Chapter 6 Flashcards
What are the Preoccupation and Obsession Disorders?
->Somatic Symptom and Related Disorders
->Previously called Somatoform Disorders (DSM-IV-TR)
What’s the difference Between DSM-IV-TR & DSM-5 TR definition of somatic symptom disorder?
->DSM-IV-TR: Emphasized that bodily symptoms are medically unexplained
->DSM-5 TR: Focuses on distress related to bodily concerns
What is Somatic Symptom Disorder (SSD)?
->Pierre Briquet (1859) – Briquet’s syndrome: Patients always feel sick or experience symptoms
->Definition: Preoccupation with health or the body (“soma” = body)
What are the key clinical features of SSD?
->Constantly feeling weak & ill
->Life revolves around symptoms
->Ex. Severe pain worsened by psychological factors → Leads to anxiety & distress
How is SSD diagnosed?
-> At least one symptom is present with intense rxn to symptoms
->Specifiers for severity & dominant symptom type
How does Somatic Symptom Disorder differ from Illness Anxiety Disorder?
Somatic Symptom Disorder:
->Physical symptoms due to stress & anxiety
->Symptoms affect daily life
Illness Anxiety Disorder:
->Minimal or no physical symptoms
->Fear of developing a serious illness (e.g., mild rash = skin cancer)
What is Illness Anxiety Disorder (IAD)?
->Persistent fear of serious illness despite few/no symptoms
->Categorical vs Dimensional approach → IAD is dimensional
->Physical symptoms are mild or absent
->Concern is about the idea of being sick
How do patients with IAD respond to medical reassurance?
->Doctor’s reassurance is not helpful → Patients go from doctor to doctor
->“Disease Conviction”: Firm belief that they have an illness despite medical evidence
->Focus on long-term process of illness and disease EX. cancer, autoimmune disease
What are the two types of Illness Anxiety Disorder?
- Care-seeking type: Frequently visits doctors/tests (more common)
- Care-avoidant type: Avoids doctors due to overwhelming anxiety
What are the key statistics for SSD & IAD? (prevelance, comorbidtiy, onset)
-> Lifetime prevalence: 1-5%
->Severe Illness Anxiety: Late onset (increases with age)
->SSD Onset: Adolescence
—>More common in unmarried women, low SES, low education
—>Culture-specific symptoms (e.g., burning sensations in hands & feet in Pakistan-India)
->Comorbidities: Anxiety & Mood Disorders
What are the causes of Somatic Symptom and Illness Anxiety Disorder?
->Cognitive factors are central (sometimes called Disorders of Cognition)
->”Catastrophic” misinterpretations of bodily sensations
->Strong beliefs that unexplained bodily changes = serious illness
->Dysfunctional mind-set leads to worry about health
What is the Cognitive Model of Health Anxiety?
->A model that explains how health anxiety develops
->Involves four contributing factors
What are the four contributing factors to health anxiety?
- Critical precipitating incident
- Previous experience of illness (e.g., “Mom had heart palpitations → cancer; I have it → cancer”)
- Inflexible or negative cognitive assumptions
- Severity of anxiety (depends on factors that increase or decrease health anxiety)
What factors influence the severity of health anxiety?
Increase health anxiety:
->Perceived likelihood of illness
->Perceived costs & burden of illness
Reduce health anxiety:
->Perceived ability to cope
->Presence of “rescue” factors (e.g., availability of medical help)
What is Enhanced Somatic Sensitivity? Possible reasons?
->Interpreting ambiguous stimuli as threatening
->Possible reasons:
—>Genetic causes (modest, nonspecific tendency to overreact to stress)
—>Stressful life events
How do people with illness anxiety disorder focus on physical symptoms?
->Disproportionate incidence of disease in the family
->Social & interpersonal factors:
—>Some may unconsciously seek attention through illness
What is the illness anxiety disorder cycle?
- Faulty interpretation of physical symptoms
- Additional physical symptoms appear
- Increased anxiety
- Intensified focus on symptoms
- Cycle repeats
Why is Somatic Symptom and Illness Anxiety Disorder difficult to treat?
