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.