
Learning Objective 8.2: Explain the causes of and treatments for somatic symptom
disorder.
LECTURE SUGGESTION
Children and Somatic Disorders

Have a class discussion about the effects of parenting on children’s somatic symptoms. Children
commonly report somatic symptoms such as stomach aches in times of stress. Attachment style,
parenting style, and parental stress level have been linked to children’s health. Should parents
shelter kids or push them to face their fears?
ACTIVITY
Mind and Body

Have students research topics such as irritable bowel syndrome to learn the links between
psychological function and body functioning. Have students list preventative/protective factors
to these somatic symptoms and share what they learned with the class.
Learning Objective 8.3: Identify the key difference between illness anxiety disorder and
somatic symptom disorder.
LECTURE SUGGESTION
Hypochondriasis as Somatic Symptom Disorder and Illness Anxiety Disorder?

The difficulties inherent in organizing something as complex as the DSM can be understood via
a discussion about where hypochondriasis should be placed. Nominally, it is related to perceived
aberrations of bodily function, which made it a somatoform disorder in the DSM-IV-TR. It
actually shares many features of anxiety disorders, however, and there was discussion of placing
it in that category. Hypochondriacs are fearful of disease and dysfunction to a degree that
exceeds the magnitude of the actual risk, just as phobic fear is unreasonable. In fact,
hypochondriasis might be seen as a disease phobia. Complicating things a little is the fact that
hypochondriacs view their fears as reasonable, whereas many phobics do not. Nevertheless, fear
is the primary emotion. It is also worth offering to the class that panic disorder, which is clearly
an anxiety disorder, is rather like an acute fear response to interoceptive cues of pending physical
calamity. Hypochondriasis is a more chronic fear of the same thing. In the DSM-5, 75 percent of
people formerly diagnosed with hypochondriasis would now be classified as having somatic
symptom disorder while the remaining 25 percent would be diagnosed with the new illness
anxiety disorder.
19
Learning Objective 8.4: Summarize the clinical features of conversion disorder, also noting
its prevalence, causes, and treatment.
LECTURE SUGGESTION
Conversion Disorder in the News

Share the story of the several girls in a Le Roy, New York, high school who started to develop
tics similar to those of Tourette’s syndrome. How could so many girls develop similar symptoms
during the same school year? Some blamed the water, some claimed conversion disorder.
Discuss the controversy and the implications with the class. The New York Times article, “What
Happened to the Girls in Le Roy,” by Susan Dominus, can be found on the New York Times’
website.
ACTIVITY
From Psychological to Physical

One theory of conversion disorder is that individuals are transferring psychological pain into
physical symptoms. Have students discuss some psychological trauma or underlying issues that
people might be dealing with. Then, for each situation, have students think of different physical
symptoms that might arise from the psychological concerns. Have students discuss the validity of
this theory.
Learning Objective 8.5: Explain the difference between factitious disorder and
malingering.
LECTURE SUGGESTION
Factitious Disorder or Illness Anxiety Disorder

Have a class discussion about the similarities and differences between factitious disorder and
illness anxiety disorder. What signs/symptoms would one look for to differentiate the two
disorders? You can use the film clips from Woody Allen’s film Hannah and Her Sisters (1986)
as an example case study.
ACTIVITY
Factitious Disorder in the News

Many individuals suffering from factitious disorder imposed on another (by proxy) have been
charged with crimes such as child abuse. Have students find recent news articles about
individuals with factitious disorder imposed on another and have them present the case to the
class. Then have them debate the merits of the diagnosis and the appropriate legal consequences.
20
Learning Objective 8.6: List three DSM-5 dissociative disorders.
LECTURE SUGGESTION
Developmental Variability in Dissociative Disorders

Although the etiology of the dissociative disorders is unclear, there are tantalizing clues that are
interesting to discuss. The relation of dissociative disorders to childhood sexual abuse is
examined in detail in the text. Students may have some of their own thoughts about this relation,
particularly on the issue of why most abused children do not become afflicted adults. It is also of
interest to discuss why dissociative disorders are more common among women. Finally, the
relation to individual differences in suggestibility and hypnotic susceptibility are worth
discussing.
ACTIVITY
Dissociative Amnesia
Ask students to do a search for online news articles on cases of individuals with dissociative
amnesia and bring them to class. Although many will have duplicates, you should be able to get
possibly ten cases. Ask students what they think about these cases. Do they think they are real?
Learning Objective 8.7: Summarize the clinical features of depersonalization/derealization

disorder.
LECTURE SUGGESTION
“I Was Unable to Feel Love”

