Chapter 7: Somatoform & Dissociation Disorders Flashcards
What defines a somatoform disorder?
- Physical symptoms are the focus of client’s attention
- Physical symptoms have little to no medical basis
- Symptoms are judge to be associated with psychological conflict or stress
- Symptoms aren’t intentionally produced or feigned
- Symptoms cause significant distress or impairment
What are the different kinds of somatoform disorders as distinguished by the DSM-V?
- Conversion disorder
- Somatic symptom disorder
- Illness anxiety disorder
What is a hysterical somatoform disorder?
Somatoform disorder in which people suffer actual changes in their physical functioning
What is the DSM-V criteria for conversion disorder?
- Dramatic loss of function resembling a serious neurological disorder
- No medical cause for loss of function
- Symptoms emerge in context of conflicts or stressful life experiences
- Symptoms not intentionally produced or feigned
- Symptoms cause clinically significant distress or impairment
- May be associated with “la belle indifference” (indifference to symptoms)
What are examples of conversion symptoms?
- Impaired coordination or balance
- Paralysis or weakness
- Inability to swallow
- Loss of touch or pain sensation
- Blindness
- Mutism
- Deafness
- Psychogenic seizures or convulsions
Onset and course of conversion disorder?
- Symptoms appear suddenly and dramatically
- Symptoms may disappear suddenly or switch to a new symptom
What is the recovery rate of conversion disorder?
90% recovery within one month
What is the gender ratio of conversion disorder?
-2:1 (female: male)
What is the psychodynamic explanation for conversion disorder?
- Trauma/conflict in childhood that is repressed, dissociated
- Reactivated by current severe stressor
- Repressed memory is converted into physical symptom
- Often metaphorical connection between conflict and symptom
- Often odd indifference for serious symptoms
- Disconnect; incongruent affect
What are the treatment methods of conversion disorder?
- Insight therapy to make conflicts conscious
- Teach coping skills to deal with stressful life situations
- Treat comorbid anxiety and depression with antidepressants
- Placebo meds
- Hypnosis or healing ritual
What is the DSM-V criteria for somatic symptom disorder?
- Pattern of abnormal behaviors, thoughts, feelings related to physical symptoms
- Individual may or may not have a diagnosed medical condition
- Symptoms cause significant distress or dysfunction
- Excessive focus on physical symptoms with reluctance to talk about psychological issues
- Symptoms prompt frequent medical visits
- Conditions mostly seen in medical settings
Onset and course of somatic symptom disorder?
- May have childhood onset
- Pain conditions may develop after injury
- Chronic course with fluctuations
- Psychological investment into physical symptoms
- Difficult to treat –> poor prognosis if poor insight
What is the etiology of somatic symptom disorder?
- Constitutional differences in pain tolerance
- History of injuries and inadequate pain management
- History of childhood abuse with weakening of immune system and pain tolerance
- Pervasive feelings of helplessness, victimization, guilt
- Intense emotional conflicts are repressed and expressed physically
- Negative, self-defeating thinking style
- Ineffective problem-solving ability and withdrawal from conflicts
- Long-term stressors
- History of illness in family members (role models)
- Reinforcement of illness behavior by others
- Cultural standards that stigmatize mental disorders
- Lack of medical knowledge and psychological sophistication
What are the treatment methods of somatic symptom disorder?
- Cognitive-behavior therapy
- Empathize with psychological distress
- Ignore illness-related behavior –> reinforce other interests
- Explore benefits from symptoms (secondary gains)
- Teach self-hypnosis and distraction techniques
- Yoga, dance, massages, moderate exercise
- Body therapies to positively reconnect with body
- Treat any comorbid conditions and deficits (depression, poor social skills, etc.)
- Antidepressants (help with pain, sleep, anxiety)
- Placebos
What is the DSM-V criteria for illness anxiety disorder?
- Preoccupation with the belief that one is seriously ill
- Fear of illness persists despite medical reassurances to the contrary
- Tendency to interpret physical sensations or minor aches as signs of serious illness
- No actual medical condition
- Symptoms cause significant distress or dysfunction
Onset and course of illness anxiety disorder?
May start at any time but usually early adulthood
What is the gender ratio of illness anxiety disorder?
1:1
What is the etiology of illness anxiety disorder?
