2 Somatic Symptom and Related Disorders and Dissociative Disorders

Question 1

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life

B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.

C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Specify if:
With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.
Specify if:
Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
Specify current severity:
Mild: Only one of the symptoms specified in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

Answer 1

Briquet’s syndrome or Somatic Symptom Disorder

Question 2

People with _____ disorder do not always feel the urgency to take action but continually feel weak and ill, and they avoid exercising, thinking it will make them worse.

Another common example of a somatic symptom disorder would be the experience of severe pain in which psychological factors play a major role in maintaining or exacerbating the pain whether there is a clear physical reason for the pain or not.

Answer 2

somatic symptom

Question 3

A. Preoccupation with having or acquiring a serious illness

B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.

C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

Specify whether:
Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.
Care-avoidant type: Medical care is rarely used

Answer 3

Formerly known as “hypochondriasis” or Illness anxiety disorder

Question 4

In _____ disorder as we know it today, physical symptoms are either not experienced at the present time or are very mild, but severe anxiety is focused on the possibility of having or developing a serious disease.

The concern is primarily with the idea of being sick instead of the physical symptom itself.

Answer 4

illness anxiety

Question 5

If Illness Anxiety Disorder has one or more physical symptoms are relatively severe and are associated with anxiety and distress the diagnosis would be _____ disorder.

Answer 5

somatic symptom

Question 6

Many of these IAD individuals mistakenly believe they have a disease, a difficult-to-shake belief sometimes referred to as _____.

Answer 6

“disease conviction”

Question 7

Statistics of Illness Anxiety Disorder

koro, in which there is the belief, accompanied by severe anxiety and sometimes panic, that the genitals are retracting into the abdomen.

_____ culture-specific disorder, prevalent in India, is an anxious concern about losing semen, something that obviously occurs during sexual activity

Answer 7

dhat

Question 8

Treatment for Illness Anxiety Disorder

Taking the time to explain in some detail the nature of the patient’s disorder (_____) in an educational framework was associated with a significant reduction in fears and beliefs about somatic symptoms and a decrease in health-care usage, and these gains were maintained at the follow-up.

CBT

Answer 8

explanatory therapy

Question 9

A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Answer 9

Conversion Disorder (Functional Neurological Symptom Disorder)

Question 10

The term _____ has been used off and on since the Middle Ages but was popularized by Freud, who believed the anxiety resulting from unconscious conflicts somehow was “converted” into physical symptoms to find expression

Answer 10

conversion

Question 11

In DSM-5, “_____ disorder” is a subtitle to conversion disorder because the term is more often used by neurologists who see the majority of patients receiving a conversion disorder diagnosis, and because the term is more acceptable to patients.

Answer 11

functional neurological symptom

Question 12

Although she was not paralyzed, her specific symptoms included weakness in her legs and difficulty keeping her balance, with the result that she fell often. This particular type of conversion symptom is called _____.

_____ is caused by midbrain, thalamic, lenticular, and frontal lobe lesions or is due to psychogenic causes.

Answer 12

astasia-abasia

Question 13

Another relatively common symptom is _____, the sensation of a lump in the throat that makes it difficult to swallow, eat, or sometimes talk.

Answer 13

globus hystericus

Question 14

It was long thought that patients with conversion reactions had the same quality of indifference to the symptoms thought to be present in some people with severe somatic symptom disorder. This attitude, referred to as _____, was considered a hallmark of conversion reactions.

inappropriate lack of concern about the implications or seriousness of one’s physical symptoms

Answer 14

la belle indifférence

Question 15

_____ are fully aware of what they are doing and are clearly attempting to manipulate others to gain a desired end. Good at faking symptoms.

They are either trying to get out of something, such as work or legal difficulties, or they are attempting to gain something, such as a financial settlement.

Answer 15

Malingerers

Question 16

_____, which fall somewhere between malingering and conversion disorders.

The symptoms are under voluntary control, as with malingering, but there is no obvious reason for voluntarily producing the symptoms except, possibly, to assume the sick role and receive increased attention.

Answer 16

factitious disorders

Question 17

When an individual deliberately makes someone else sick, the condition is called _____. It was also known previously as Munchausen syndrome by proxy. In any case, it is really an atypical form of child abuse

Answer 17

factitious disorder imposed on another

Question 18

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

B. The individual presents himself or herself to others as ill, impaired, or injured

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Answer 18

Factitious disorders

Question 19

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.

B. The individual presents another individual (victim) to others as ill, impaired, or injured

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder

Answer 19

Factitious Disorder Imposed on Another

Previously Factitious Disorder by Proxy

Question 20

A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/ or physical numbing).
2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)

B. During the depersonalization or derealization experiences, reality testing remains intact.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).

E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

Answer 20

Dissociative Disorders: Depersonalization-Derealization Disorder

Question 21

A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition)

D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder

Specify if ;
300.13 (F44.1) With dissociative fugue: Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.

most prevalent of all the dissociative disorders

Answer 21

Dissociative Amnesia

Question 22

People who are unable to remember anything, including who they are, are said to suffer from ______. _____ may be lifelong or may extend from a period in the more recent past, such as 6 months or a year previously.

Answer 22

Generalized amnesia

Question 23

Far more common than general amnesia is _____ amnesia, a failure to recall specific events, usually traumatic, that occur during a specific period.

Answer 23

localized or selective

Question 24

A subtype of dissociative amnesia is referred to as _____ with fugue literally meaning “flight” (fugitive is from the same root).

unexpected trip (or trips)

Mostly, individuals just take off and later find themselves in a new place, unable to remember why or how they got there.

During these trips, a person sometimes assumes a new identity or at least becomes confused about the old identity.

Answer 24

dissociative fugue

Question 25

An apparently distinct dissociative state not found in Western cultures is called _____(as in “running _____”). Most people with this disorder are males. _____ has attracted attention because individuals in this trancelike state often brutally assault and sometimes kill people or animals.

A syndrome first reported in the Malay people, usually male, consisting of a period of brooding followed by a sudden outburst of indiscriminate murderous frenzy, sometimes provoked by an insult, jealousy or sense of desperation.

when children are in a store, and they begin screaming and running about. The definition of _____ is the action of murder or violence by a person in a crazed state of mind. An example of something going _____ is when during the L.A. riots people rampaged stores, killed civilians, and started fires.

Answer 25

amok

Question 26

A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

B. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Answer 26

Dissociative Identity Disorder

Question 27

People with dissociative identity disorder (DID) may adopt as many as _____ new identities, all simultaneously coexisting, although the average number is closer to 15.

Answer 27

100

Question 28

Statistics of DID

Of people with DID, the ratio of females to males is as high as _____. Onset 4. Frequency of switching decreases with age.

Answer 28

9:1

Question 29

Statistics of DID

Because auditory hallucinations are common, DID is often misdiagnosed as a _____. But the voices in DID are reported by patients as coming from inside their heads, not outside as in _____.

Answer 29

psychotic disorders

Question 30

Causes of DID

Child _____ abuse. You can escape into a fantasy world; you can be somebody else. Chaotic, nonsupportive family environment.

Answer 30

sexual or physical

Question 30

Causes of DID

Child _____ abuse. You can escape into a fantasy world; you can be somebody else. Chaotic, nonsupportive family environment.

Answer 30

sexual or physical

Question 31

There is also the phenomenon of _____, in which individuals can dissociate from most of the world around them and “suggest” to themselves that, for example, they won’t feel pain in one of their hands.

Answer 31

self-hypnosis

Question 32

According to the _____ model, people who are suggestible may be able to use dissociation as a defense against extreme trauma

Answer 32

autohypnotic