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PSYC 337 > Chapter 8 > Flashcards

Chapter 8 Flashcards

1
Q

% of physical symptoms that cause people to seek medical care that are medically unexplained

A

20-50%

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2
Q

4 most important disorders in somatic symptom category (need to be able to differentiate for exam)

A

new category in DSM5!
- somatic symptom disorder
- illness anxiety disorder
- conversion disorder
- factitious disorder

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3
Q

Somatic symptom disorder

A
  • has been called hypochondriasis, somatization disorder, and pain disorder
  • for diagnosis, need to be experiencing chronic somatic symptoms that are distressing to them AND dysfunctional thoughts/feelings/behaviors
  • prevalence: 5-7%
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4
Q

Controversy around Somatic symptom disorder

A
  • Freud: defense against repressed ideas
  • recent focus on cognitive factors (increased awareness of body, see sensations as somatic symptoms+attribute them to illness, catastrophizing cognitions, seek help bc very distressed)
  • criteria probably too broad bc physical symptoms do not need to be medically unexplained
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5
Q

Causes and Risk Factors of Somatic Symptom Disorder

A
  • disorder of both perception and cognition
  • attentional bias for illness-related information
  • can be predisposed by past experiences w illness and dysfunctional assumptions ab symptoms/diseases
  • risk factors: negative affect, absorption (degree to which you can absorb ideas – makes you hypnotizable), alexithymia (don’t have language for internal experiences)
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6
Q

Characteristics of Somatic Symptom Disorder

A
  • more likely to inflict women
  • high comorbid levels w depression and anxiety
  • symptoms may be maintained to some degree by secondary reinforcements (ie negative reinforcement by getting out of hard stuff)
  • not malingering (consciously faking symptoms)
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7
Q

Treatment of Somatic Symptom Disorder

A
  • CBT widely used for treatment (but clients are often resistant to psychological intervention bc they believe problem is only physical pain)
  • focus on assessing beliefs ab illness and modifying misinterpretations of bodily sensations
  • might include having patient induce innocuous symptoms by focusing on parts of body to learn that selective perception of bodily sensations could play major role in symptoms
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8
Q

Treatment of Somatic Symptom Disorder involving chronic pain

A
  • relaxation training
  • support and validation that pain is real (have to act like you believe patient)
  • scheduling of daily activities (ppl with pain have overly sedentary lifestyle, getting them moving helps)
  • cognitive restructuring
  • reinforcement of ‘no pain’ behaviors
  • tricyclic antidepressants and SSRIs shown to reduce pain intensity (independent of effects on mood)
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9
Q

Illness Anxiety Disorder

A
  • new to DSM5
  • have high anxiety about having or developing a serious illness
  • anxiety is distressing/disruptive, but few (or very mild) somatic symptoms
  • less severe than Somatic Symptom Disorder where ppl have more comorbid conditions and visit doctor more
  • avg onset at 20yrs (same as somatic symptom disorder)
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10
Q

Conversion Disorder

A
  • characterized by presence of neurological symptoms in absence of a neurological diagnosis
  • symptoms or deficits affecting either senses or motor behavior
  • ex: partial paralysis, blindness, deafness, episodes of limb shaking w impairment or loss of consciousness resembling seizures
  • 4 categories of symptoms: sensory, motor, seizures, and mixed presentation
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11
Q

Conversion Disorder - Sensory Symptoms

A
  • visual system deficits, auditory system deficits, deficits in sensitivity to feeling (esp in anesthesias)
  • anesthesias: person loses feeling in part of body
  • conversion blindness: person reports being unable to see but navigates spaces without problems
  • conversion deafness: report not being able to hear but orient appropriately upon ‘hearing’ own name
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12
Q

Conversion Disorder - Motor Symptoms or Deficits

A
  • wide range, including
  • conversion paralysis, usually single limb
  • aphonia (speech-related disturbance)
  • globus (sensation of lump in throat)
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13
Q