->Patients firmly believe they are ill despite reassurance
->Medical tests don’t relieve their concerns
What are common treatments for SSD & IAD disorders?
- Explanatory Therapy
-> Education & reassurance (explain the disorder, show test results)
- Cognitive-Behavioral Therapy (CBT)
->Reduce stress
-> Minimize help-seeking behaviors
-> Broaden social relationships beyond symptoms
How does Exposure-Based Therapy work?
->Expose patients to their fears without allowing safety behaviors
Ex. Show them a documentary on skin cancer → Don’t let them check their body for signs
What are Psychological Factors Affecting Medical Condition?
-> A diagnosed medical condition (e.g., asthma, diabetes, severe pain)
->Negatively affected by psychological/behavioral factors (e.g., anxiety, denial)
Ex. A person denies high blood pressure and refuses medication, worsening their condition
What is Functional Neurological Symptom Disorder (Conversion Disorder)?
->Previously called Hysteria (originally used to describe what are now known as conversion disorders)
->Origin of term: Believed to be caused by a wandering uterus (presumed to symbolize the longing to produce a kid)
->Freud’s theory: Repressed conflict converts into physical symptoms
How did Freud explain Conversion Disorder?
->Energy from repressed instincts is diverted into sensory-motor channels
->Physical dysfunction occurs without an organic cause
->Symptoms are a way for the unconscious mind to express conflict
What are common symptoms of Conversion Disorder? Examples?
->People appear neurologically impaired, but tests show no organic cause
Examples:
- Globus hystericus – Lump in throat, difficulty swallowing
- Astasia-abasia – Inability to stand/walk despite normal motor function
- Psychogenic seizures – Resemble epilepsy but EEG is normal
What are the two main symptom categories of Conversion Disorder?
- Motor Symptoms/Deficits (most common):
->Impaired coordination/balance
->Paralysis
->Abnormal limb posturing
->Muscle weakness (most frequent) - Anesthesia (Loss of Sensation) (less common):
->Sudden blindness or tunnel vision
->Aphonia (loss of voice, can only whisper)
->Anosmia (loss of smell)
->Psychogenic seizures (appear suddenly in stressful situations)
How do Conversion Disorder symptoms progress?
->Acute episode: Symptoms last less than 6 months, often disappear with stress relief
->Persistent: Symptoms last more than 6 month
What are two closely related disorders?
- Malingering (faking symptoms for external gain)
-> La belle indifférence: Emotional indifference to symptoms (e.g., someone paralyzed but unconcerned)
- Factitious Disorder (faking illness for attention, not external reward)
->two types:
- Factitious disorder imposed on self (fake own illness)
- Factitious disorder imposed on another (e.g., often a mom making a child sick → previously called “Munchausen by Proxy”)
What are the key psychological processes in Conversion Disorder?
->Unconscious mental processes
->Dissociation of experiences from awareness
->Some may fake symptoms (malingering or factitious disorder)
What are the statistics on Conversion Disorder?
->Rare in mental health settings
->More common in neurological settings (30% prevalence)
->Primarily affects women, usually develops in adolescence
What are the biological causes of Conversion Disorder?
-> Weak evidence for biological causes
->Brain scans show:
—>Left side of body more affected
—>Failure to activate right inferior frontal cortex
—>Increased amygdala-motor connectivity (linked to stress processing)
How does behavioral theory explain Conversion Disorder?
-> Symptoms persist due to attention and benefits received
-> Can be a way to justify poor performance or avoid stress
->Illness behaviors learned from parents (e.g., exposure to parental illness)
What were Freud’s four stages of Conversion Disorder?
- Trauma/conflict → Anxiety
- Repression of conflict (unconscious)
- Conversion to physical symptoms → Anxiety reduced (primary gain)
- Social attention/support received (secondary gain)
What social and cultural factors contribute to Conversion Disorder?
-> Substantial stress (e.g., abuse, divorce)
->More common in less educated, lower socioeconomic groups
->Limited medical knowledge influences symptom selection
What treatments are available for Conversion Disorder?
