Acute and PTSD, Dissociative & Somatoform Disorders

Question 1

Somatic Symptom Disorders

Answer 1

• Somatic symptom disorders lie at the interface of abnormal psychology and medicine.
• Disorders in which psychological problems are manifested in physical symptoms.
• In response to the symptoms the person also experiences abnormal thoughts, feelings, and behaviors.
• High levels of functional impairment are common, as is comorbid psychopathology—especially depression and anxiety.
• Occurs in individuals who have had 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.
• Range from believing they have a disease to displaying symptoms
• Placebos used to be the best treatment

Question 2

Soma

Answer 2

Greek word for body.

Question 3

Factitious Disorder

Answer 3

Individuals with factitious disorder intentionally produce medical or psychological symptoms (or both).
• Absence of external rewards
• Motivated by benefits of “sick role”

Question 4

Malingering Disorder

Answer 4

Malingering involves the intentional production of symptoms or the exaggeration of symptoms.
• Motivated by external factors
i.e. a wish to claim insurance money, avoid work or military service, or to get leniency in a criminal prosecution

Question 5

Hypochondriasis

Answer 5

• Preoccupation with fears of having or getting serious disease
- automatically jump to worst case scenario
• Not a disorder in DSM-5, and about 75% of people with hypochrondriasis will meet criteria for somatic symptom disorder
• People with hypochondriasis are preoccupied with fears of getting a serious disease or the idea that they already have one
• Cognitive-behavioral views of hypochondriasis are most widely accepted
• Cognitive-behavioral therapy can be a very effective treatment

Question 6

Somatization Disorder

Answer 6

• Subsumed into somatic symptom disorder
• Somatization disorder is characterized by many different complaints of physical ailments
- catastrophize
- tend to see bodily sensations as somatic symptoms
• Somatization disorder characteristics
- Lasting several years
- Beginning before age 30
- Not adequately explained by independent findings of physical illness or injury
- Leading to medical treatment or to significant life impairment
• often have multiple unnecessary hospitalizations and surgeries
• significant similarities between this and hypocondriasis

Question 7

Pain Disorder

Answer 7

• Experience of persistent and severe pain in one or more areas of body
• Not intentionally produced or feigned, but there is no pathology to it
• Acute (duration less than 6 months) or chronic (duration over 6 months)
• Now a part of somatic symptom disorder
• The symptoms of pain disorder resemble the pain symptoms of somatization disorder, but with pain disorder, the other symptoms are not present

Question 8

Conversion Disorder

Answer 8

Involves patterns of symptoms or deficits affecting sensory or voluntary motor functions leading one to think there is a medical or neurological condition, even though medical examination reveals no physical basis for the symptoms.
• Not intentionally producing or faking the symptoms
• It is crucial that patients receive a thorough medical and neurological examination to rule out organic illness.
• Seems to be precipitated by stressful life events
- trauma
> i.e. saw something horrible, now can no longer see (eyes can see but brain refuses to see)
• Doesn’t panic about the symptom while most people would

Question 9

Hysteria

Answer 9

Older term used for conversion disorders; involves the appearance of symptoms of organic illness in the absence of any related organic pathology.

Question 10

Primary Gain

Answer 10

• In psychodynamic theory it is the goal achieved by symptoms of conversion disorder by keeping internal intrapsychic conflicts out of awareness.
• In contemporary terms it is the goal achieved by symptoms of conversion disorder by allowing the person to escape or avoid stressful situations.

Question 11

Secondary Gain

Answer 11

• External circumstances that tend to reinforce the maintenance of disability.
• originally referred to advantages that the symptom(s) bestow beyond the “primary gain” of neutralizing intrapsychic conflict,

Question 12

Dissociative Identity Disorder

Answer 12

In dissociative identity disorder, the person manifests at least two or more distinct identities that alternate in some way in taking control of behavior.
• Seems to occur more often in females
• When they switch identities, a gap in memories have happened - often for things that have happened to other identities.
• This disorder is quite rare
• The disorder usually starts in childhood
• Controversial - many psychiatrists, and others, don’t believe it’s real

Question 13

What are the primary features of dissociative disorder?