- Family history of anxiety disorders or actual illness
- Overlap with GAD and OCD
What are some treatments of illness anxiety disorder?
- SSRI meds for obsessions and compulsive reassurance seeking
- Cognitive therapy
- Prognosis is poor if insight remains poor
What is factitious disorder? (Munchausen disorder)
- Symptoms of physical or mental illness are deliberately simulated or induced without an apparent incentive
- Presumably done for psychological gain (attention)
What is factitious disorder by proxy?
- Physical symptoms are induced in a child, typically by a parent
- Psychological gain is the recognition for the sacrifice the parent is making
- Often history of similar childhood abuse in abusing parent
Define malingering.
Faking a disorder to achieve some external reward (disability status, insurance settlement, insanity plea)
How does culture play a role in dissociation?
- Cultures differ in their tolerance for dissociation and altered states of consciousness
- In some cultural contexts, dissociation is induced for spiritual or healing purposes
What defines a dissociative disorder?
- Disruptions or gaps in the normal integration of subjective experiences resulting in discontinuities in affect, memory, and behavior
- Causes clinically significant distress or impairment
- All assumed to be trauma-based disorders
What are the different dissociative disorders?
- Depersonalization/Derealization disorder
- Dissociative amnesia
- Dissociative identity disorder
What is the criteria for depersonalization/derealization disorder?
- Depersonalization (episodes of feeling detached from one’s self or body) OR derealization (feelings of having a sense of unreality about one’s surroundings)
- Episodes are persistent or recurrent and cause significant distress or dysfunction
- Person may feel as if he were living in a dream or acting like a robot
- Person tends to engage in self-ruminations, thinking in circles
- Feelings exhausted and anxious
- Person is NOT psychotic and “looks normal”
- Often a history of trauma or neglect
Depersonalization states can be found with what other disorders?
- PTSD
- Panic disorders
- Depression
- Schizophrenia
- Borderline personality disorder
- Medical conditions (seizures, head injury, dementia)
- Drug-induced states (especially with hallucinogens)
What does the diagnosis of depersonalization disorder depend on?
Can only be made if symptoms occur in absence of another diagnosis
What is the criteria for dissociative amnesia?
- Inability to recall info about oneself, usually of traumatic or stressful nature
- Amnesia is of psychological origin, not caused by brain injury
- Memory presumably is “split off” b/c it’s emotionally painful, traumatic
- Memories are repressed
- Symptoms are causing significant distress or impairment in life functioning
What is the specifier of dissociative amnesia?
With dissociative fugue
What is dissociative fugue? Cause? Onset? Recovery?
- Sudden, unexpected travel or wandering away from home
- Associated with amnesia for identity or important autobiographical info
- Often following a natural disaster or in wartime
- Onset and recovery are sudden
What is the criteria for dissociative identity disorder?
- Existence of 2 or more distinct personalities, each with its own memories, attitudes, perceptions
- Person switches back and forth between personalities
- There’s at least partial amnesia of these personalities for each other
- Experience of possession can be an alternate personality
What is the psychodynamic dissociation-trauma model for dissociative identity disorder?
- Severe trauma in early childhood (physical, sexual, witnessing)
- Child escapes psychologically through imagining a new identity and self-hypnosis
- Dissociative experience leads to distinct memories, unique feelings, and the beginnings of a new identity
- Dissociated identities first formed in childhood reappear as alter personalities within the same person
- Disorder triggered by stressors occurring in adulthood
What is the iatrogenic perspective on dissociative identity disorder?
- Disorder created by the therapist
- Distressed, suggestible individuals with poor sense of self can be made to believe they have multiple personalities
- Facilitated by hypnosis and other suggestive techniques to recover memories
- Multiple personality hype in the 1980s-90s
What is the diatheses etiology of dissociative disorders?
- Ability to psychologically remove oneself from traumatic situation
- High levels of imaginative involvement and fantasy proneness
- High hypnotizability
- History of childhood trauma
What is the stressor etiology of dissociative disorders?
- Sudden unexpected trauma at present time
- Strong emotional conflict
What is the main treatment of dissociative disorders?
Psychological
What are the treatment methods of dissociative disorders?
- Antidepressants are helpful
- Create safe space and trusting rapport
- Teach stress management skills
- Facilitate talk about trauma/childhood while staying present
- Facilitate integration of split-off memories or sub-personalities
- Psychodynamic framework
