L11 - Dissociative and Somatic Symptom Disorders Flashcards
What are somatic symptom disorders?
They are disorders that have prominent somatic symptoms associated with significant distress and impairment.
Mental disorders that take the form of physical mental disorders
What are dissociative disorders?
They are characterised by a disruption and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behaviour.
Dissociative symptoms can potentially disrupt every area of psychological functioning.
How are dissociative disorders and somatic symptom disorders similar?
They may share a common underlying mechanism.. a disconnect between mental awareness and another part of the usually integrated mental system
Dissociative disorders - higher mental functions (memory, identity) are SPLIT OFF
somatic - part of mental functioning that is SPLIT OFF involves sensory and motor system and affects physical functioning.
THEY -BOTH- CONTAIN MEDICALLY UNEXPLAINED MENTAL/PHYSICAL SYMPTOMS
What was hysteria?
These were non-fatal bodily complaints by women, reported by hippocrates
What is somatisation?
Psychological distress manifesting as physical symptoms.
Sometimes hard to distinguish between physical and somatoform disorder.
must note: severity, degree of bodily preocupation, intensity of worry, forcefulness of healthcare seeking, and history with disgruntlement with healthcare system
—> other psychological disorders can cause somatisation.
depression - fatigue
anxiety - heart palpitations
eating disorders - vomitting and weight change
what are characteristics of normal and abnormal somatisation?
normal - wake up with a headache and realise it’s from stress, relax and move on.. feel better
abnormal - wake up with headache and immediately attribute headache to brain tumour. Engage in help seeking behaviour.
What are some cultural differences to do with somatisation?
Somatisation is viewed as abnormal in western cultures
it is seen as more normal in some eastern countries.
Describe the aetiology of somatic symptom disorders.
BIOLOGICAL
- HPA axis
- neurobiological factors
- gate-control theory
TRAUMA
- individuals with these disorders very likely to have experienced adverse childhood events
- van der kolk: memory of trauma stored in emotions and bodily sensations, not declarative memory
FAMILY
- learned illness behaviour: could learn that illness is the way to express distress, or that other people will show affection and care.
ENVIRONMENTAL
- during adulthood reinforcing illness behaviour.
What are cognitive factors associated with somatic symptom disorders?
- tendency to experience somatic symptoms as INTENSE and DISTRESSING
- more sensitive to physical sensations
- selective attention to bodily sensations
- more likely to attribute cause of Sx to physical cause than psychological
- abnormal illness behaviour - treatment seeking
- vicious cycle: pain –> seek help –> nothing found –> more anxiety –> more pain etc.
What is the impact of somatic symptom disorders
- HUGE levels of disability
- cost to community - days off work etc
- burden on health care system
- compsensation seeking
- problems for family members
What is somatic symptom disorder?
1 + somatic symptoms. 6+ months.
DISPROPORTIONATE persistent thoughts about seriousness of symptoms + high anxiety + Excessive time devoted to health concerns
Associated cog features with somatic symptom disorder?
- attentional focus on somatic symptoms
- attribution of normal bodily sensations to physical illness
- fear that physical activity will harm body –> leads to avoidance
Associated behavioural features to do with somatic symptom disorder?
- Avoidance of physical activity
- repeated body checking
- reassurance and medical help seeking
Somatic symptom disorder and comorbidities?
high comorbidity with depression and increased suicide risk.
Risk factors of somatic symptoms disorder?
- being female
- older age
- fewer years of education
- being unemployed
- social stress
- concurrent chronic physical illness/psychiatric disorder
- reported history of sexual abuse / other childhood adversity
What is illness anxiety disorder?
A preoccupation with having or acquiring an illness, which assumes a prominent part and affects activites in daily life.
- do not respodn to appropriate medical reassurance… may actually increase anxiety
Cognitive and psychological aspects to illness anxiety disorder?
- persistence rumination, heightened anxiety surrounding health
- hypersensitivity to bodily sensations
- catastrophising benign signs
- optimistic bias towards making judgement about own health
- bias in thinking bout threat or reality of serious disease
- childhood learning experiences of illness behaviour
Behavioural aspects associated with illness anxiety disorder?
- intrustive thoughts lead to compulsive reassurance seeking behaviour from medical professionals despite distrust of medical opinion
Treatment for illness anxiety disorder?
- ## Challenges: making client feel understood, and enabling patient to consider psychological alternative explanation for their problems –> suggested treatment rationale
usually they don’t come to treatment b/c they dont want to hear it.
What’s the difference between illness anxiety and OCD?
OCD ppl fear of getting a disease in the future and compulsions f1or other fears too… illness anxiety only have intrusive thoughts about having a disease with associated compulsive behaviour.
What’s the difference between illness anxiety and GAD?
GAD people worry about multiple concerns, where as illness anxiety only worry about health
What’s the difference between illness anxiety and MDD?
MDD can be associated with rumination about health and illness, however, IAD is diagnosed if there is EXCESSIVE illness worry, after remission of a major depressive episode.
What’s the difference between illness anxiety and somatic delusions?
Somatic delusions are usually bizarre (like organ is rotting or dead) and are rigid, whilst IAD individuals can acknowledge that feared disease is not present. Concerns about illness are not founded in reality, but are plausible.
What’s the difference between illness anxiety and panic disorder?
Panic disorder involves misinterpretations of bodily sensations, which leads to avoidance of situations that usually trigger the sensations..
Avoidance is to cope with catastrophe.
They also can be concerned that PA reflects medical illness, but anxiety is acute and episodic..
in IAD, the anticipated harm is less imminent.. they feel they have time to prevent the disaster from happening (medical treatment). concerns about health are persistent and enduring, and panic attacks may result form it..
