Dissociative Disorders and Somatic Symptom Disorders

Question 1

Dissociative Disorders

Answer 1

split off, or dissociated, from core sense of self. Memory and identity become disturbed; these disturbances have a psychological rather than physical cause.

Question 2

Dissociative disorders listed in the DSM-5

Answer 2

dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder.

Question 3

Five core symptoms

Answer 3

Amnesia, Depersonalization, Derealization, Identity confusion, Identity alteration

Question 4

Amnesia

Answer 4

recurrent memory problems, often described as “losing time”, these gaps in memory can vary from several minutes to years.

Question 5

Depersonalization

Answer 5

a sense of detachment or disconnection from one’s self, this can include feeling like a stranger to yourself, feeling detached from your emotions, feeling robotic or like you are on autopilot, or feeling like a part of your body does not belong to you. Some people self-injure when depersonalized, for example in order to feel “real”.

Question 6

Derealization

Answer 6

a sense of disconnection from familiar people or one’s surroundings, for example, close relatives or your own home may seem unreal or foreign. Episodes of derealization may happen during flashbacks; you may suddenly feel much younger and feel your present environment is unreal during this time.

Question 7

Identity confusion

Answer 7

an inner struggle about one’s sense of self/identity, which may involve uncertainty, puzzlement or conflict. Severe identity confusion regarding sexual identity has been reported in people who have been sexually abused.

Question 8

Identity alteration

Answer 8

a sense of acting like a different person some of the time. Recognizable signs of identity alteration include using of different names in different situations, discovering you have items you don’t recognize, or having a learned skill which you have no recollection of learning. Mild identity alteration is widespread in the non-clinical population and does not cause difficulties for the person, for example a person assumes different roles but remained aware of this alteration. Mood or behavior changes which don’t feel under your control, but don’t involve using different names or changes in memory or perceived age, etc, indicate moderate identity alteration. This is common in non-dissociative disorders, for example in borderline personality disorder.

Question 9

dissociative fugue

Answer 9

(from the word “to flee” in French), whereby they suddenly wander away from their home, experience confusion about their identity, and sometimes even adopt a new identity

Question 10

validity of dissociative amnesia

Answer 10

it has even been characterized as a “piece of psychiatric folklore devoid of convincing empirical support”

Question 11

dissociative identity disorder (DID)

Answer 11

(formerly called multiple personality disorder). People with dissociative identity disorder exhibit two or more separate personalities or identities, each well-defined and distinct from one another.

Question 12

Controversy with DID

Answer 12

1. Some believe that people fake symptoms to avoid the consequences of illegal actions.
2. over diagnose the disorder

Question 13

How is DID usually developed?

Answer 13

traumatic experiences can cause people to experience states of dissociation, suggesting that dissociative states—including the adoption of multiple personalities—may serve as a psychologically important coping mechanism for threat and danger

Question 14

DSM-5 section Somatic Symptom and Related Disorders

Answer 14

experiencing physical symptoms that suggest physical illness or injury but that are not explained by medical test results or a diagnosed medical condition.

Question 15

somatic preoccupation

Answer 15

do not pass the diagnostic criteria for a somatic symptom disorder but still present physical symptoms

Question 16

four somatic symptom disorders

Answer 16

Psychological Factors Affecting other Medical Conditions

Illness Anxiety Disorder

Conversion Disorder

Factitious Disorder

Question 17

Psychological Factors Affecting other Medical Conditions

Answer 17

A medical symptom or condition is present (other than a mental disorder)
Excessive thoughts, feelings or behaviors related to the symptoms, as shown by at least one of the following:
Persistent thoughts about the seriousness of symptoms
High anxiety about health
Excessive energy spent on these symptoms

Question 18

Illness Anxiety Disorder

Answer 18

Preoccupation with having a serious illness
Somatic symptoms aren’t present
High level of anxiety about health
Engaging in excessive health-related behaviors
Preoccupation with health must be present for at least 6 months
The symptoms aren’t explained by other disorder
Formally known as Hypocondriasis.

Question 19

Conversion Disorder

Answer 19

One or more symptoms of motor impairment
Evidence that there is no connection between symptoms and medical condition
The symptoms aren’t explained by other disorder
The symptoms cause significant impairment in life functioning

Question 20

Factitious Disorder

Answer 20

Falsification of physical signs or symptoms of illness/disease/injury
One presents self to others as injured or ill
Absence of obvious external rewards
The symptoms aren’t explained by other disorder
Formally known as Munchausen Syndrome.

Question 21

DSM-5 somatic symptom disorder

Answer 21

The individual exhibits physical symptoms that suggest physical illness or injury.
The person’s physical symptoms are not fully explained by a general medical condition, substance use, or a different mental disorder (e.g., panic disorder).
The person must be excessively worried about their symptoms out of proportion to the severity of the physical complaints.
The individual must have been experiencing these symptoms for at least six months.

Question 22

Treatment for Somatic Symptom Disorder

Answer 22

cognitive behavioral therapy (CBT) in collaboration with a patient’s primary care physician

Question 23

Münchausen syndrome

Answer 23

severe form of factitious disorder, was the first to be identified and was for a period used as the umbrella term for all such disorders

Question 24

DSM-5

Answer 24

Münchausen syndrome has officially been renamed “factitious disorder imposed on self.”

Question 25

Munchausen syndrome by proxy

Answer 25

“factitious disorder imposed on another."

Question 26

DSM-5 differentiates among two types of factitious disorder

Answer 26

Factitious disorder imposed on self (formerly Münchausen syndrome). Factitious disorder imposed on another (formerly Münchausen syndrome by proxy); this diagnosis is assigned to the perpetrator, while the victim may be assigned an abuse diagnosis such as child abuse.

Question 27

In order to be diagnosed with either of these forms of factitious disorder

Answer 27

the person must deliberately aim to deceive others by feigning or causing physical or mental symptoms, illness, or injury (in themselves or another). They must continue this deception over time, even with a lack of any apparent reward or benefit from their behavior. Factitious disorders should be distinguished from somatoform disorders, in which the patient is truly experiencing the symptoms and has no intention to deceive. In addition, the symptoms must not be attributed to another mental disorder (such as a psychotic disorder).