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Psychopathology > Lecture 10 - Somatic and Dissociative Disorders > Flashcards

Lecture 10 - Somatic and Dissociative Disorders Flashcards

1
Q

Explain the difference between factitious and malingering disorders

A
  • factitious: deliberate feigning of disorder (often about seeking attention from people)
  • malingering: recognised incentive for feigning disorder (deception, but also mental illness involved)
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2
Q

What are somatic disorders?

A
  • present with prominent somatic sx, but cannot be explained medically
  • mental disorders take the form of physical disorders
  • prominent somatic sx associated with distress and impairment
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3
Q

What are dissociative disorders?

A
  • disruption and/or discontinuity in the normal integration of consciousness, identity, memory, emotion, perception, body representation, motor control and behaviour
  • can disrupt potentially every area of psych functioning

dissociative sx experienced as:

  • intrusions into awareness/behaviour + loss of continuity in subjective experience (i.e. +ve dissociative sx)
  • inability to access info/control mental functions that normally are readily amenable to access or control (i.e. -ve dissociative sx)
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4
Q

Explain the history of somatic and dissociative disorders

A
  • Hippocrates: ‘hysteria’ > non-fatal bodily sx in women
  • 17th century: ‘hypochondriasis’ > male
  • Anna O > looking after father (mute, vision loss, headaches, limb weakness): Freud and Breuer
  • “conversion”: transformation of physical/mental excitation into chronic somatic symptoms
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5
Q

What are the 4 somatic disorders and their associated features?

A
  • somatic symptom disorder: freq medical visits; impaired functioning
  • illness anxiety disorder: fear of illness persists despite med reassurance; interpret physical sensations as signs of illness
  • conversion disorder: emerges in context of stress/conflict
  • factitious disorder: sx do not result in any obvious gain; 2 types (imposed on self v. others)
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6
Q

How common are medically unexplained symptoms in general practice?

A
  • very common, up to 30%

- rship b/w the no. of somatic sx someone has and anxiety/depression

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7
Q

Explain the impact of somatic symptoms disorders (4)

A
  • huge disability and handicap problems
  • costs to community > days off work
  • compensation seeking
  • problems to family members (separation difficulties bc children become carers for parents; kids miss school which reduces social opps)
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8
Q

Explain the cultural differences of somatic symptoms

A
  • Western: somatisation abnormal
  • some Eastern: somatisation the norm (expressing psych distress is abnormal)

Highlight ongoing debate about mind-body split

  • Western: chronic fatigue, IBS
  • China: Shenjing shuairuo
  • Korea: Hwa-byung
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9
Q

What is illness anxiety disorder?

A
  • preoccupation with having or acquiring a physical illness
  • easily alarmed by hearing about illness
  • do not respond to appropriate medical reassurance/tests/benign course
  • doctors attempts do not alleviate concerns (may heighten them)
  • illness concerns assume a prominent place in life, affect daily activities, may lead to invalidism
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10
Q

Differentiate IAD from 5 other disorders

A

GAD: worry about multiple concerns (one may be health)
IAD: sole focus of worry is health

OCD: fearful of getting disease in future; O+Cs about other things too
IAD: intrusive thoughts about disease associated with compulsions (eg. reassurance)

MDD: may involve health concerns
IAD: illness worry persists after MDE

DELUSIONS: somatic delusions bizarre and rigid
IAD: can usually acknowledge that feared disease not present; illness concerns not real but plausible

PANIC: misinterpretations of bodily sensations > avoid situations; misinterpret anxiety signs; may worry that PA reflects medical illness but worry is acute/episodic
IAD: anticipated harm less imminent than in panic (have time to get med attn and prevent it); health anxiety/fears are persistent and enduring (may have PA resulting from illness concerns)

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11
Q

What are the cog and psych aspects of illness anxiety disorder?

A
  • hypersensitivity to bodily sensations
  • heightened anxiety regarding health/illness
  • biased thinking about threat/reality of serious disease
  • excessive reassurance seeking
  • distrust med opinion BUT more help-seeking
  • childhood learning experiences of illness behaviour
  • catastrophic misinterpretations of benign sings
  • optimistic bias towards making judgments about own health risks
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12
Q

What is the treatment of illness anxiety disorder? What are three challenges of this?

A
  • CBT (psych therapy better than med)

CHALLENGES

  • help client feel understood
  • enable client to consider: non-catastrophic alternative explanation + suggested treatment rationale and strategies that flow from it
  • engagement in psych treatment is problematic > they believe they have a physical illness and that the last thing they need it psych treatment
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13
Q

What is conversion disorder? What are the symptoms? What are the specifiers? Give two examples of it.

A
  • altered voluntary motor or sensory function
  • no medical/neuro explanation
  • often spontaneously remit without treatment

SYMPTOMS

  • weakness/paralysis
  • abnormal movement (tremor, gait etc.)
  • swallowing
  • speech
  • attack/seizures
  • sensory loss
  • special sensory sx (visual, olfactory, hearing)
  • mixed sx

SPECIFIERS:

  • acute v. persistent
  • with/without psych stressor

EXAMPLES

  • soldiers in wartime
  • mass psychogenic disorder/mass hysteria > Melb Airport 2005
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14
Q

What is used to measure dissociative symptoms?

A

Dissociative Experiences Scale

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15
Q

What is Dissociative Identity Disorder?

