Chapter 6: Somatoform and Dissociative Disorders- Text Flashcards
Somatoform disorders…give a general description of what they entail?
- conditions that seem initially to be physical disorders but there actually is no identifiable medical conditioning causing the physical complaints.
Dissociative disorders…give a general description of what they entail….
-alterations or detachments in consciousness or identity
L> which are so extreme that one loses their identity entirely and assume a new one, or they lose their memory or sense of reality and are unable to function..
What is neurosis?
L> Is it still an accepted term?
- disorders resulted from underlying unconscious conflicts, anxiety that resulted from those conflicts and implementations of ego defence mechanisms.
- not accepted anymore…it’s too vague (1980)
What are the five basic somatoform disorders?
- Hypochondrias
- somatization disorder
- conversion disorder
- pain disorder
- body dysmorphic disorder
Research indicates that hypochondriasis shares many with features with ___ and ___ disorders which are often in comorbid with hypochondriasis ; particularly ___ disorder.
anxiety, mood and panic disorders
Hypochondriasis is characterized by what?
Individuals are preoccupied with _____, misinterpreting them as indicative of illness or disease. Almost any _____ may become the basis of concern for individuals with hypochondriasis.
- severe anxiety or fear focused on the possibility of having a serious disease.
- bodily symptoms.
- physical sensation
Does reassurance ease by professionals ease the mind of those with hypochondriasis ?
- no if anything it only reduces fear and anxiety for a short term.
What is the difference between hypochondriasis and illness phobia?
- illness phobic individuals are preoccupied with the fear of developing a disease; where as, hypochondriac patients are afraid that they already developed it.
What percentage of those with illness phobia were found to go on and develop hypochondriasis and panic disorder? (Benedetti et al. 1997)
60%
Is hypochondriasis more common in those with panic disorder or those with social phobia? Also for comparison those in a control group?
- panic : 48%
- social phobia: 17%
- control: 17%
What is an important difference between panic disorder and hypochondriasis ?
- individuals with hypochondriasis are concerned with long term process of illness and disease…ex: cancer..AID’s
Stats for Hypochondriasis?
- medical patients that end up developing it?
- sex ratio?
- onset?
- 1 to 14%
- 50-50
- peak ages are in adolescence, middle age ( 40 to 50) and after 60
Culture specific syndromes of Hypochondriasis?
Koro
Dhat
-Hot sensations in head, crawling in head ?
-sensation of burning in hands and feet ?
(last two what cultures do they belong to?)
- genitals are retracting into the abdomen, Chinese males and some females.
- losing semen, symptoms of dizziness, weakness and fatigue….India!
- African
- Pakistani or Indian patients.
Describe the process of determining the cause of hypochondriasis in a patient. (3)
- physician rules out a physical cause for somatic complaints.
- mental health professional determines the nature of the somatic complaints…..to figure out if they are related to a specific somatoform disorder or are they part of some other psychopathology.
- clinician must be aware of culture specific somatic symptoms
Most people agree that Hypochondriasis is a disorder of what?? (3)
- cognition, perception and strong emotional roots.
Hypochondriacs tend to interpret what as threatening?
- ambiguous stimuli
L> they take a “better safe than sorry approach”
Is there a genetic basis for hypochondriasis?
Yes it runs in families
modest genetic contribution !
Children with hypochondriacal concerns often report the same kinds of symptoms that other family members may have reported at some time therefore it is safe to assume what?
- learned from family members to focus their anxiety on specific physical conditions and illness.
What two types of learning are connected to Hypochondriasis ?
- instrumental and vicarious learning
L> IL: rewarded by parents for bodily complaints…aka staying home form school
L> VL: observing a parent or family member expressing anxiety about a bodily sensation..
What are the three factors that contribute to the etiological process of hypochondriasis?
- stressful life event
- disproportionate incidence of disease in their family as kids
- Sick role: when a sick person gets specially benefits for being sick…more attention
What is the best type of therapy for Hypochondriasis?
- Cognitive Behavioural Therapy
L>exposure to health and illness info
L>learning to challenge misinterpretations of benign bodily sensations
L>83% of those that undergo this no longer meet having Hypochondriasis
What pharmacology treatment is affective for people with Hypochondriasis?
- antidepressants
L> Selective serotonin re-uptake inhibitors
ex: Fluoxetine
What is a huge difference between Hypochondriasis and Somatization disorder?
- people with somatization disorder are not afraid of the direction the symptoms can talk but rather the symptoms themselves.
Somatization Disorder …describe it go!
-Onset?
-What are the four criteria for symptoms that are required to be met for diagnosis.
give examples
2 -4 do not include symptoms related to just pain..
- Four pain symptoms: ex: head, abdomen, back and joints.
- Two gastrointestinal symptoms: nausea, diarrhea, vomiting and bloating are examples.