Discuss the challenges associated with treating somebody with depersonalization/derealization
disorder. Then share the video about Sarah called “Depersonalization Disorder: ‘I Was Unable to
Feel Love,’” which can be found at www.bbc.com. Discuss the symptoms and possible
treatment for her disorder. How is this different from symptoms of schizophrenia?
Learning Objective 8.8: Describe the clinical features of dissociative amnesia.
LECTURE SUGGESTION
Does Dissociative Amnesia Exist?

Ask students to read this section prior to coming to class. At the start of class, ask students if
they think it is possible to see this level of memory deficit in individuals who have not suffered
some traumatic brain injury (like Clive Waring). Under what circumstances would they expect
someone to develop a case of dissociative amnesia?
21
ACTIVITIES
Cultivating Dissociation
Many people can report dissociative experiences, such as walking into another room but
forgetting why, dialing the phone number of one friend when intending to call another, “reading”
a paragraph only to realize the words weren’t processed, reaching for the stick shift in an
automatic transmission car, being able to dial a phone number without being able to state it, and
so on. Ask students to describe their own dissociative experiences. Then talk about the
dissociative continuum and how dissociative disorders are at the extreme end of that continuum.
Some artists are described as being capable of cultivating dissociative experiences for artistic
purposes. Students can try this through automatic writing, in which they try to let the words
come automatically rather than deliberately, or through drawing, letting their hands move with
minimal guidance from their conscious mind. Students who succeed in cultivating dissociation
will gain a greater appreciation for its potential use as a way to cope with severe trauma,
particularly for young children.
Is Repression Real?
Elizabeth Loftus is one of the key researchers in the area of false memory creation. Her now
influential Lost at the Mall studies has changed the way the field views memory systems and has
shaped the way the legal world views eyewitness testimony. Have students read the following
article: Loftus, E. (1997). Creating False Memories. Scientific American, vol. 277(3), 70–75.
Have students read the article and then find a criminal court case involving false memories (for
example the McMartin trial). Then have them write two paragraphs on the Loftus article, one
paragraph describing the case they found and another applying Loftus’s work to the criminal
case. If your university has a law school and you get students who are prelaw as well as psych
majors, you may want to modify the assignment and have them read the following article instead
of the Loftus article. Piper, A., Lillevick, L., Kritzer, R (2008). What's wrong with believing in
repression?: A review for legal professionals. Psychology, Public Policy, and Law, vol. 14(3),
223–242.
Learning Objective 8.9: Describe the clinical features of dissociative identity disorder and
explain why this disorder is so controversial.
LECTURE SUGGESTIONS
Dissociative Identity Disorder or Schizophrenia?

Dissociative identity disorder (formerly known as multiple personality disorder) is often
confused with schizophrenia, even though there is no relationship at all between the two
disorders. This is probably because the term “schizophrenia” evokes an image of splitting of the
mind/personality, coming as it does from Greek words for “split” and “mind.” For instance, if a
country’s foreign policy is called schizophrenic because it penalizes some human rights violators
but not others, then the policy is actually better compared to dissociative identity disorder than to
schizophrenia. Even dictionary definitions of schizophrenia support the conflation between these
disorders, but this just won’t do for purposes of this course. Once this is pointed out, it is not
22
unusual for a student to ask “Well, then, what IS schizophrenia?” revealing the depth of the
confusion on this point. Schizophrenia will be described in detail later in the course, but for now
it is reasonable to offer that the “split” in schizophrenia is between reality, perceptions, emotions,
ideas, and behaviors—not between separate personalities. You might also tell students that if
they would like to show off their erudition, they should henceforth describe contradictory actions
of single entities as “dissociative identity disordered” not “schizophrenic”!
Do You Have Multiple Personalities?