Answer 13

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.

Question 14

Dissociative Disorders

Answer 14

• Conditions involving disruptions in normally integrated functions
- Consciousness
- Memory
- Identity
- Perception
• Appear mainly to be ways of avoiding anxiety and stress and of managing life problems that threaten to overwhelm the person’s usual coping resources.
• Several types of pathological dissociation. These include depersonalization/derealization disorder, dissociative amnesia, dissociative fugue (a subtype of dissociative amnesia) and dissociative identity disorder.

Question 15

Dissociation

Answer 15

The human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness.

Question 16

Implicit Memory

Answer 16

Memory that occurs below the conscious level.

Question 17

Implicit Perception

Answer 17

Perception that occurs below the conscious level.

Question 18

Dissociative Fugue

Answer 18

A dissociative amnesic state in which the person is not only amnesic for some or all aspects of his or her past but also departs from home surroundings.
• May suddenly emerge from the fugue randomly or with help from others
• Considered to be a subtype of dissociative amnesia

Question 19

Depersonalization/Derealization Disorder

Answer 19

Depersonalization/derealization disorder occurs in people who experience persistent and recurrent episodes of depersonalization and/or derealization
• During the depersonalization or derealization experiences, reality testing remains intact.
• Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• 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).
• The disturbance is not better explained by another mental disorder
• Elevated rates of comorbid anxiety and mood disorders as well as avoidant, borderline, and obsessive-compulsive personality disorders

Question 20

Dissociative Amnesia

Answer 20

Dissociative amnesia involves an inability to recall previously stored information that cannot be accounted for by ordinary forgetting and seems to be a common initial reaction to highly stressful circumstances.
• Memory loss is primarily for episodic (pertaining to events experienced) or autobiographical memory (pertaining to personal events experienced).

Question 21

Dissociative Fugue

Answer 21

A dissociative amnesic state in which the person is not only amnesic for some or all aspects of his or her past but also departs from home surroundings.
• Want to escape so badly that they actually, mentally, do

Question 22

Illness Anxiety Disorder

Answer 22

Illness anxiety occurs in individuals who are very anxious about getting an illness even though there are no apparent symptoms.
• New to DSM-5
• 25% of people who met criteria for hypochondriasis will be diagnosed with illness anxiety disorder

Question 23

Host Identity

Answer 23

The identity in dissociative identity disorder which is most frequently encountered and carries the person’s real name. This is not usually the original identity and it may or may not be the best adjusted identity.

Question 24

Somatization Disorder: Prevalence, Rates, and Causal Factors

Answer 24

• Usually begins in adolescence
• Is 3-10 times more common in women than in men
• Often occurs with other disorders such as major depression or panic disorder
• relatively chronic condition, sometimes remits spontaneously
• There may be a genetic predisposition to the disorder
• Other contributory causal factors may include personality, cognitive, and learning variables

Question 25

Conversion Disorder: Prevalence and Comorbidity

Answer 25

• Prevalence
- Highest estimated prevalence is .005% of general population
- Decreasing prevalence
- Two to three times more common in women than men
- fairly common during WWI and II, most frequently diagnosed disorder among soldiers
• Comorbidity
- Occurs most frequently with major depression and anxiety disorders

Question 26

Conversion Disorder: Categories of Symptoms

Answer 26

(1) Sensory symptoms or deficits
i. e. can’t see
(2) Motor symptoms or deficits
i. e. can’t walk
(3) Seizures
(4) Mixed presentation from first three categories

Question 27

Somatic Symptom: Disorders must have one of the following three features:

Answer 27

(1) disproportionate and persistent thoughts about the seriousness of one’s symptoms;
(2) persistently high level of anxiety about health or symptoms; and/or
(3) excessive time and energy devoted to these symptoms or health concerns

