Chapter 8 Flashcards
% of physical symptoms that cause people to seek medical care that are medically unexplained
20-50%
4 most important disorders in somatic symptom category (need to be able to differentiate for exam)
new category in DSM5!
- somatic symptom disorder
- illness anxiety disorder
- conversion disorder
- factitious disorder
Somatic symptom disorder
- 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%
Controversy around Somatic symptom disorder
- 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
Causes and Risk Factors of Somatic Symptom Disorder
- 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)
Characteristics of Somatic Symptom Disorder
- 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)
Treatment of Somatic Symptom Disorder
- 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
Treatment of Somatic Symptom Disorder involving chronic pain
- 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)
Illness Anxiety Disorder
- 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)
Conversion Disorder
- 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
Conversion Disorder - Sensory Symptoms
- 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
Conversion Disorder - Motor Symptoms or Deficits
- wide range, including
- conversion paralysis, usually single limb
- aphonia (speech-related disturbance)
- globus (sensation of lump in throat)
Conversion Disorder - Seizures
- resemble epileptic seizures, but are not true seizures
- no EEG abnormalities and no confusion or memory loss afterwards
Diagnosis of Conversion Disorder
- 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
Prevalence and Demographic Characteristics of Conversion Disorder
- 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
Causes of Conversion Disorder
- 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
Treatment of Conversion Disorder
- 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
Factitious Disorder
- 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
Identifying factitious disorder
- no tangible external rewards
- being the focus of medical attention is what is rewarding
- different from malingering bc no tangible external rewards
Malingering
- intentionally producing or grossly exaggerating physical symptoms
- motivated by external incentives (avoiding work, evading prosecution, etc.)
- prevalence not well established
Dissociative Disorders
- 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)
Key Dissociative Disorders for the course
- Depersonalization/derealization disorder (lose sense of self/place)
- Dissociative amnesia (forget major parts of life)
- Dissociative identity disorder (multiple personalities)
Derealization/depersonalization disorder (+ age of onset and comorbid disorders)
- 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
Retrograde/Anterograde Amnesia and Dissociative Amnesia
- 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