Dissociative and Somatic Symptoms Flashcards
Sigmund Freud explanation of dissociation
Due to sexual trauma and impulses
What is Dissociation
Lack of normal integration of thoughts, identity, memory and consciousness
Defining symptom of Dissociative Disorders
Dissociation
What are dissociative experiences linked to?
Trauma and Distress
Types of Dissociative Disorders
Dissociative Amnesia (Dissociative fugue)
Depersonalization/ Derealization
Dissociative Identity Disorder
Dissociative Amnesia
Can’t recall significant personal info
There is no biological cause for memory issue
Sudden onset, related to trauma
5 patterns of memory loss
5 patterns of memory loss
Localized Amnesia Selective Amnesia Continous Amnesia Systematized Amnesia Generalized Amnesia
Localized Amnesia
Can’t remember a specific time period (several hours to 1-2 days)
Selective Amnesia
Only some parts of a trauma can be remembered.
A veteran of a war may recall some details, such as taking prisoners, but not others, such as seeing a good friend get hit.
Continuous Amnesia
Can’t remember from a specific date to present day.
Systematized Amnesia
Certain categories of info are forgotten.
Generalized Amnesia
Person forgets entire life.
Dissociative Fugue
Forget identity and move away, assume new identity and start life over.
Sudden and unexpected travel away from home or work
Inability to recall past.
Must be differentiated from malingering
Repressed Memories
Controversial
Certain life events are repressed to help coping
False memory syndrome
False Memory Syndrome
People are made to remember events that never occurred, by therapists
Many people falsely accuse and imprison based on uncovered ‘repressed’ memories
Depersonalization/ Derealization
Depersonalization: sense of unreality/detachment from self
Derealization: disconnect with surroundings
Chronic
No memory or identity impairment
May be due to brain abnormalities in perceptual pathways
Dissociative Identity Disorder (DID)
Multiple Personality Disorder
2 or more personalities take over person’s behaviours.
What triggers Switching between alters usually
Stressful event or cue.
How many alters must be present for diagnosis of DID
At least 2
Can alters be aware of each other?
Yes they can be but not necessarily
How many alters does an average DID patient have
Host+ average of 13-16 ‘alters’
Ethology of Dissociative Disorders
Trauma Model
Socio-Cognitive Model
Pseudogenic Theory
Trauma Model
Diathesis-Stress Model
Result as a response to trauma and personality traits that predispose them to use dissociation as a defence mechanism
Evidence to support trauma model
Patients report higher rate of sexual abuse
Higher rate of dissociation among traumatized individuals
Socio-Cogniotive Model
Multiple personality is roleplaying due to selective reinforcement of symptoms
Leading questions and demand characteristics.
Evidence for Socio-Cognitive Model
DID is usually diagnosed in adulthood, not childhood, when it supposedly starts
Pseudogenic Theory
Occurs due to secondary gains
Financial gain
Legal benefits
Needy, attention-seeking behaviour
Treatment
Try to cope with stress and trauma better
Psychotherapy
Hypnosis
Medication
Psychotherapy
3 stages
Step 1: Build rapport
Step 2: Coping skills
Step 3: Reintegration of personalities
Hypnosis
Popular but criticized
Medication
Only helpful for comorbid disorders
Somatic Symptom Disorders
Physical symptoms, usually no physical cause
Physical cause may be present but psychological stress must be more
Conversion Disorder
Loss of functioning, despite no medical abnormality
Through medical examination needed prior to diagnosis to rule out a medical causes (Abnormal medical readings, inconsistencies and unusual symptom patterns. )
Characteristics of Somatic Symptom Disorders (Long)
Usually no physical cause
Preoccupation with minor symptoms (physical) and normal bodily functioning
No control over symptoms Many forms (sensory impairment, muscular issues)
5-20% of patients
Prevalence of Conversion Disorder
0.4%
Characteristics of Somatic Symptom Disorders (Short)
Cause
Preoccupation
Control
Forms
Diagnosis of Somatic Symptom Disorder
One or more somatic symptom +
Distress
Impairment
Presence/absence of medical condition
Etiology of SSD
High sensitivity to bodily sensations, blamed on disease
Not reassured by negative medical results
Pain Subtype
Main Symptom is pain
May/may not have physical cause but worry is excessive
Mindfulness and CBT help
Can be come dependent of painkillers
Illness Anxiety Disorder
Worry of disease despite negative results
Must last at least 6 months
No physical symptoms
Can be triggered by health information
Factitious Disorder
Faking or generating to get medical attention
Can use dangerous methods to generate symptoms
Common motivations of factitious disorder
Sympathy, care and attention.
Diagnosis of Factitious Disorder
No evidence of a secondary/external reward for faking.
Etiology of SSD, IAD and FD
Biopsychosocial Model
Biological and physiological factors
Psychological Factors
Social Factors
Biopsychosocial Model
Interaction of different factors
Biological and physiological factors
Chronic stress and HPA axis
Psychological Factors
cognitive factors, emotions and personality
Social Factors
early adversities and abuse
Treatment
CBT (Most common)
Cognitive techniques
Emotional techniques
Behavioural techniques
Cognitive Techniques
Cognitive restructuring
Changing automatic thoughts and preoccupations
Emotional techniques
Coping strategies
Emotion regulation
Relaxation techniques
Identifying, understanding and regulating emotions/stress
Behavioural Techniques
Behavioural activation
Reducing sick role behaviours
Body Dysmorphic Disorder
Now a obsessive-compulsive disorder
Preoccupation with exaggerated defect in appearance
Repetitive checking behaviours
Preoccupation with Defect
Intrusive, time consuming and hard to control
Specific or vague
Repetitive checking behaviours
Time consuming
Common Behaviours Mirrors Comparisons with others Camouflaging Seeking reassurance
% of BDD patients that attempt suicide
25%
When does BDD begin
Adulthood, teenage years
Tends to be chronic
BDD vs OCD
Similarity: obsessions and compulsive behaviour
Difference: obsessions focus on appearance and have greater severity in BDD
BDD vs. Eating Disorders
Similarities: Obsessions and concern over appearance
Differences: BDD obsessions focus on more than just weight and fat.
BDD vs. psychotic Disorders
Similarities: Delusional Beliefs
Differences: no other positive or negative symptoms.
Prevalence of BDD
2-2.5%
Women have more comorbid eating disorder rates
Men have more genital and muscle preoccupation
CBT for BDD
Thought restructuring
Exposure exercises
Ritual prevention
Perceptual retraining
Ritual prevention
Preventing compulsive behaviours
Perceptual retraining
focus on the ‘whole’, not a specific part