CP: Lecture 6 Dissociative disorders & somatic symptom related disorders Flashcards
history of dissociative disorders
1900 BC – Egyptians: Hysteria - ‘Wandering Womb’
Middle ages: satanic possession
Paul Briquet (1796 –1881): somatisation
Jean-Martin Charcot (1825 – 1893): hypnosis
Pierre Janet (1859 – 1947): dissociation
Sigmund Freud (1856 – 1939): repressed memories
meest voorkomende somatic symptom
chest pain
somatic symptom disorders main criteria=
excessive concerns about physical concerns or health
illness anxiety =
unwarranted fears about a serious illness in the absence of any significant symptoms
conversion disorder =functional neurological disorder =
neurological symptoms that cannot be explained by medical disease or culturally sanctioned behavior
malingering
intentionally faking psychological or somatic symptoms to gain something
factitious disorder
falsification of psychological or somatic symptoms without evidence of gains from those symptoms
vroeger Munchausen syndrome by proxy (Gyspy Rose)
ocd cycle
obsession -> anxiety -> compulsion -> relief
In DSM-IV-TR: physical symptoms have no
known physical cause
◦ Nearly impossible to know actual cause
In DSM 5: focus on positive symptoms:
◦ Somatic symptoms; medically explained or
unexplained
◦ Psychological and behavioural factors
oke
somatic symptom disorder criteria in detail
at least one somatic symptom that is distressing
excessive thought, feeling, behaviours related to concerns via at least 1 of these:
health-related anxiety
disproportionate concerns about the medical seriousness of symptoms
excessive time and energy devoted to concerns
hoelang moet somatic symptom disorder
at least 6 months
specify if … bij somatic symptom disorder
predominant pain
persistent (langer dan 6 maanden)
illness anxiety disorder criteria in detail
- Preoccupation with and high level of anxiety about having or acquiring a serious disease
- Excessive behaviors (e.g., checking for signs of illness, seeking reassurance)
or maladaptive avoidance (e.g., avoiding medical care)
- But: no more than mild somatic symptoms are present
hoelang moet illness anxiety minimaal
6 maanden
functional neurological symptom disorder basic
one or more symptoms:
sensory or motor function impaired but no known neurological cause. (vision, seizures, paralysis, aphonia, anosmia)
factitious disorder=
fabrication or induction of physical or psychological symptoms/injury/disease.
deceptive behaviour without external rewards
imposed on self or imposed on others
somatic symptom disorder model
pathogenesis -> symptoms <-> consequences/coping (focus on pain, attribute pain to disease)
= reinforcement of sickness behaviour
somatic symptom disorder model: mechanisms
medical symptoms + psychiatric disorder/stress/trauma
leiden tot
physiological disturbance + emotional arousal
attention to body
symptoms are attributed to serious illness
health anxiety (gaat terug naar emotional arousal)
leidt tot
help seeking & communication of distress of avoidance & disability
social response (gaat terug naar avoidance + emotional arousal)
cognitive behavioural factors of ssd
attention to bodily sensations + attributions of those sensations
->
sick role (limits health life style) and help seeking behaviours are reinforced by attention and sympathy
pain model
injury -> painful experience
catastrophizing -> fear of movement/reinjury -> avoidance -> disability + disuse + depression
non-catastrophizing -> confrontation -> recovery
dissocation definitie
“a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior”
2 mogelijke functies van dissociation
defense mechanisme
adaptive processes gone awry
transdiagnostic symptoms of dissociation
high comorbidity with mood, Borderline Personality Disorder, Schizophrenia spectrum, Conversion, PTSD
A criteria van depersonalization/derealisation disorder
presence of persistent or recurrent experiences of depersonalisation or derealisation
depersonalisation =
experiences of unreality, detachment, or being an outside observer with respect to ones thoughts, feelings, sensations, body or actions
derealisation =
experiences of unreality or detachmetn of surroundings
during the depersonalisation or derealisation, what remains intact?
reality testing!
-> the ego recognizes the difference between the external and internal world.
dissociative amnesia
inability to recall important autobiographical information, usually of traumatic or stressful nature that is inconsistent with normal forgetting.
vaak: localized/selective amnesia for a specific event, or generalised amnesia for identity and life history
prevalence ocd and related disorders=
0-3%
gender in ocd
women meer OCD en BDD
gelijk: hoarding disorder
prevalence DID and depersonalisation/derealisation
0-3%
prevalence PTSD and dissociative amnesia =
3-10%
trauma prevalence
75-100%
Restriction of the blood supply to a specific area resulting in a lack of oxygen in these brain areas.
ischaemia
bleeding in the brain =
haemorrhage
A collection of symptoms resulting from interruption of the blood supply to the brain.
stroke
Necrosis in brain tissue due to obstruction of an artery.
infarct
specification dissociative amnesia
with dissociative fugue: apparently purposeful travel or bewildered wandering that is associated with amnesia for identity
dissociative identity disorder criteria A
disruption of identity characterized by two or more distinct personality states, whcih may be described in some cultures as possession.
disruption in identity involves marked discontinuity in sense of self and sense of agency + changes in affect, behaviour, consiousness, memory, perception, cognition, sensory-motor functioning.
may be observed by others or reported by the individual
dissociative identity disorder criteria B
recurrent gaps in recall of everydaty events/personal info/traumatic events that are inconsistent with ordinary forgetting
binding problem =
discontinuity of the time frame
2 models for DID
- post-traumatic stress disorder: DID is a defense mechanism, to take on a personality that did not go through the trauma
- social-cognitive model: a creation of psycotherapy and the media
more vulnerable to DID
childhood trauma
emotional dysregulation
sleep dysregulation
hyperassociativity
metacognition
alexithymia
fantasy proneness
meta cognition =
Metacognition is an awareness of one’s thought processes and an understanding of the patterns behind them.
alexithymia =
Mensen die hieraan lijden hebben te maken met moeilijkheden met het verwoorden en begrijpen van emoties en met het omgaan met hun emoties.
