Chapter 6: Somatoform and Dissociative Disorders Flashcards
Definition of “somatoform”
Taking bodily form
Five factors to consider when diagnosing
1) Patient has lost or altered physical functioning
2) Symptoms cannot be explained by a known physical or neurological condition
3) Positive evidence that psychological factors are related to the symptom
4) The patient is often, but not always, indifferent to the physical loss
5) Symptoms are not under voluntary control.
Define conversion disorder
In which psychological stress is converted into physical symptoms
Somatization Disorder:
Define Briquet’s Syndrome
- The person had many physical complaints that began before age thirty, resulting in a complicated history of medical treatment.
- Complains involve many different organs and cannot be fully explained from known physical causes, nor are they under voluntary control.
Somatization Disorder:
What are four symptoms of Briquet’s Syndrome
1) History of pain related to at least four different areas, such as the head, stomach, back, joints, arms and legs, rectum, chest, or pain on sexual intercourse, menstruation or urination.
2) Fatigue, fainting, palpitations, menstrual problems, nausea, gas, indigestion, back pain, joint or limb pain, dizziness, sleep complaints, diarrhea or constipation, breathing difficulties
3) Pseudoneurological or conversion symptom that is not limited to pain, such as impaired coordination, paralysis, blindness, deafness, loss of sensation of touch.
4) Unnecessary surgery, addiction to prescription medicines, depression, attempted suicide are common complains of this syndrome
What is the difference between somatization and conversion disorder?
- Patient with somatization will suffer from many physical symptoms
- Patient with conversion generally has only one complaint
- Interestingly, symptoms occur more often on the right side of the body than the left, suggesting left-hemisphere involvement.
Define “pain disorder” (Psychalgia)
- Pain in one or more parts of the body causing marked distress or impairment.
- Psychological factors account for onset and severity.
- Involuntary
Define “hypochondriasis”
-Conviction of having a serious medical disease or fear of contracting one in spite of extensive evidence and reassurance to the contrary
What are the symptoms and behaviors of hypochondriasis?
- Conviction of having a serious medical disease or fear of contracting one in spite of extensive evidence and reassurance to the contrary
- Go to different doctors a lot because of inadequate care or diagnosis
- Refuses to accept that they are suffering from a mental disorder rather than something physical
Define “body dysmorphia”
Exaggerating a slight bodily imperfection to wholesale ugliness
How does one diagnose somatoform disorder?
Ruling out other disorders like Munchaussen Syndrome, malingering and factitious disorders.
Define “malingering disorder”
- Symptoms of malingering are under control
- Environmental goal with the symptom, such as sympathy, disability (SSI), getting out of work, etc.
Define “Munchaussen Syndrome”
Involves multiple hospitalizations and operations in which the individual voluntarily produces the signs of illness, not through underlying anxiety, but by psychological tampering
Who is at risk for somatoform disorder?
- Correlated with depression, alcoholism, and antisocial personality disorder
- Children of alcoholics
- Those with antisocial personality disorder
- Women, particularly those with moms who have or had it.
How does psychoanalysis explain how somatization disorder develops?
-Individual is anxious about some unacceptable idea and the conversion is a defense against the anxiety.
-Psychic energy is transmuted into a somatic loss
Anxiety is detached from the unacceptable idea, rendering it neutral.
-Because anxiety is psychic energy, it must go someplace.
-In this case, it debilitates a body part.
-The somatic loss symbolizes the underlying conflict.
How does the communicative theory explain how somatization disorder develops?
- People who have trouble expressing distress verbally
- Defending against depression, guilt or anxiety or anger.
- Physical illness distracts from psychological distress
Define “alexithymic” and how it relates to somatoform disorder.
- Meaning “no words for feelings.”
- These people are particularly prone to somatoform disorders
- Those with trauma who have not told about it are more likely to have physical symptoms and illnesses than those who disclosed information to others.
According to the “precept blocking view,” who is vulnerable to somatoform disorder?
-People with unbearable anxiety or distress or other distressing emotions
How does the “precept blocking view” explain somatoform disorder?