Conversion Disorder - Seizures

A
  • resemble epileptic seizures, but are not true seizures
  • no EEG abnormalities and no confusion or memory loss afterwards
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14
Q

Diagnosis of Conversion Disorder

A
  • need to distinguish between disorder and true neurological disturbances
  • look for frequent failure to conform clearly to symptoms of particular disease/disorder
  • see if during hypnosis or narcosis symptoms can be removed, shifted, or reinduced at suggestion of therapist
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15
Q

Prevalence and Demographic Characteristics of Conversion Disorder

A
  • most frequently diagnosed psychiatric symptom among soldiers in WWI, common in WWII
  • found in approx 5% of ppl referred for treatment at neurology clinics
  • gen. pop. prevalence unknown
  • occurs more in rural populations from lower SES
  • 2-3x more often in women vs men
  • rapid onset after significant stressor; often resolves within 2 weeks if stressor is removed
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16
Q

Causes of Conversion Disorder

A
  • thought to develop as result of stress/internal conflicts
  • Freud used term conversion hysteria; believed symptoms were expression of repressed sexual energy
  • repressed anxiety threatens to become conscious so is unconsciously converted into bodily disturbance
  • primary gain: reduction in anxiety and intrapsychic conflict
  • secondary gain: receiving sympathy/attention
  • theory no longer accepted! (but clinical observations of primary/secondary gain reflected in current views)
  • likely linked to stress; genetic marker linked to depression also linked to conversion disorder
17
Q

Treatment of Conversion Disorder

A
  • knowledge is very limited bc few studies (and pretty low prevalence plus quick recovery)
  • behavioral approach: specific exercises prescribed to increase movement or walking, reinforcement provided when patient shows improvement
18
Q

Factitious Disorder

A
  • intentionally producing psychological or physical symptoms (or both)
  • used to be called munchausen’s
  • goal to obtain and maintain benefits of ‘sick role’
  • factitious disorder imposed on another (Munchausen’s by proxy); diagnosis is for the person making the other sick/appear sick
19
Q

Identifying factitious disorder

A
  • no tangible external rewards
  • being the focus of medical attention is what is rewarding
  • different from malingering bc no tangible external rewards
20
Q

Malingering

A
  • intentionally producing or grossly exaggerating physical symptoms
  • motivated by external incentives (avoiding work, evading prosecution, etc.)
  • prevalence not well established
21
Q

Dissociative Disorders

A
  • group of conditions involving disruptions in normally integrated functions of consciousness, memory, identity, or perception
  • only pathological when symptoms perceived as disruptive/recurrent/intrusive
  • we don’t know much about why/how they develop or how to treat them
  • dissociation itself is naturally occurring and happens to a lot of people (ie arriving at destination and not remembering drive)
22
Q

Key Dissociative Disorders for the course

A
  • Depersonalization/derealization disorder (lose sense of self/place)
  • Dissociative amnesia (forget major parts of life)
  • Dissociative identity disorder (multiple personalities)
23
Q

Derealization/depersonalization disorder (+ age of onset and comorbid disorders)

A
  • derealization: temporary loss of sense of reality of outside world
  • depersonalization: temporary loss of sense of self, memory distortion, time distortion
  • may be diagnosed when episodes become consistent or recurrent and interfere with normal functioning (can involve feeling detached, attenuated emotional experiences, higher levels of memory fragmentation)
  • in DSM4 were two diff. disorders, combined in DSM5
  • no exact prevalence data, no clearly effective treatment yet
  • mean age of onset is 16
  • 80% of cases are chronic
  • comorbid disorders: esp. mood/anxiety, avoidant/borderline/o-c PDs
24
Q

Retrograde/Anterograde Amnesia and Dissociative Amnesia

A
  • Retrograde amnesia: partial or total inability to recall or identify previously acquired info or experiences
  • Anterograde amnesia: partial or total inability to retain new info
  • dissociative amnesia characterized primarily by retrograde amnesia
  • following head injury, problems are primarily characterized by anterograde amnesia
25
Q