Most college students report that they revert in many ways when they return home for vacations.
Surely, their table manners vary depending on the circumstances. And who wouldn’t put their
best foot forward for a job interview? Nobody is perfectly consistent. With this minimal
orientation to the idea of normal multiple personalities, a student volunteer can then be solicited
to participate in a brief exploration of the topic. In doing so, the instructor can demonstrate how
multiple personalities can be encouraged iatrogenically in therapy. First, the student volunteer is
asked about his or her different personalities. Then, the contradicting behaviors are grouped into
categories, like “neat” vs. “messy,” “responsible” vs. “irresponsible,” “serious” vs. “fun-loving.”
If contradictions are not immediately evident, they can be elicited by questions like “yes, but
isn’t the opposite also sometimes true?” Then ask the student to give a new name to each of these
different personalities. The neat, responsible, and serious side can be given one name and the
messy, irresponsible, and fun-loving side can be given another name. Then, the instructor can ask
to talk to just one side. This “personality” can then be elaborated upon in detail, followed by a
similar elaboration upon the other personalities. Although the instructor has made clear that there
is normal contradiction within all normal personalities, ask what effect it might have on a person
to be told that the degree of personality elaboration “discovered” through this interview is
abnormal and that one actually “has” multiple personality disorder?
Learning Objective 8.10: Describe the cultural factors, treatments, and outcomes in
dissociative disorders.
LECTURE SUGGESTIONS
Repressed or False Memories of Abuse?

During the late 1980s and throughout the 1990s the U.S. legal system struggled to deal with
recovered memories of childhood sexual abuse. Often elicited via hypnosis and other highly
suggestive techniques by poorly trained therapists, these memories of events occurring decades
previously were the basis of a wave of lawsuits against parents, friends, and relatives of people,
mostly women, who were now adults and who believed various symptoms and life difficulties
they were currently experiencing were the result of these previously forgotten episodes. The
backlash against this trend, often termed the false memory syndrome, was quite vigorous (e.g.,
Gardner, 1993, Skeptical Enquirer). In retrospect, it appears that earnest and well-meaning
therapists who truly believed their techniques were effective got caught up in the perceived
pervasiveness of the phenomenon they were discovering, failing to recognize the limitations of
their techniques.
23
Solution Manual for Abnormal Psychology, 18th Edition, Jill M Hooley, Matthew Nock, James Bu
Clive Waring
You may want to discuss the case of Clive Waring. If you Google the name, you can usually find
the video clips on YouTube. Clive lost his hippocampus and suffered other traumatic brain injury
in the mid-1980s after a severe case of encephalitis. Although he lost his episodic memories and
suffers from both anterograde and retrograde amnesia, he still retains much semantic knowledge
about his life. His memory is about two minutes long and students often find it fascinating that
this exists not just in movies like “50 First Dates.” It is good to point out that there are well-
documented cases of these types of severe memory deficits.
ACTIVITY
Film Screening and Discussion: Sybil

Most students in Abnormal Psychology are aware of Sybil, either the best-selling 1973 book or
the movie that was later based on the book. As the result of childhood abuse, Sybil purportedly
developed 16 distinct personalities who did things without her knowledge. The book and movie
cover how therapy with psychiatrist Cornelia Wilbur helped Sybil eventually overcome her
disorder. Along with The Three Faces of Eve, Sybil is probably the most famous depiction of
dissociative identity disorder and is worth screening for students, perhaps in an optional evening
class meeting. Recently, psychologist Robert Rieber reported that taped conversations between
Wilbur and the book author, Flora Rheta Schreiber, both deceased, show the story is incorrect. In
fact, the psychiatrist and author appear themselves to have been “not totally unaware” that the
story they told was wrong. Rieber’s report suggests that there was as much self-deception as
deception of others going on between Wilbur and Schreiber. Wilbur was a colleague of Rieber’s
at John Jay, and she gave him the tapes of her interactions with Schreiber. Rieber forgot about it
for 25 years. Herbert Spiegel hypnotized Sybil and concluded that her so-called personalities
actually arose from Wilbur’s therapeutic technique of giving names to various emotional states
Sybil experienced. Wilbur then mistakenly came to believe that they really were distinct
personalities. For example, when discussing something with Spiegel, Sybil asked whether she
should be “Helen,” as Dr. Wilbur preferred. When he said no, she said, “Fine, I’d prefer it that
way.”
Revel Videos
Henry: Illness Anxiety Disorder
Factitious Disorder: Why People Fake Serious Illness
Sharon: Dissociative Amnesia
Sharon: Living with Dissociative Amnesia
Randomized Controlled Trial
Expert Falls Victim to False Memories
24
Visit TestBankBell.com to get complete for all chapters