->Difficult to treat
->Identify and reduce stress
->Minimize help-seeking behaviors
->Cognitive-Behavioral Therapy (CBT)
—>Shifts focus away from symptoms
—>Cognitive restructuring (changing how they interpret symptoms)
->Symptom-focused CBT:
—>Teaching coping strategies
—>Emphasizing psychological/social factors
What is Obsessive-Compulsive Disorder (OCD)?
Chronic disorder characterized by:
- Unwanted intrusive thoughts (obsessions)
- Repetitive behaviors or mental acts (compulsions) to reduce distress
->Causes significant distress & interference with daily life
->Not always logically connected to its purpose
What mental health conditions commonly co-occur with OCD?
->Generalized anxiety
->Recurrent panic attacks
->Debilitating avoidance
->Major depression
->Suicidal ideation & attempts
->Severe obsessions predict suicide risk more than compulsions
What does it mean that obsessions in OCD are ego-dystonic?
->Thoughts feel “out of line” with one’s identity and values
->Causes distress and discomfort because they contradict personal beliefs
How severe is OCD in terms of impairment?
->One of the top ten most impairing conditions (World Health Organization)
->More severe obsessions → poorer quality of life
What are the three main subtypes of OCD (include obsession and compulsion of each)?
- Symmetry/Exactness (“Just Right”)
->Obsession: Needing things to be perfectly symmetrical or aligned
->Compulsion: Ordering, arranging, repeating rituals - Forbidden Thoughts/Actions (Aggressive/Sexual/Religious)
->Obsession: Fears of harming self/others, offending God
->Compulsion: Checking, avoidance, seeking reassurance - Cleaning/Contamination
->Obsession: Fear of germs/contamination
->Compulsion: Excessive washing, wearing gloves/masks
What is the comorbidity of OCD?
Highly comorbid with:
->Anxiety disorders
->Mood disorders
->Impulse-control disorders
->Substance use disorders
->Leads to high impairment and difficulty in treatment
How are Tic Disorder and OCD related?
->Involuntary movements can co-occur with OCD
->Tourette’s syndrome is commonly linked
->Tic-related OCD: Obsessions almost always about symmetry
->movements may not be tics but compulsions
What are the statistics on OCD? (prevalence, onset, common in)
->Lifetime prevalence: 1%–3%
->More common in boys during childhood, but equalizes in adolescence
->Onset: Early adolescence to mid-20s
->Rarely develops after early 30s
->Chronic once it develops
How does culture influence OCD?
->The content of obsessions and type of compulsions may vary
Ex. Middle Eastern cultures → obsessions related to cleanliness & religion
What are examples of intrusive harming thoughts in OCD?
Impulses to:
->Jump out of a window
->Jump in front of a car
->Push someone in front of a train
->Drop a baby
->Wish someone would die
What brain structures are linked to OCD?
- Frontal lobes → Increased activation (overconcern with thoughts)
- Basal ganglia → Linked to motor behavior & tics (a set of subcortical structures caudate, putamen (smaller in people with OCD), globus pallidus, and amygdala)
—>Smaller putamen in people with OCD
—>PET scans show increased activation
—>Connection to Tourette’s syndrome
What is Freud’s psychoanalytic explanation for OCD?
->Fixation at anal stage due to harsh toilet training
Reaction formation:
->Resisting the urge to soil → compulsively neat and clean
What is Rachman & Shafran’s theory of obsessions?
->Inflated sense of personal responsibility for preventing harm
Ex: Seeing a sharp object on the road and feeling responsible if someone crashes
->Thought-action fusion:
- Thinking about something makes it more likely to happen
- Thinking about something is as bad as doing it
What are the most effective treatments for OCD?
->SSRIs (help 40-60% but relapse is common)
->Exposure & Response Prevention (ERP) → Most effective
—>Expose person to fear without allowing compulsion
—>High dropout rate
Cognitive Behavioral Therapy (CBT)
->Psychosurgery (Cingulotomy) → Last resort
->Deep Brain Stimulation → Reversible but invasive
What is Body Dysmorphic Disorder (BDD)?