What is conversion disorder?
Altered voluntary motor or sensory function that can’t be better accounted for by some other medical condition or mental disorder.
- incompatibility between symptoms and recognised neurological and medical conditions.
- sig distress and/or impairment in func
- may spontaneously appear and resolve, so treatment isn’t ALWAYS needed…
- can occur in people already with real medical conditions 0 pseudo-seizures.
Examples of conversion disorder.
Video seen in class - paralysis, abnormal movement - seizures in legs, speech symptoms
Mass psychogenic disorder/mass hysteria - melbourne airport 2005
What is Factitious disorder?
Faking or manufacturing physical or psychological symptoms, or induction of injury or disease without apparent motive (different to malingering which is a form of deception).
two types - imposed on self, and imposed on another.
What is malingering?
This is when an individual has an identifiable external incentive for deliberately faking symptoms. eg. money.
this is NOT A MENTAL DISORDER - it is a form of deception
Some characteristics of presentations of factitious disorder?
- person is dramatic, details are vague and inconsistent - may have extensive knowledge of medical routines - disappear or discharge when confronted.
- person may undergo multiple investigations, and are wide travellers.
- chronic.
- maybe an underlying personality disorder.
seeking affection, attention. care.
behaviour - eg. burning themselves, injecting faeces.
What is dissociative identity disorder?
Disruption of identity characterised by two or more distinct personality states.
- marked discontinuity in sense of self, agency and altered affect, behaviour, consciousness, memory, perception, cognition and or/ sensory motor functioning.
- recurrent gaps in recall of everyday events, important personal information and/or traumatic events that are inconsistent with ordinary forgetting
- sig distress/imapriment
What is the development/course of DID
- can happen at any age
- children: changes in attachment, not usually identity changes
- adolescents: sudden changes in identity that may be mistaken for adolescent turmoil, or beginnings of another disorder
- older: disruptive affects and memory increasingly intrude into awareness w/ advancing age; may be mistaken for OCD, paranoia or dissociative amnesia
Risk factors of DID?
- severe childhood trauma
- lack of soothing experiences following trauma
- capacity to dissociate (easily hypnotised)
- elaboration of alternate identities
Triggers for DID?
- removal from traumatising situation
- individual’s children reaching age at which they were abused
- death or fatal incident to abuser
Associated features of DID?
- concealment or non-awareness of disruptions of consciousness, amnesia or other dissociative symptoms
- dissociative flashbacks
- trauma experiences
- self mutilation/suicdal behaviour
- high levels of hypotisability
DID comobidities?
often comorbid depression, anxiety, substance abuse, non-epileptic seizures, self harm, PTSD.
Outline the controversy surrounding diagnosis of DID.
- can traumatic memory be repressed and later recovered????? could this be FALSE RECALL?
- what explains the rapid increase in prevalence? is this not a social influence?
- Iatrongeneic/sociocognitive theory - psychotherapists legitimise idea of multiple identities, create symptoms through hypnosis and shape behaviour through differential reinforcement.
- media coverage of DID has also influenced/legitimised the disorder –> culture bound syndrome?
What is dissociative amnesia?
Inability to recall important autobiographical information, often of stressful or traumatic nature, that is inconsistent with ordinary forgetting.
What are the subtypes of dissociative amnesia.
LSGSC - LOST SCHOOL GIRLS SCOUT CANDY
candy makes them dissociate??
localised amnesia selective amnesia systemised amnesia continuous amnesia generalised amnesia
What is localised amnesia?
A subtype of dissociative amnesia.
This is when there is failure to recall events during a circumscribed period of time (months or years associated with traumatic event)
What is selective amnesia?
A subtype of dissociative amnesia.
This is when one can recall some but not all events during a specific period of time
What is systematised amnesia?
A subtype of dissociative amnesia.
This is when there is a loss of memory for a specific category of information. eg. memories relating to family, or abuse.
What is continuous amnesia?
A subtype of dissociative amnesia.
When there is a loss of memory for each event as it occurs.
What is generalised amnesia?
A subtype of dissociative amnesia.
Complete loss for one’s life history. Can involve loss of identity, semantic or procedural knowledge.
What is the developmental course of dissociative amnesia?
- sudden onset
- single episode will predispose to multiple episodes
- in adults, children and adolescents (all ages)
Comorbidities with dissociative amnesia?
Depression
Associated features/effects of dissociative amnesia?
- dissociative flashbacks
- high levels of hypnotisability
- sexual dysfunc
- difficulty forming and maintaining relationships
Risk factor to dissociative amnesia?
- history of trauma
and more common in females
What is Depersonalisation/derealisation disorder?
Presence of persistent or recurrent derealisation, depersonalisation or both.
DEPERSONALISATION is experiences of unreality, detachment, being an outside observer with respect to one’s thoughts feelings sensations, body or actions (disorted sense of time, absent self, emotional or physical numbing).
DEREALISATION is experiences of unreality or detachment with respect to surroundings. (objects are experiences as unreal, dreamlike, foggy, lifeless..)
developmental course of depersonalisation/derealisation disorder?
- sudden or gradual onset
- average 16 years old. after 40 is rare
- episodes can be prolonged or brief
- episodes can be discrete, continuous or episodic course may become continuous.
Precipitants of depersonalisaion or derealisation?
- stress
- anxiety / depression
- substance use
- history of trauma common, but not as common as in other dissociative disorders
Comorbidities in depersonalisation/derealisation?
- anxiety/depression
Associated features in depersonalisation/derealisation
- fear of going crazy, or brain damage
- subjectively altered sensation of time
- lightheadedness
- exreme rumination or obsessional preoccupation
- anxiety and depression