Solution Manual For Abnormal Psychology 18th Edition Jill M Hooley Matthew Nock James Butcher

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Solution Manual For Abnormal Psychology 18th Edition Jill M Hooley Matthew Nock James Butcher

Uploaded by

Copyright:

Available Formats

Solution Manual for Abnormal Psychology, 18th

Edition, Jill M Hooley, Matthew Nock, James Butcher

To download the complete and accurate content document, go to:

Abnormal Psychology 18e, Hooley/Butcher

Chapter 8: Somatic Symptom and

Visit TestBankBell.com to get complete for all chapters

Detailed Chapter Outline

3. In the past, somatic symptom disorders (formerly somatoform disorders) and

I. SOMATIC SYMPTOM AND RELATED DISORDERS: AN OVERVIEW

1. The category of somatic symptom and related disorders is new to DSM-5.

II. SOMATIC SYMPTOM DISORDER

3. For the diagnosis to be made, individuals must be experiencing chronic somatic

A. Causes of Somatic Symptom Disorder

1. It was long thought that symptoms developed as a defense mechanism against

4. An individual’s past experiences with illness contribute to the development of a

5. Negative affect is regarded as a risk factor. Other characteristics that may be

8. Somatic symptom disorders may be maintained to some degree by secondary

B. Treatment of Somatic Symptom Disorder

1. The cognitive-behavioral model provides a good explanation of the causes of

3. Techniques might include having the patient induce innocuous symptoms by

4. Sometimes patients are also directed to engage in response prevention by not

5. Cognitive-behavioral techniques are also widely used in the treatment of somatic

III. ILLNESS ANXIETY DISORDER

IV. CONVERSION DISORDER (FUNCTIONAL NEUROLOGICAL SYMPTOM

1. Conversion disorder is characterized by the presence of neurological symptoms

a. Examples include partial paralysis, blindness, deafness, and episodes of limb

b. La belle indifférence—French for “the beautiful indifference”—occurs in only

A. Range of Conversion Disorder Symptoms

2. Sensory Symptoms or Deficits

3. Motor Symptoms of Deficits

a. Motor conversion reactions cover a wide range of symptoms, including (1)

B. Important Issues in Diagnosing Conversion Disorder

1. Because the symptoms in conversion disorder can mimic a variety of medical

a. The frequent failure of the dysfunction to conform clearly to the symptoms of

b. The nature of the dysfunction is highly selective.

c. Under hypnosis or narcosis, the symptoms can usually be removed, shifted, or

C. Prevalence and Demographic Characteristics

1. Conversion disorder was the most frequently diagnosed psychiatric syndrome

2. Conversion disorders are found in approximately 5 percent of people referred for

4. It is more common among rural populations from lower socioeconomic circles.

D. Causes of Conversion Disorders

1. Conversion disorders are thought to develop as a result of stress or internal

a. In Freud’s view, the repressed anxiety threatens to become conscious, so it is

c. Freud’s theory is no longer accepted outside of psychodynamic circles.

4. Individuals with depression and individuals with conversion disorder showed

E. Treatment of Conversion Disorder

1. Knowledge of how to treat conversion disorder is limited because few well-

2. Some hospitalized patients have been successfully treated with a behavioral

1. In factitious disorder, the person intentionally produces psychological or

A. Identifying Factitious Disorder

1. In factitious disorder, the person receives no tangible external rewards.

2. The person who is malingering is intentionally producing or grossly exaggerating

5. Factitious disorder imposed on another (sometimes referred to as

B. Distinguishing Between Different Types of Somatic Symptom and Related Disorders

1. It is sometimes difficult to distinguish between disorders and make a correct

VI. DISSOCIATIVE DISORDERS: AN OVERVIEW

Learning Objective 8.6: List three DSM-5 dissociative disorders.

1. Dissociative disorders are a group of conditions involving disruptions in a

3. Dissociation is “a disruption of and/or discontinuity in the normal, subjective

4. Dissociation only becomes pathological when the dissociative symptoms are

5. Implicit memory is remembering things an individual cannot consciously recall.

6. Implicit perception is responding to sights and sounds as if they had been

7. The normally useful capacity of maintaining ongoing mental activity outside of