A
  • disruption of identity; 2+ distinct personality states
  • discontinuity in sense of self and sense of agency
  • alterations in: affect, behaviour, consciousness, memory, perception, cognition, sensory-motor function
  • recurrent gaps in recall of everyday events, personal info, traumatic events
  • not normal given cultural and religious context
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16
Q

Explain the prevalence of Dissociative Identity Disorder

A
  • 1957: “Eve” only case in world
  • 1980: approx 200 cases reported internationally
  • more recently: 1% of adult population
  • large-scale population based studies required
17
Q

What are the associated features of Dissociative Identity Disorder?

A
  • comorbidities: anxiety, depression, substance use, self-injury, non-epileptic seizures, other
  • concealment or non-awareness of disruptions in consciousness, amnesia or other dissociative sx
  • dissociative flashbacks
  • other experiences of trauma (non-abuse)
  • self-mutilation/suicidal behaviour
  • high levels of hypnotisability
18
Q

Explain the aetiology of Dissociative Identity Disorder

A
  • severe childhood trauma (almost always ~90%) > majority with DID have PTSD

ADDITIONAL FACTORS

  • capacity to dissociate
  • elaboration of alternate identities
  • lack of soothing experiences after trauma
19
Q

Explain the differences in Dissociative Identity Disorder at different age groups

A

CHILDREN: memory/concentration/attachment problems; usually don’t present with identity changes; present with overlap/interference among mental states
ADOLESCENTS: sudden changes in identity may appear to be just adolescent turmoil or early stages of another disorder
OLDER: present to treatment with what appear to be late-life mood dx, OCD, paranoia, psychotic mood dx, or cog dx

20
Q

What can trigger overt changes in identity in Dissociative Identity Disorder?

A
  • removal from traumatising situation
  • individual’s children reaching same age at which individual was originally abuse or traumatised
  • later traumatic experiences (even seemingly inconsequential ones eg. minor car accident)
  • death of, or onset of, a fatal illness in abuser(s)
21
Q

Explain the controversy in Dissociative Identity Disorder

A

RECOVERED MEMORY DEBATE

  • is it possible that a trauma memory of abuse can be repressed so that the memory is inaccessible, but can later be recalled accurately?
  • hypnosis/guided imagery treatment if repressed memory thought possible
  • careful assessment to minimise likelihood of false recall + use CBT to reduce anx/dep etc. if repressed memory not thought possible

IATROGENIC/SOCIOCOG THEORY

  • psychologists play a role in development of DID: suggest possibility of multiple identities and legitimise it
  • also: create sx through hypnosis and then shape behaviour through differential reinforcement
  • media cases: Eve and Sybil
22
Q

What is dissociative amnesia? What is the specifier?

A
  • inability to recall important autobiographical memory (usually trauma/stressful memory) inconsistent with normal forgetting

WITH DISSOCIATIVE FUGUE
- purposeful travel/bewildered wandering that is associated with amnesia for identity/for other important autobiographical information

23
Q

What are the 5 subtypes of dissociative amnesia?

A
  • LOCALISED: memory loss in a circumscribed period of time (may be broader than one single event)
  • SELECTIVE: can recall some, but not all, of the events during a circumscribed period of time
  • SYSTEMATISED: memory for a specific category of info lost
  • CONTINUOUS: forget each new event as it occurs
  • GENERALISED: complete loss of life history (personal identity, semantic knowledge, procedural knowledge)
24
Q

What are the associated features of dissociative amnesia?

A
  • history of trauma (v common)
  • difficulty forming and maintaining rships
  • dissociative flashbacks (possible)
  • depression
  • suicide/self-harm (common)
  • high levels of hypnotisability
  • sexual dysfunction (common)
25
Q

What is the prev and course of dissociative amnesia?

A
  • 12mth prev: 1.8% (1%M, 2.6%F)
  • children, adolescents and adults

COURSE:

  • generalised: onset sudden
  • localised + selective: less known (rarely evident)
  • may have many episodes (one episode can predispose others); may/may not be symptomatic b/w episodes
  • any age
26
Q

What is derealisation/depersonalisation disorder?

A
  • depersonalisation: unreality, detachment or feeling like an outsider with respect to thoughts, feelings, sensations, body, actions (distorted sense of time, perceptual alterations, emotional or physical numbing)
  • derealisation: unreality or detachment with respect to surroundings (dream-like, foggy, unreal, lifeless, distorted)
27
Q

What are the associated features of derealisation/depersonalisation disorder?

A
  • fear ‘going crazy’
  • fear ‘brain damage’
  • subjectively altered sensation of time (too fast/slow)
  • lightheadedness
  • extreme rumination or obsessional preoccupation (do I really exist?)
  • anxiety + depression
28
Q

What is the course of derealisation/depersonalisation disorder?

A
  • onset: 16yrs (<20% after 20yrs; 5% after 25yrs)
  • onset: range extremely sudden to gradual
  • duration of episodes: vary brief (hrs/days) to prolonged (wks, mths, yrs)
  • 1/3 cases discrete episodes; 1/3 continuous sx; 1/3 initially episodic then continuous
29
Q

What is the aetiology of derealisation/depersonalisation disorder?

A
  • childhood interpersonal trauma < association to this not as strong as with other dissociative disorders
  • proximal precipitants: severe stress (interpersonal, financial, occupational), depression, anxiety (esp. panic attacks), illicit drug use
30
Q

Explain the treatment of dissociative disorders

A
  • derealisation/depersonalisation: pharamacotherapy (SSRIs, antipsychotics > limited evidence); CBT?
  • dissociative amnesia: imaginal exposure, hypnosis
  • DID: treatment guidelines, more empirical research needed

Psychopathology (14 decks)

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