->Preoccupation with an imagined defect in appearance
—>“Imagined ugliness” despite looking normal
->Ritualistic/compulsory behaviors:
—>Mirror checking, excessive grooming, skin picking
—>Some avoid mirrors entirely
->Co-occurs with OCD
->High suicide risk
What areas of concern are common in BDD?
With muscle dysmorphia clarify:
- Good/Fair insight
->(know your imagining it)= more likely to respond to treatment then poor
->(know what your feeling about self is it’s probably true) - Absent insight
->100% convinced that body dysmorphia is true
What are statistics for BDD? (prevalence, onset, common)
- Prevalence- Difficult to estimate- tends to be kept secret
- Affects 1.7-2.4% people worldwide
- Strong interest in art and design
- Onset in early adolescence through the 20s
- High degree of stress, reduced quality of life, and impairment common
What are the causes of BDD? (bilogical, cognitive, & psychoanalytic)
- Biological:
->Reduced brain volume in:
—>Right orbitofrontal cortex (self-image processing)
—>Left anterior cingulate cortex (emotional regulation) - Cognitive factors:
->Catastrophic thinking about appearance
->Maladaptive coping (ex: mirror checking, avoiding social situations) - Psychoanalytic explanation:
->Displacement of anxiety onto physical appearance
What are effective treatments for BDD?
->SSRIs (Fluvoxamine - specific for OCD/BDD)
->CBT (focuses on stopping compulsive behaviors)
->Exposure & Response Prevention (ERP)
Ex: Prevent mirror checking or encourage social interactions
Why is plastic surgery NOT an effective treatment for BDD?
->It is avoidance behavior, not a real solution
->Most patients seek repeated surgeries
->8%-25% of plastic surgery patients have BDD
->Plastic surgeons should screen for BDD before operating
When does hoarding typically start, and when do people seek treatment?
->Starts early in life and worsens over time
->Patients usually seek treatment after age 50
What are the three major characteristics of hoarding disorder?
- Excessive acquisition of items
- Difficulty discarding anything
- Extreme clutter and disorganization
What is unique about animal hoarding?
-> It’s not about the number of animals but how they are treated
Ex. A person keeps a dead pet’s body because they can’t part with it
What are the possible causes of hoarding disorder?
->Genetic factors may contribute
->Cognitive factors:
—>Erroneous beliefs about the importance of possessions
—>Emotional attachment to objects due to lack of emotional attachments with people
What are the treatments for hoarding disorder?
-> SSNRI (venlafaxine)
->Cognitive-Behavioral Therapy (CBT) → Focuses on faulty thoughts about attachment to objects
What is Trichotillomania (Hair-Pulling Disorder)?
->Compulsive pulling of hair, leading to hair loss
->Common areas: Scalp, eyebrows, eyelids
->Affects 1%–5% of college students, more common in females
->Intense shame → People try to hide it with hats, wigs, etc.
What is Excoriation (Skin-Picking Disorder)?
->Compulsive picking of the skin → Leads to scabs, scars, and open wounds
->Affects 1%–5% of the population
->Common areas: Face, hands, arms
->Tools used: Fingernails, tweezers, needles
->Must be chronic and cause skin lesions to qualify as a disorder
What are the two main causes of Trichotillomania and Excoriation? (trigger and behavior for each model)
- Emotion Regulation Model
Trigger: Negative emotions (stress)
Behavior: Hair-pulling or skin-picking reduces stress (negative reinforcement)
- Frustrated Action Model
Trigger: Boredom or frustration
Behavior: Hair-pulling or skin-picking relieves boredom
What is the most effective treatment for Trichotillomania and Excoriation?
->Habit Reversal Training (HRT) → Helps replace behavior with a competing response
- Self-monitoring: Track frequency/intensity of behavior
- Awareness training: Identify triggers
- Competing response: Replace behavior with a different action
Ex: Instead of picking skin, sit on hands or use a stress toy