Dissociative Amnesia

A
  • failure to recall previously stored personal info
  • gaps in memory most often occur after intolerably stressful experiences
  • typically cannot remember certain aspects of personal life history/important facts ab identity
  • only affects episodic/autobiographical memory (not semantic and procedural memory), implicit memory remains intact
  • symptoms cause distress/impairment
  • amnesic episodes last days-years
26
Q

Dissociative Fugue

A
  • subtype of dissociative amnesia where person also flees home surroundings
  • accompanied by confusion ab personal identity or even assumption of new identity
  • unaware of memory loss for prior stages of life
  • memory of what happens during fugue intact
  • behavior usually quite normal/unlikely to arouse suspicion but is different from old lifestyle
27
Q

Dissociative Identity Disorder

A
  • formerly known as multiple personality disorder
  • disruption of identity characterized by two or more distinct personality states as well as recurrent episodes of amnesia
  • DSM5 includes pathological possession in diagnostic criteria (common form of DID); here alters are external and not ‘part of you’
28
Q

Spiegel argued that the problem with DID is not having more than one personality, it is _______

A

having less than one

29
Q

Symptoms of Dissociative Identity Disorder

A
  • host identity: most frequently encountered and carries person’s real name (usually not original identity)
  • alter identity: fragments of a single person; take control at different times; can switch very quickly
  • depression, self-injurious behavior, frequent suicidal ideation/attempts, erratic behavior, headaches, hallucinations, posttraumatic symptoms, other amnesic and fugue symptoms
  • one study found avg 5 comorbid diagnoses
30
Q

Onset and Prevalence of DID

A
  • usually starts in childhood; most patients in teens-20s-30s at time of diagnosis
  • 3-9x more females vs males (women also have more alters)
  • number of alters varies a lot, has increased over time
  • recent trend of bizarre and unusual identities
  • childhood abuse reported in significant number of patients (not specific risk factor for DID); might be more likely to seek treatment
31
Q

Controversies About DID

A
  • controversial diagnostic issue, can be used strategically to avoid conviction
  • according to trauma theory, DID starts in early childhood to protect individual from overwhelming sense of hopelessness/powerlessness
32
Q

Sociocognitive Theory and DID

A
  • DID develops when highly suggestible person learns to adopt and enact roles of multiple identities
  • mostly bc clinicians inadvertently reinforce/legitimize/suggest them
  • consistent with evidence of no clear DID symptoms prior to therapy and increase in # of alters throughout therapy
  • also consistent with increased DID, as more therapists become aware of condition
33
Q

Repressed memories in DID

A
  • repressed memories may be false (product of leading questions/suggestion techniques)
  • not sure if memories are repressed or even exist
34
Q

Prevalence of DID

A
  • 1-1.5% prevalence
  • more evidence supports sociocognitive model
  • multiple causal pathways likely to be involved
35
Q

Cultural factors in DID

A
  • no diagnosis if spirit possession is sanctioned in culture
  • prevalence influenced by degree to which they are accepted as normal or as legitimate mental disorders
36
Q

Treatment and Outcomes in DID

A
  • little known ab effective treatment (absence of randomized controlled trials)
  • hypnosis may be useful; modest effect of some meds
  • treatment typically psychodynamic/insight oriented (based on trauma model and not sociocognitive model)
  • goal to integrate personalities
  • need long treatment to be successful (often years)
37
Q

Trance and Possession

A

Trance
- temporary marked alteration in state of consciousness or identity
- narrowing of awareness of immediate surroundings, stereotypes behaviors/movements beyond person’s control
Possession
- similar except alteration in consciousness//identity is replaced by new identity attributed to influence of deity/spirit
- amnesia for trance state present for both

  • pathological when occur involuntarily, outside accepted cultural contexts, and cause distress
  • common form of DID in non-western countries

PSYC 337 (15 decks)

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