Anxiety, Somatoform, and
Dissociative Disorders Outline and Case Analysis of
In life people will have experiences that create feelings of
sadness and fear that is considered to be a normal part of life. In the field of abnormal psychology,
psychologist seeks to examine those experiences to determine how they may
contribute to behaviors that may appear to be abnormal in an effort to clarify
if a mental disorder is present.
Anxiety, Somatoform and Dissociative disorders are mental disorders that
can cause individuals to have problems with engaging in normal social
relationships, and functioning normally on a daily basis. In addition to analyzing past experiences to
understand how they contribute to abnormal behavior, abnormal psychology also
examines biological, emotional, cognitive and behavioral components in an
effort to have an accurate diagnosis of an individual that may be suffering
from an mental disorder.
The feeling that someone has when they think something bad is
going to happen can sometimes be justified depending on the situation, however
anxiety is “a feeling of dread, fear or apprehension , often with no clear
justification” ("anxiety," 2013).
While anxiety occurs in everyday life and can be considered normal in
certain circumstances, if it persists and the individual cannot seem to control
those feelings there is a possibility that an anxiety disorder could be
present. An individual experiencing
severe anxiety may show signs of “sweating, dizziness, numbness or pins and
needles in the fingers, hands (or whole parts if extreme), rapid heartbeat,
difficulty breathing, stomach upset or nausea, diarrhea, inability to
concentrate, confusion, irritability, shaking or trembling, restlessness,
avoidance behavior and tense muscles and/or muscle twitches” (Thomasson,
2013). The DSM-IV-TR categorizes six
anxiety disorders where an individual may experience either some or all of
those symptoms, generalized anxiety disorder, panic, disorder, phobias,
obsessive-compulsive disorder, posttraumatic stress disorder, and acute stress
disorder.
An individual suffering from generalized anxiety disorder will
experience “chronic, pervasive and debilitating nervousness” (Hansell &
Damour, 2008 p. 119). Generalized
anxiety disorder can interfere with an individual’s normal daily functions in
life because they will feel tense and worried almost all of the time. Panic disorder can be defined as “discrete
episodes of intense terror known as panic attacks-in which they feel
overwhelmed by anxiety and have a strong urge to escape or get help” (Hansell
& Damour, 2008 p.120). Panic attacks
can sometimes just happen or can be caused by certain situations. Phobia is “an intense, persistent and
irrational fear and avoidance of a specific object or situation” (Hansell &
Damour, 2008 p.121). Phobias are said to
be the most common anxiety disorder and are separated in to three
subcategories, social phobia “in which fears are focused on social situations
or other activities where there is a possibility of being observed and judged”;
Agoraphobia is “a fear of wide open spaces or crowded places”; and specific
phobia, which is “any phobia that is not a social phobia or agoraphobia”
(Hansell & Damour, 2008).
Obsessive-compulsive disorder is “anxiety disorder in which distressing
and unwanted thoughts leads to compulsive rituals that significantly interfere with
daily functioning” (Hansell & Damour, 2008 p. 128). According to the DSM-IV-TR, “posttraumatic
stress disorder and acute stress disorder involve a variety of anxiety symptoms
that occur in the wake of a traumatic experience” (Hansell & Damour, 2008
p.128).
The biological components of anxiety disorders involve the
autonomic nervous system, limbic system, neurotransmitters, autoimmune
processes, and genetic factors. Whenever
an individual experiences a feeling of fear and anxiety the autonomic nervous
system become activated as it “regulates involuntary bodily systems” (Hansell
& Damour, 2008 p.136). The autonomic
nervous system consists of the “sympathetic and parasympathetic systems”. Survival responses are activated by the
sympathetic division when an individual may notice a threat, which may bring on
many of the symptoms that relate to anxiety because the “adrenal glands secrete
stress hormones (adrenaline and noradrenaline)” (Hansell & Damour, 2008
p.136). The fight or flight response is
the result of the sympathetic nervous system becoming highly activated in which
danger is sensed and an individual must respond by either staying and fight or
take flight to escape. Individual’s
suffering from anxiety disorders may have an overactive amygdala and hypothalamus
creating confusion and misunderstanding they receive from their sensory
signals, which triggers the fight or flight response prematurely. The limbic system is made up of the amygdala,
hippocampus and hypothalamus and takes part in “emotional reactions (such as
anxiety), motivation, learning and certain aspects of memory” (Hansell &
Damour, 2008 p.136). Neurotransmitters
are chemicals in the brain that transfer signals to different parts of the
nervous system in order to communicate and control an individual’s mood and
behavior. Autoimmune processes suggest
that there is some type of abnormality caused by streptococcal infection in the
basal ganglia, which is “a subcortical brain structure involved in the
regulation of movement” (Hansell & Damour, 2008 p. 138). Genetics play a role in anxiety disorders
because certain genetic traits are passed from parents to their offspring’s
which could consist of chemical imbalances that contribute to certain anxiety
disorders.
The biological components of anxiety disorders give a breakdown of
what an individual may be experiencing mentally; however the emotional
components of anxiety disorders are the result of increased feelings of
concerns and tension that an individual may feel in moments of distress that
may be prompted by anxiety.
An individual suffering with an anxiety disorder is often the
result of them having negative misleading thoughts, which is the cognitive
component of anxiety disorders.
