Chapter 6 - Dissociative and Somatic Symptoms Flashcards
What do dissociative disorders include?
a wide range of different symptoms that involve severe disruptions in consciousness, memory, and identity
What do somatic symptom disorders include?
long-standing beliefs that they have a serious illness, resulting in excessive anxiety and dysfunction
Hysteria
emotional excitability and physical symptoms such as convulsions, paralyses, numbness, loss of vision etc. - in the absence of any evident organic cause
What did Plato believe about hysteria? (Ancient Greece)
symptoms were caused in women by a wondering womb - believed womb was like an animal that desired to reproduce
Hysteria - Middle Ages
supernatural explanations - demonic possession and exorcism was usually the treatment
Pierre Janet
viewed breakdown in mental processes occurring as a result of exposure to traumatic experiences
Josef Breuer and Sigmund Freud
trauma (often as sexual nature) was a pre-disposing factor for hysteria and established a relationship between dissociation and hypnotic-like states
Conversion symptoms - Freud
expressions of unconscious psychological symptoms
ex. “conversion” of anxiety is more acceptable physical symptoms relieved the pressure of having to dealing directly with the conflict
primary gain
avoidance of conflict - primary reinforcement maintaining the somatic symptoms
secondary gain
benefits a patient may either unknowingly or knowingly seek by adopting a sick role
dissociative disorders
severe maladaptive disruptions or alterations of identity, memory, and consciousness that are experienced as being beyond one’s control
dissociation
lack of normal integration of thoughts, feelings, and experiences in consciousness and memory
dissociative amnesia
inability to recall important personal information - no organic impairment
five patterns of memory loss
1) localized amnesia
2) selective amnesia
3) generalized amnesia
4) continuous amnesia
5) systematized amnesia
localized amnesia
specific period of time is not recalled
selective amnesia
certain aspects of the event are not recalled
generalized amnesia
all information from the past is not recalled
continuous amnesia
from specific time until present is not recalled
systematized amnesia
certain types of information is not recalled
which three patterns of memory loss are less common
generalized amnesia, continuous amnesia and systematized amnesia - commonly associated with diagnosis of dissociative identity disorder
what is a subtype of dissociative amnesia
dissociative fugue
dissociative fugue
patient forgets their identity and may move away and assume a new identity - functioning is rarely impaired, linked to trauma
repressed memories
memories of traumatic events that a person forgets about/repress
depersonalization/derealization disorder
dissociation disorder in which the individual has persistent or recurrent experiences of depersonalization/derealization
depersonalization
sense of unreality and detachment from their own thoughts, feelings, sensations, actions, or body
derealization
sense of unreality/detachment from surroundings - experience people or objects in their environment as unreal, dreamlike, foggy or distant
when is depersonalization/derealization disorder?
when severe depersonalization is the primary problem
dissociative identity disorder (DID)
patient has two or more distinct personality that regularly take control of the patient’s behaviour
alters
each subsequent personality
host
one personality is considered this
average number of personalities in DID
13-16
when does switching occur in DID
in stressful situations ex argument with spouse
age onset of DID
29-35 years old
gender differences in DID
3-9x more diagnosable in women than men
what are associated features with DID
1) self-harm
2) suicidal/aggressive behaviour
3) childhood trauma
4) family history
5) high hypnotic susceptibility
trauma model
dissociative disorders are a result of severe childhood trauma, including sexual, physical and emotional abuse accompanied by personality traits that predispose the individual to employ dissociation as a defence mechanism or coping strategy
socio-cognitive model
multiple personality is a form of role-playing in which individuals come to construe themselves as possessing multiple selves and then begin to act in ways consistent with their own or their therapist’s conception of the disorder
iatrogenic condition
caused by treatment
Pseudogenic theory
occurs without any therapy intervention and is the stimulation of symptoms for secondary gain such as financial benefits or legal benefits
Psychotherapy steps for DID
1) build rapport
2) coping skills
3) reintegration of personalities
hypnosis for DID
popular - to contact alters and to uncover memories of traumatic childhood abuse - criticized now because of retrieving memories and personalities
medication for DID
not useful in direct treatment of dissociative disorders - helpful in treating comorbid disorders such as depression and anxiety
somatic symptom and related disorders
group of disorders which are presented with physical symptoms along with significant psychological distress and functional impairment
Conversion disorder
loss of functioning in a part of their body that appears to be due to a neurological or other medical cause but without any underlying medical abnormalities ex. motor deficits, seizures
signs of conversion disorder
abnormal medical readings (ex. EEG), inconstancies over time, unusual symptom patters, symptoms inconsistent with physiology
glove anaesthesia
loss of all sensation throughout the hand
la belle indifference
nonchalant lack of concern about the nature and implications of one’s symptoms
somatic symptom disorder
multiple recurrent somatic symptoms such as pain, fatigue, nausea, muscle weakness, numbness or indigestion which may or may not be due to a diagnosed medical illness or disease - also have distress or impairment
what do patients with somatic symptom disorder act like
worry excessively about healthy, devote excessive time and energy thinking about them - may restrict activities, avoid social events, take sick days a lot etc.