Question 28

Sociocultural Factors in Dissociative Disorder

Answer 28

• Prevalence varies with acceptance of dissociative phenomena in the culture
• DID has been identified in all racial groups, SES classes, and cultures in which it has been studied; No systematic controlled research has been conducted
• In some cultures, dissociative trances or possession trances may occur

Question 29

Somatic Symptoms and Related Disorders include:

Answer 29

(1) somatic symptom disorder;
(2) illness anxiety disorder;
(3) conversion disorder; and
(4) factitious disorder

Question 30

Somatic Symptoms and Related Disorders include:

Answer 30

(1) somatic symptom disorder;
(2) illness anxiety disorder;
(3) conversion disorder; and
(4) factitious disorder

Question 31

Hypochondriasis: Causal Factors

Answer 31

cognitive-behavioral views most widely accepted

• it is a disorder of cognition and perception
• the misinterpretation of bodily sensations (which is a defining feature of the syndrome) may be a causal factor
• individual’s past experience with illness and pain
• perhaps also of having observed some of the secondary benefits that sick people sometimes reap

Question 32

Freud and Conversion Disorder

Answer 32

• Freud believed that the symptoms were an expression of repressed sexual energy (“conversion hysteria”)
- unconscious conflict
• the repressed anxiety threatens to become conscious, so it is unconsciously converted into a bodily disturbance, thereby allowing the person to avoid having to deal with the conflict.
• thought that the reduction in anxiety and intrapsychic conflict was the “primary gain” that maintained the condition,
- noted that patients often had many sources of “secondary gain” as well, such as receiving sympathy and attention from loved ones

Question 33

Conversion Disorder Symptoms: Sensory Symptoms or Deficits

Answer 33

• most often in:
(1) visual system (especially blindness and tunnel vision),
(2) auditory system (especially deafness),
(3) sensitivity to feeling (especially the anesthesias).
• evidence supports the idea that the sensory input is registered but is somehow screened from explicit conscious recognition

Question 34

Conversion Disorder Symptoms: Motor Symptoms or Deficits

Answer 34

For example:

• conversion paralysis is usually confined to a single limb such as an arm or a leg, and the loss of function is usually selective for certain functions
• most common speech-related conversion disturbance is aphonia, in which a person is able to talk only in a whisper although he or she can usually cough in a normal manner
• globus hystericus, is difficulty swallowing or the sensation of a lump in the throat

Question 35

Conversion Disorder Symptoms: Seizures

Answer 35

• relatively common form of conversion symptom,
• involve pseudoseizures, which resemble epileptic seizures in some ways but can usually be fairly well differentiated via modern medical technology
• patients with conversion seizures often show excessive thrashing about and writhing not seen with true seizures, and they rarely injure themselves in falls or lose control over their bowels or bladder, as patients with true seizures frequently do.

Question 36

Important Issues in Diagnosing Conversion Disorder

Answer 36

• crucial that a person with suspected conversion symptoms receive a thorough medical and neurological examination
• misdiagnosis, currently 4%
• Criteria commonly used for distinguishing between conversion disorders and true neurological disturbances:
- frequent failure of the dysfunction to conform clearly to the symptoms of the particular disease or disorder simulated.
> i.e. paralyzed, but no wasting away of limbs
- selective nature of the dysfunction
> i.e. blind, but don’t bump into people
- under hypnosis or narcosis (a sleeplike state induced by drugs), the symptoms can usually be removed, shifted, or reinduced at the suggestion of the therapist

Question 37

Derealization

Answer 37

Losing one’s sense of reality of the outside world)

• usually caused by trauma
• dissociate, pretend it’s not happening

Question 38

Depersonalization

Answer 38

Losing one’s sense of oneself and one’s own reality

Question 39

Similarities between Dissociative Amnesia and Fugue

Answer 39

• people experiencing both are typically faced with extremely unpleasant situations from which they see no acceptable way to escape.
  > Eventually the stress becomes so intolerable that large segments of their personalities and all memory of the stressful situations are suppressed.
• subtle loss of function in the right anterior hemisphere
  > changes similar to those seen in the brains of patients with organic memory loss
• implicit memory is generally intact