- One sexual symptom: ex: erectile dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy.
- One pseudoneurologic Symptom: conversion symptoms like blindness, double vision etc dissociative symptoms or loss of consciousness
Is somatization disorder common?
no it’s very rare
How many symptoms are required out of the listed 35 for diagnosis ?
8 symptoms
What is Undifferentiated somatoform disorder?
- when someone is diagnosed with less than 8 symptoms of the required 35 for the diagnosis of somatization disorder.
What are the stats for somatoform disorder?
- prevalence in large cities ?
- prevalence in primary care settings?
- 4.4% in a large city
- 16.6%
Gender variations for somatization disorder?
- tend to mostly be women (68% were female in Kirmayer’s study)
- un married
- lower SE groups
In addition to physical symptom complaints those with somatization disorder can also have?
L>common?
- psychological complaints
L> commonly mood or anxiety related
What personality disorder is somatization disorder linked to in family and genetic studies?
Antisocial Personality Disorder (APD)
aetiology of Somatization disorder?
mirrors APD
- early life onset
- chronic
- +++ in low SE
- difficult to treat
- associated with marital discord, drug and ethanol abuse and suicide attempts.
APD and Somatization disorder have what biological link? (theorized)
-Neurobiologically based disinhibition syndrome
L> short term gain with long term problems
L> continual development of new somatic symptoms gains immediate sympathy and attention but eventually social isolation occurs.
So what causes the difference in Somatization disorder and APD???
- Gender roles
L>
Are people with somatization disorder quick to seek treatment?
- no they are reluctant …very resistant to have psychological causes applied to their physical symptoms
In treatment what is done to limit the amount of visits for people with somatization disorder?
- gatekeeper physician screens all physical complaints
L> visits with specialists will be authorized by the gatekeeper.
What type of therapy has shown to be the most effective when treating Somatization disorder?
- Group Cognitive Behavioural Therapy
L> reducing health care costs and improving somatization disorder patients psychological well being.
Describe Conversion Disorder?(General idea)
- common ailments?
- What new name is suggested for the DSM5 ?
- generally have to do with paralysis, blindness or difficulty speaking ( aphonia) without any physical or organic pathology to account for the malfunction.
- most seem to suggest neurological disease is affecting sensory motor systems.
- Functional Neurological disorder
What is astasia-abasia
Also what is it an example of?
- weakness in legs, difficulty keeping balance but not actual paralysis
- conversion symptom- conversion disorder
What is globes hystericus?
What is it an example of/ symptom?
- sensation of a lump in the throat that makes it difficult ti swallow, eat or sometimes talk.
- conversion disorder
The follow are disorders very similar to Conversion Disorder that one must rule out first before diagnosis, explain them: - Malingering L> La belle indifférence? -Factitious disorders L> example?
-faking……
L> hallmark of conversion symptoms.
- symptoms are under voluntary control…no obvious reason for faking them except possibly assuming the sick role…
EX: Munchausen syndrome by proxy (factitious disorder by proxy) - making a child sick for attention..
What are two defining symptoms of conversion disorder? (2)
La belle indifference
conversion symptoms precipitating after a stressful event
**unaware either of this ability or sensory input
The reduction in anxiety from conversion disorder is considered a ___ gain whereas the attention gained from assuming the sick role is considered a ___ gain.
- primary, secondary
Cognitive Behavioural Therapy involving Image exposure is used for treating?
conversion disorder
Pain disorder?
- may have had clear physical reasons for pain but psychological factors maintain it,
Acute: less than six months
Chronic: six +
Body dysmorphic Disorder?
- normal looking people imagine they are so ugly they are noble to interact with others or function normally via fear of mockery
BDD
fixated on?(3)
Idea of reference?
- skin>hair> mirrors
- everything going on in the world is related to them
Treatment for BDD ?
- SSRI
- exposure and response prevention - behavioural therapy
- cognitive behaviour therapy : exposure and response + restructuring
Plastic Surgery and BDD?
- it actually increases imagined ugliness causing them to return for touch ups or new areas of concern.
Suggestibility and DID?
- autohypnotic model?
- personality trait
- those who are very suggestible are able to use dissociation as a defence mech against trauma
Biological link with DID?
- seizure disorders, experience many of the same dissociative symptoms
Individuals with what two dissociative disorders usually get better on their own?
- amnesia and fugue
Treatment of Dissociative disorders focus on?
difficult cases?
- recalling what occurred in the dissociative state, confront it, integrate it into their conscious exp.
L> Hypnosis and benz are used in difficult cases
DID treatment?
- reintegration of their identities through long term psychotherapy.
Modern treatment of DID?
- identify triggers that provoke memories of trauma or dissociation and neutralize them
- confront and relive aspect of the trauma until it is simply a terrible memory instead of a current event.
-hypnosis
antidepressants in some cases