Individual’s with anxiety disorders “tend to misinterpret events in
their life by fixating on perceived dangers and threats, overestimating the
severity of the perceived danger or threat, and they drastically underestimate
their ability to cope with the dangers and threats they perceive” (Hansell
& Damour, 2008 p.152).
Somatoform disorders are classified as “disorders in which
physical symptoms are caused by psychological factors” (Hansell & Damour,
2008 p.206). Individual’s that suffer
from somatoform disorders experience symptoms that are related to physical
diseases medical professions often do
not find anything wrong with their body.
“Conversion disorder, somatization disorder, pain disorder,
hypochondriasis, and body dysmorphic disorder” are all somatoform disorders
classified by the DSM-IV-TR. According
to the DSM-IV-TR, “these disorders are encountered primarily in medical
settings and have two important features in common: a focus on bodily
complaints that have no physical basis, and symptoms that are not being
intentionally produced or faked” (Hansell & Damour, 2008 p.227).
Conversion disorder may cause an individual to lose their voice,
sight, and hearing or become paralyzed in one or more of their limbs, as well
as trembling in different parts of their body.
Conversion disorder is said to begin suddenly after an individual has
experienced an extremely stressful in their life and “the symptoms or affected
body part is usually related in some way to the trauma or stress that triggered
the conversion reaction” ("Somatoform Disorders," 2010). Individual’s suffering from somatization
disorder will experience “recurrent gastrointestinal, sexual, or pseudo
neurological symptoms without a physiological cause”. Pain disorders are symptoms of “physical pain
without a physiological cause”. An
individual preoccupied with the fear of contracting a disease, “or the mistaken
idea that one has a serious disease” are the symptoms of hypochondriasis. Body dysmorphic is the “preoccupation with an
imagined or exaggerated defect in physical appearance” (Hansell & Damour,
2008 p. 227).
Individuals that suffer from somatoform disorders may experience
the same biological components of those suffering from anxiety disorders,
however many emotional components can be contributed to traumatic events from
their past. Memory loss is a common
cognitive component with somatoform disorder as the individual is working to
remove certain events in their life that may have caused stress that led to
them developing the disorder.
Dissociative disorders “are a group of mental disorders that
affect consciousness defined as causing significant interference with the
patient’s general functioning, including social relationships and employment”
(Frey & Cataldo, 2011). There are
four different dissociative disorders recognized by the DSM-IV-TR, “depersonalization
disorder, dissociative amnesia, dissociative fugue, and dissociative identity
disorder”. Individual’s suffering from “depersonalization
disorder experience persistent and distressing feelings of being detached from
one’s mind or body; Dissociative amnesia is the inability to recall important
personal information, usually of a traumatic or stressful nature; Dissociative
fugue is sudden and unexpected travel away from home accompanied by forgetting
of one’s past and personal identity; and dissociative identity disorder is the
“presence of two or more distinct personalities or identity states that recurrently control an
individual’s behavior” (Hansell & Damour, 2008 p.248).
Biological components of dissociative disorders suggest that “the
dissociation involves alterations in the normal functioning of the hippocampus,
amygdala, and thalamus” (Hansell & Damour, 2008 p.270). The changes in the
normal functioning in the brain can sometimes be contributed to the use of
certain drugs that give off dissociation affects. Cognitive components of dissociative
disorders involve memory loss and short attention span associated with
dissociation that is also common with the use of certain drugs. Many individuals suffering from dissociative
disorders experienced a traumatic event in their life that resulted in them
wanting to separate themselves from reality.
Operant conditioning explains the behavioral component of dissociative
disorders because “during a traumatic experience, the splitting of
consciousness can bring relief; this negatively reinforced behavior may then be
repeated in response to new upsetting events” (Hansell & Damour, 2008 p.
266).
In examining the case of “Alix” Empress Alexandra Fedorovna it was
evident that she suffered from somatoform disorder that was contributed to her
past experienced that she encountered.
Alexandra Fedorovna married Czar Nicholas II and from that union
Alexandra was expected to give birth to a boy to become heir to the throne,
however Alexandra gave birth to four girls before having her son. Alexandra was expected to give birth to a boy
and she was received a great deal of pressure to makes this happen which could
have ultimately contributed to her feelings of anxiety. Shortly after the birth of her son he was
diagnosed with hemophilia, “an inherited blood-clotting deficiency, transmitted
in a sex-linked recessive Mendelian pattern” (Meyer, Chapman, & Weaver,
2009 p. 75). The pressures of being
expected to give birth to a son and then the baby having an illness along with
the stress of being rejected by Russian’s because she was German affected
Alexandra’s emotional state severely.
Alexandra experienced trauma as a child when she lost her mother due to
illness and soon she began to complain of sciatica, which is a symptom of pain
affecting the lower back, buttock and numbness and weakness in different parts
of the legs and foot. Alexandra was
never able to communicate her feelings of distress to anyone which also
contributed to the development of Somatization disorder. All of these factors contributed to the
development of this disorder in Alexandra because they increased her levels of
stress in the situations that she was dealing with making it more difficult for
to cope as situations began to worsen.
The field of abnormal psychology analyzes the biological,
emotional, cognitive, and behavioral components of anxiety, somatoform, and
dissociative disorders and how it relates to abnormal behavior. Many individuals suffering from these
disorders have symptoms that cause psychological and physical affects having an
adverse impact on one’s daily living.
Many of these disorders are the result of an individual experiencing an
traumatic event in their life and cognitive behavioral therapy is a very
effective method that could help overcome these disorders.
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