what do patients with somatic symptom disorder often display
excessive amount of sensitivity to relatively minor bodily symptoms ex. breathing
what is one of the most frequent bodily symptoms associated with somatic symptom disorder
pain
somatic symptom disorder with predominant pain
individual must have pain in one or more body sites that is sever enough to cause significant distress or to disrupt the individual’s daily life, possibly leading to inability to work, attend school etc.
what do patients with somatic symptom disorder with predominant pain run the risk of
becoming dependent on prescription medications such as painkillers or tranquilizers or may develop complications due to overuse of over the counter treatments
illness anxiety disorder
patients think the may have a serious medical disease despite the fact that thorough medical examination reveals that there is nothing seriously wrong with them
difference between illness anxiety disorder and somatic symptom disorder
patients with illness anxiety disorder do not have any significant bodily symptoms and are primarily concerned with the idea that they are ill
how long must the preoccupation in illness anxiety disorder must last?
6 months - feared illness may change
Factitious Disorder
fake or generate the symptoms of illness or injury to gain medical attention
motivation of factitious disorder
to receive sympathy, care and attention
factitious disorder imposed on another
individual falsifies illness in another person, most commonly one’s own child
psychological factors of factitious disorder
cognitive factors, emotions, personality
social factors of factitious disorder
early childhood adversity and abuse, reinforcement
most common treatment of factitious disorder
CBT
emotional techniques for factitious disorder
coping strategies, emotion regulation skills
behavioral techniques for factitious disorder
behvaioral activation, reducing “sick role” behavior
body dysmorphic disorder (BDD)
excessive preoccupation with an imagined or exaggerated body disfigurement, sometimes to the point of a delusion
BBD vs. OCD
BDD obsessions focus on appearance, greater severity
BDD vs. eating disorder
BDD obsessions focus more than just weight and fat
BDD vs. psychotic disorders
BDD unlike schizophrenia, no other positive or negative symptoms; unlike delusional disorder - may have insight, engages in “checking behaviours”
what do traditional psychoanalytic explanations propose about disorders
conversion of the anxiety associated with unconscious conflicts and unacceptable sexual drives into somatic symptomatology and distress
biopsychosocial model
the way the factors interact leads to different disorders
when does BDD begin
begins in adolescence and tends to be a chronic disorder
gender differences for BDD
women higher rates comorbid eating disorders, men have higher rates of genital preoccupation, muscle dysphoira
is cosmetic surgery effective in BDD
no
How does CBT make use of cognitive restructuring techniques?
for modifying dysfunctional thoughts, interpretations, preoccupations relating to bodily symptoms and illness, as well as methods for helping patients to identify, understand, and regulate their emotions
perceptual retraining
focus on the “whole” aspect
ritual prevention
preventing compulsive behaviors