- The conversion process consists in blocking the precept from awareness
- Unbearable anxiety, or need to communicate distress or reinforcement of anxiety reduction
Who is at risk of dissociative disorder?
People who have suffered a strong psychological trauma sometimes experience a profound and lasting disturbance of memory.
Symptoms of dissociative disorder?
- Amnesia
- Depersonalization
- Derealization
- Identity confusion
- Identity alteration
Define “derealization”
When world seems unreal
Define “identity alteration”
In which one displays surprising skill that one did not know one had
Define “dissociative amnesia?”
A loss of personal memory caused by severe trauma.
Dissociative amnesia:
Define “fugue state”
Those with DA will take up a new life and travel far away from home during what is called a “fugue state,” meaning flight
What are the different kinds of Dissociative Amnesia?
1) Global or generalized amnesia
2) Localized amnesia
3) Post-traumatic amnesia
4) Anterograde amnesia
5) Selective or categorical amnesia
6) Organic amnesia
Define “Global or generalized amnesia”
All the details of all personal life are gone
Retrograde amnesia
Define “localized amnesia”
in which all events immediately before some trauma are forgotten
Define “anterograde amnesia”
Difficulty remembering new material with almost always an organic cause like a stroke or head trauma
Define “selective/categorical amnesia”
When only memories of events related to a particular theme vanish
Dissociative vs. Organic Amnesia
Both
Can be caused by alcoholism, Alzheimer’s or stroke
Organic
- Can remember distant past very well, but after trauma, they remember recent past poorly
- Knowledge and memory only gradually returns
- Need not be stressed or troubled
- Lose general and personal knowledge
- Does not always have neural damage
- Four-fold amnesia that no one with OA will have.
- Loses past, both recent and remote
Dissociative
- Loses personal identity
- Knowledge remains intact
- Reverses abruptly
- Existence of DA is not universally accepted and causes are unknown. Based on case studies and said to be a non-disclosure of embarrassing or shameful acts that must be ruled out
- Comorbid with other conditions, causing it to be overshadowed or overlooked.
Who is susceptible to dissociative amnesia?
- More common in wartime or natural disasters
- Occur more in men than women
- More younger than in older people
Define “depersonalization disorder”
The persistent experience of feeling detached from one’s mind or body
Symptoms of “depersonalization disorder”
- Out of body experience
- Can feel like you are a fly on the wall, dream-like, emotion is flat, lack of control.
- One remains aware that this is not real, so therefore, reality testing remains intact
What is depersonalization disorder comorbid with?
Depression, hypochondriasis, substance abuse
What is “dissociative identity disorder?”
Also known as “multiple personality disorder,” in which two or more distinct personalities exist within the same individual and each leads a rather full life.
What is the psychodynamic etiology of multiple personality disorder?
- Identities are generated as coping mechanism for past traumas
- Significant emotional problem and may be generated by PTSD
- Creation of identity to relieves stress and anxiety of regular self. A coping mechanism.
Describe the psychodynamic approach to treating multiple personality disorder
- Make patient aware of problem
- Call up alter ego to have them speak freely
- Patient can introduce identities
- Must avoid dodging back into the hypnotic state to avoid confrontation
- May enlist aid of identities.
- Tell patient that personalities are a product of self-hypnosis at an early age without conscious or malicious intent
- Patient told that she no longer needs these identities and can be rid of them
- Therapy can last for years.
- Those who achieve integration in therapy showed long-term improvement
Describe the controversy surrounding multiple identity disorder:
- Lawyers are part of the battle
- Used to excuse serious crimes
- Both sides have a stake in its validity
- False memory controversy
- The condition can be feigned
- Unquestioned acceptance of one’s accounts of traumatic memories and past.
- Politically correctness
- May make patients actually worse
- Self-hypnotizing patients may also be very receptive to the therapist’s suggestions and may even forge memories based on what they think the therapist might want them to say.
- Pseudo-memories
- Memory retrieval therapy made lives worse
