CP: Chapter 8 Dissociative disorders and somatic symptom-related disorders Flashcards
depersonalisation/derealisation disorder =
Experience of detachment from the self and reality/surroundings
dissociative amnesia
Lack of conscious access to memory, typically of a
stressful experience. The fugue subtype involves
traveling or wandering coupled with loss of memory
of one’s identity or past
unable to recall imporant personal information
dissociative identity disorder
at least 2 distinct personality states that act independently of each other. they usually do not know that the other exists
depersonalisation =
being detached from one’s own mental processes or body (dus de self)
derealisation =
being detached from ones surroundings (seem unreal)
2 andere criteria van depersonalisation/derealisation disorder
symptoms are persistent or recurrent
not explained by psychosis/other conditions
the symptoms of depersonalization and derealisation are usually caused by…
stress
important to rule out these disorders…
ptsd
schizophrenia
borderline personality disorder
dissociative amnesia kenmerken verder
usually about traumatic experience
holes in memory too extensive to be explained by normal forgetfullness
not permanently lost! but cannot be retrieved during the period of amnesia
hoe lang last dissociative amnesia
several hours or several years
fugue
more severe subtype of dissociative amnesia, more extensive memory loss. person typically dissappears from home, work, wander away, take on a new name etc.
wanneer increased prevalence of DID
1970
waardoor kwam die increase in DID
misscien meer mensen die de symptomen hadden, meer media attention to the diagnosis.
ethiology of DID
- posttraumatic model
- sociocognitive model
- alters share implicit memories, even when they report amnesia about explicit memories
posttraumatic model
waarschijnlijk:
childhood abuse -> dissociative symptoms -> more risk for other psychological disorders
sociocognitive model
people who are abused seek explanations, or may want to get in another personality to avoid their trauma. also may be due to media attention
treatment of DID
psychodynamic treatment: convince the person that splitting into different personalities is not the key to deal with trauma. overcome repressions, as dissociative identity disorder is believed to be due to blocking traumatic events from the conscious
somatic symptom disorders key characteristic
excessive concerns about physical health or symptoms
wat zijn 3 lastige punten aan somatic symptom disorder
- heel heterogeen
- heel subjectieve criteria, wat is de threshold for ‘too much concern’
- diagnosis is often stigmatized
somatic symptom disorder (een)
excessive anxiety, energy or behaviour focused on somatic symptoms
illness anxiety disorder
fears fo a severe disease in the absence of somatic symptoms
functional neurologic disorder
vroeger conversion disorder!!
= sensory and motor dysfunctions that cannot be explained by medical tests.
voorbeelden functional neurological disorder symptoms
paralysis of arms and legs
seizures
coordination disturbances
insensitivity to pain
anaesthesia
loss of sensations
malingering =
person intentionally fakes a symptom to avoid a responsibility (work/military) or to achieve some goal/be rewarded.
factitious disorder
people intentionally produce physical symptoms (sometimes psychological ones) to assume the role of a patient, without gains from those symptoms
somatic symptom disorder heritability
the symptoms are not genetically determined
which brain regions are different in ppll with ssd
brain regions involved in processing the unpleasantness of bodily sensations may be hyperactive
= anterior cingulate and anterior insula
cognitive behavioural factors
some ppl are overly attentive to physical concerns and make negative interpretations about these symptoms
wat voor treatment voor ssd cognitief
behavioural reinforcement, for maintaining the help seeking behaviour
conversion disorder sackeim model
2 stage psychodynamic model:
people lack conscious awareness of perceptions
people are motivated to have these symptoms
social and cultural factors in conversion disorder
social influences seem important, as groups of co workers can have the same factors.
the prevalence over time is unclear
treatment of somatic symptoms and related disorders: obstacle
most people want medical care instead of mental health care
dus wat voor treatments zijn er wel mogelijk
- interventions in primary care: make physicians address the symptoms nicely, and limiting medical tests
- cognitive behavioural treatment: adress the distress over somatic symptoms, try to reduce excessive attention to bodily cues, and adress overly negative interpretations of physical symptoms, reinforce behaviour that is not consistent with the sick role
- for pain: antidepressants may help
somatic symptom disorder DSM
at least one somatic symptom that is distressing
excessive thought/distress/behaviour about symptoms, indicated by at least one of these:
1. health anxiety
2. disproportionate and persistent concerns aout the seriousness of symptoms
3. excessive time and energy devoted to health concerns
hoelang moeten ssd symptoms bestaan voor diagnose
at least 6 months, maar hoeven niet continously present te zijn!!!
specificy if it is predominantly pain
illness anxiety disorder dsm
- Preoccupation with and anxiety about having or acquiring a serious disease
- Excessive illness behavior (e.g., checking for signs of illness, seeking reassurance)
or maladaptive avoidance (e.g., avoiding medical care) - No more than mild somatic symptoms are present
- Preoccupation lasts at least 6 months, although need not be present continuously during that time
functional neurological disorder dsm
- One or more symptoms affecting voluntary motor or sensory function
- The symptoms are incompatible with any recognized medical disorder
- Symptoms cause significant distress or functional impairment or warrant medical evaluation
factitious disorder dsm
- Fabrication or induction of physical or psychological symptoms, injury, or disease
- Deceptive behavior is present in the absence of obvious
external rewards - In factitious disorder imposed on self, the person presents himself or herself to others as ill, impaired, or injured
- In factitious disorder imposed on another, the person fabricates or induces symptoms in another person and then presents that person to others as ill, impaired, or injured
3 soorten dissociative disorders
depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder
ethiology of depersonalization/derealisation disorder is believed to be…
related to difficulties integrating somatic and sensory information.
People with dissociative identity disorder (DID) often retrospectively report
severe physical or sexual abuse during childhood, but prospective research does not suggest that early adversity predicts the onset of DID.
posttraumatic model says on did
extensive reliance on dissociation to fend off overwhelming feelings arising from abuse puts people at risk for developing dissociative identity disorder.
sociocognitive model on did says
Proponents of the sociocognitive model point out that some therapists use strategies that suggest such symptoms to people and that most people do not recognize the presence of alternate personalities until
after they see a therapist.
Although one of the defining features of
DID is the lack of shared memories among alternative personality states, evidence suggests that the alternate personalities may share more memories than they report. Also, symptoms of DID can be role-played effectively.
oke
psychodynamic treatment en dissociative disorders?
Psychodynamic treatment is perhaps the most commonly used treatment for dissociative disorders, but some of the techniques involved, such as hypnosis and age regression, may make symptoms worse.
health anxiety heritability
moderate
Neurobiological models suggest that key brain regions involved in processing the unpleasantness of bodily sensations may be hyperactive among people with somatic symptom and related disorders. These regions include the anterior cingulate cortex and the rostral anterior insula. Cognitive variables are also important: Some people are overly attentive to physical concerns and make overly negative interpretations of symptoms and their implications. Avoidance may lead to health declines, and behavioral reinforcement may maintain help-seeking behavior. Safety behaviors may prolong and intensify health anxiety.
oke
findings on conversion/functional neurological disorder
consistent with the psychodynamic idea that people with conversion disorder may not be conscious of their perceptions (in the case of blindness) or their control of
movements (in the case of movement symptoms). Sociocultural influences also appear important in conversion disorder.
treatment for ssd en conversion disorder
When pain is a primary concern in somatic symptom disorder, CBT, hypnosis, ACT, and low doses of antidepressant medication may be helpful. Small trials indicate that CBT may also be helpful for conversion disorder.