Question 40

Alter Identities

Answer 40

In a person with dissociative identity disorder, personalities other than the host personality.
• May differ in striking ways involving gender, age, handedness, handwriting, sexual orientation, prescription for eyeglasses, predominant affect, foreign languages spoken, and general knowledge
• Certain roles such as a child and someone of the opposite sex are extremely common
• Identities reflect a failure to integrate various aspects of a person’s identity, consciousness, and memory
• Take control at different points in time
• Average 6-12 identities
• Alter identities are not in any meaningful sense personalities

Question 41

Disassociative Identity Disorder: Prevalence

Answer 41

• until recently, extremely rare
  What may have lead to more frequent diagnosis:
• increased public awareness
• tightened criteria for schozophrenia is DSM-III
• increase may be artificial
  > therapists looking for evidence of DID in certain patients may suggest the existence of alter identities (especially when the person is under hypnosis and very suggestible)
  > therapist may subtly reinforce the emergence of new identities

Question 42

Research on Dissociative Identity Disorder Has Shown:

Answer 42

The primary focus of these studies has been to determine the nature of the amnesia that exists between different identities.
• Although Identity 2 may not be able to recall consciously the things learned by Identity 1, these apparently forgotten events may influence Identity 2’s experiences, thoughts, and behaviors unconsciously
• Related studies on implicit transfer of memories have shown that emotional reactions learned by one identity often transfer across identities
• Differences in brain wave activity when the patients with DID were in different personality states and that these differences were greater than those found in the simulating subjects
• The traumatic identity state (but not the neutral identity state) showed subjective and cardiovascular reactivity reflecting emotional distress to the personal traumatic memory

Question 43

Posttraumatic Theory

Answer 43

The view that DID starts from the child’s attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse.
• Associated with Dissocitaive Identity Disorder
- 95% report memories of severe and horrific abuse
> dissociate to escape
> leads to decreased pain sensitivity
• Childhood abuse may play a nonspecific role for many disorders, with other, more specific factors determining which disorder develop

Question 44

Possession Trance

Answer 44

A possession trance is similar except that the alteration of consciousness or identity is replaced by a new identity that is attributed to the influence of a spirit, deity, or other power.
• Typically amnesia for the trance state.

Question 45

Somatization Disorder - Treatment

Answer 45

• Difficult to treat

* Combination of medical management and cognitive-behavioral therapy

Question 46

Pain Disorder - Treatment

Answer 46

Used in treatment of both subtypes of pain disorder

• Cognitive-behavioral techniques are widely used in the treatment of both subtypes of pain disorder

Question 47

Conversion Disorder - Treatment

Answer 47

• Motor conversion symptoms have been successfully treated with behavioral therapy
• Psychogenic seizures have been treated with cognitive-behavioral therapy
• Hypnosis can be successful when paired with other problem-solving strategies

Question 48

Types of Somatic Symptoms Disorder

Answer 48

Includes:

(1) hypochondriasis
(2) somatization disorder
(3) pain disorder

Question 49

Classic Symptoms of Somatization Disorder

Answer 49

• Shortness of breath
• Reproductive issues
• Burning organs
• Lump in throat
• Amnesia
• Vomiting
• Painful extremities

Question 50

Boot or Glove Anesthesia

Answer 50

• Type of conversion disorder symptom

* Can’t feel up to where these garments would lay on the body when worn

Question 51

Munchhausen’s Syndrome

Answer 51

and all of its subtypes are types of factitious disorders

• Munchhausen’s by proc-see
• by adult proc-see
• by pet proc-see

Question 52

Pseudologia Fantastica

Answer 52

Compulsive lair

• fairly rare