Chapter 6 - Dissociative and Somatic Symptom and related disorders

Question 1

What’s dissociative amnesia?

Answer 1

• Characterized by the inability to remember personal info without any evidence of organic impairment
• Childhood trauma is significantly linked to it

Question 2

What is dissociation?

Answer 2

• Persistent maladaptive disruptions in the integration of memory, consciousness, and identity
• Becomes pathological when prolonged and/or persistent and when it interferes with people’s quality of life
• A symptom common in many mental disorders

Question 3

What are the different forms of dissociative amnesia?

Answer 3

• Localized - can’t recall info from a specific time period
• Selective - parts of events are remembered, others forgotten
• Generalized - forgets all past personal info
• Continuous - can’t recall info from a pecific date (possibly of trauma) to present
• Systematized - the person forgets certain categories of info such as certain people or places

Question 4

Which are the two most common forms of dissociative amnesia?

Answer 4

• Localized and selective

Question 5

What’s a dissociative fugue?

Answer 5

• A rare and unusual form of amnesia where people have a loss of memory for their past and personal info, and also travel suddenly and unexpectedely, sometime for long distances
• Often triggered by intense stress and/or trauma

Question 6

What’s the difference between depersonalization and derealisation?

Answer 6

• Depersonealization - feelings of unreality, detachment from self and your thoughts
• Derealisation - feelings of unreality, detachment from surroundings

Question 7

What’s depersonalization/derealisation disorder?

Answer 7

• Characterized by persistent or recurrent episodes of depersonalization and/or derealisation
• Likely related to emotional trauma
• May have reduced emotional reactivity to stressful or emotionally intense stimuli
• Also have cognitive disruptions, and disruptions in perceptual and attentional processes

Question 8

T/F: Depersonalization is the thrid most common reported symptom in mental health.

Answer 8

• TRUE

Question 9

What’s dissociative identity disorder (DID)?

Answer 9

• Patients present with 2 or more distinct personality states that can take control of the patient (where switching occurs)
• Personalities represent a disruption in identity and a marked discontinuity in sense of self and agency
• Very rare, diagnosed around ages 29-35
• High rate of self-injury

Question 10

What are some of the psychological factors that contribute to the etiology of dissociative disorders?

Answer 10

• TRAUMA
• State-dependent learning - a person with trauma may start behaving differently when in a dissociation. Was used as a mechanism to evade harm during traumatic episodes.
• Attachment theory (i.e., disorganized attachemnt during childhood)

Question 11

What are some of the social factors that may contribute to dissociative disorders?

Answer 11

• Speculations about what happens when parents are both loving and abusive (disorganized attachment)
• Introgenic effects - dissociative disorders arise because patients follow the lead and speculations of their therapist. Think it’s the best way to receive treatment

Question 12

What’s the major focus for treatment of dissociative disorders?

Answer 12

• Emphasis on uncovering and expressing past traumas
• Medication may help reduce distress

Question 13

What does treatment look like in those with DID?

Answer 13

• Reintegrating all the personalities into a whole
• Must recognise the central personality and identify which components of other personalities would be useful

Question 14

What’s the prominent feature of somatic symptom disorders?

Answer 14

• The prominence of somatic symptoms associated with significant distress and impairment
• The individual may or may not have a diagnosable medical condition to meet criteria

Question 15

What’s conversion disorder/functional neurological symptom disorder?

Answer 15

• Characterized by a loss of functioning in a body part
• Appears neurological in nature but no underlying abnormality
• Symptoms can be quite dramatic
• Symptoms do not always follow logical neurological mechanisms (ex. glove aneasthesia), sometimes patients show inconsistencies
• Cannot be diagnosed through a medical examination

Question 16

What are some of the etiological considerations for conversion disorder?

Answer 16

• Symptoms may be associated with a potential dynamic reorganization of the brain circuits that link volition, movement, memory, and perception
• Cn also be viewed as a form of dissociation (i.e., a lack of integration between conscious awareness and sensory processes and/or voluntary control over physical symptoms

Question 17

What’s somatic symptom disorder?

Answer 17

• Manifestation of one or more physical symptoms accompanied by excessive thoughts, feelings, and behaviours in response to these symptoms, which cause distress and dysfunction
• Diagnosis requires a search for positive symptoms
• Patients can and often do have physiologically based medical diagnoses
• Typically identified first in primary care physicians

Question 18

What’s somatic symptom disorder with predominant pain?

Answer 18

• Complaints of pain in one or more sites of body
• Pain must be sufficient to warrant professional attention and cause distress/work interruptions
• Psychological factors must play a role in the onset, exacerbation in the maintenance and severity of the pain
• Excessive and unrealistic thoughts related to pain symptoms
• May do a lot of “doctor shopping” for prescriptions

Question 19

What’s illness anxiety disorder (hypochondriasis)?

Answer 19

• Long standing fears, suspicions/convictions of having a serious disease
• Excessive concern over bodily functions and misinterpretations of symptoms
• Always seem to be a life-threatening condition
• Usually not interested in other medical interpretations
• Concerned they will die later

Question 20

What’s factitious disorder (Munchausen syndrome)?

Answer 20

• Deliberate faking of medical conditions to gain medical attention
• Can be physical or psychiatric faking
• Must not be any evidence of obvious external rewards, motivated only by sympathy and attention

Question 21

What’s Munchausen syndrome by proxy?

Answer 21

• Factitious disorder imposed on another, usually one’s own child

Question 22

What’s the biggest danger for somatic symptom disorders?

Answer 22

• Misdiagnosis (i.e., there’s actually a medical condition)

Question 23

What’s the two-factor psychobiological theory concerning SSD etiology?

Answer 23

1) Increased bodily signals due to biological factors related to polonged distress, lack of physical condition, chronically stimulated HPA axis
2) A deficient filter system that amplifies body signals rather than inhibiting them or effectively selecting them

Question 24

What are some of the psychological factors that contribute to SSD etiology?

Answer 24

• Childhood environment
• Unconscious expression of conflict, negative affect
• Secondary gain
• Positive and negative reinforcement
• Learned sick role
• Tendency to pay close attention and amplify somatic symptoms
• Misattribution of normal somatic symptoms (don’t know what’s going on)

Question 25

What’s alexithymia?

Answer 25

• A person’s deficit in capacity to recognize and verbalize emotions, so instead they use somatic symptoms
• Common in children

Question 26

T/F: Cultrual factors contribute to SSD epidemiology.

Answer 26

• TRUE

Question 27

What are some psychosocial factors regarding SSDs?

Answer 27

• More frequent in the unemployed and people with impaired occupational functioning
• More frequent in those who have experienced significant losses
• High comorbidity with other disorders
• Severe somatization has been associated with personality disorders, particularly avoidant, paranoid, and OCPD

Question 28

What are the recommended treatments for SSDs?

Answer 28

• A cognitive behavioural approach, including reinforcement of successful coping and life adaptation, control over one’s interpretation of bodily symptoms, and cognitive restructuring
• Treatment of comorbid disorders when present
• Consistent patient-physician relationship
• Educating family members