lecture 3+4+DLA Flashcards
Body dysmorphic disorder (BDD)
Preoccupation with a perceived flaw in physical appearance (the flaw is minimal or non-observable)
Repetitive behaviors or mental acts are performed in response to the appearance concerns
cannot be associated with eating disorder
must cause functional impairment
can even be delusional (absent insight add on)
Hoarding Disorder (HD)
Accumulation of possessions in living areas that compromises their intended use
Excoriation Disorder
Recurrent unwanted skin picking causing lesions
Trichotillomania
Recurrent unwanted pulling out of one’s hair
causes of somatic disorders
it is multi factorial
- physiological
overactivity of certain brain areas
amplify perception of pain - cognitive bias
over attentiveness about somatic symptoms
negative thoughts about somatic symptoms - behavioral consequences
conform to a sick role
get reinforced to play the sick role - psychological
transfer psychological stress into physical symptoms
treatment for those with somatic disorders
CBT
reduce stress reduce excessive attention to body correct cognitive distortions reinforce non-sick role address emotional stress
factitious disorder
diagnosis is often overlooked:
A person fakes/induces (feigns) physical or
psychological symptoms, in self or others, in the
absence of obvious “external” rewards.. but no secondary rewards
unexplained persistent symptoms
dramatic presentation
insistence on treatment
grid abdomen
the goal is to stop further medical treatment that is not needed, when diagnosed
report ‘by proxy’ cases to CPS ( imposed on another)
obsessive compulsive disorder (OCD)
recurrent obsessions and compulsions
are time consuming and disruptive
symptoms not explained by another disorder
obsession: intrusive thoughts and urges that lead to distress
compulsions: repetitive behaviors that are done to lower distress
can have an ‘absent insight’ add on
contributing factors to OCD
Cortico-striato-thalamo-cortical (CSTC) circuit overactivity
serotonin deficiency
treatment for those with OCD
- behavioral therapy (exposure and response prevention)
- medication
SSRI’s (fluoxetine)
treatment for refractory OCD
neuro surgery :
lesion:
anterior cingulate gyrus
anterior limb of the internal capsule
deep brain simulation:
electrical stimulation of specific brain areas (subthalamus)
somatic symptoms disorder (SSD)
more than one disruptive somatic symptom
at least one indicator of excessive thoughts or behaviors (such as a lot of anxiety about the symptom)
The diagnosis of SSD focuses on the abnormal behaviors/thoughts/feelings in response to the distressing somatic symptom.
can still have a medical explanation for the symptom but still have SSD
illness anxiety disorder (IAD)
preoccupation with having or acquiring a serious illness
Patient performs excessive health-related behaviors
or shows maladaptive avoidance
somatic symptoms are not present, if they are they are mild.
SSD VS IAD
In IAD the patient does not have any distressing physical complaints, but worries about their health
SSD has a physical complaint with excessiveness
Delusional Disorder (DD), Somatic Type
A Schizophrenia Spectrum disorder characterized by a persistent fixed, false belief about body/health
In DD, the belief is held with delusional intensity (100% certainty); In SSD and IAD, the belief is less strongly believed
conversion disorder
altered voluntary motor or sensory function
Evidence of incompatibility between the symptom and neurological conditions
many subtypes:
ex: speech issue or abnormal movement
factitious disorder vs malingering
malingering:
A person fakes/induces (feigns) physical or
psychological symptoms in self/others for “external”
rewards (such as missing work)
a secondary gain (external reward)
FD is a primary gain, with no external reward
posttraumatic stress disorder (PTSD) symptoms
exposure to a traumatic stressor
can be directly involved, witnessed, or learning about an event.
must have 1+ symptoms of each of the four categories:
- intrusive symptoms
(dreams, feeling of event reoccurring, distress when being reminded of event) - avoidance symptoms
avoids things that remind them of event (can be a place, thought, conversation) - negative mood and cognition
(negative beliefs, negative emotional states, no positive emotion, low interest, detachment) - alterations in arousal and reactivity
(sleep issues, irritable, reckless behavior, lack of concentration, large startle response)
PTSD diagnosis
must last for longer than 1 month
usually begin within 3 months of the trauma, but can happen at any time
there are more vulnerable populations:
usually young adults, but can be anyone
those who have sudden life-threating medical issues can have PTSD
acute stress disorder (ASD)
exposure to a traumatic stressor
9+ PTSD-like symptoms must develop from the four PTSD symptom categories or an additional category: Dissociative Symptoms (can remember or dissociation)
duration of disorder is 3 days to 1 month after the exposure
PTSD VS ASD
ASD: symptoms start and resolve within 30 days
PTSD: symptoms last more than 30 days
Adjustment Disorder Diagnosis
Significant and disproportional emotional/behavioral symptoms in direct response to a stressor
acute onset, brief duration, can be psychosocial or traumatic ex: divorce
Adjustment Disorder diagnosed ONLY if there is a causal stressor AND no other disorder explains the symptoms
subtypes:
Ex: depression, anxiety, disturbance of conduct
Reactive Attachment Disorder (RAD) Diagnosis
child does not have a secure, healthy emotional bond with a caregiver
- pattern of inhibited, withdrawn behavior
(child doesn’t seek comfort) - at least 2 persistent social/emotional disturbances
limited positive affect, unexplained sadness, minimal social effort - at least 1 extreme insufficient childcare
persistent lack of needs / changing of caregivers a lot - Insufficient childcare precedes withdrawn behavior
Disinhibited Social Engagement Disorder (DSED)
very similar to RAD, but the child will approach and interact with unfamiliar adults in more than two ways
willingness to go off with a stranger
want to venture away even in unfamiliar settings
Age and culturally inappropriate verbal or physical behavior
PTSD and ASD etiology
hyperesponsive amygdala (more fear)
under-response of the prefrontal cortex (failure to inhibit fear)
reduced volume and dysfunction of the hippocampus
RAD and DSED Etiology
a direct result of pathogenic care in early childhood
social emotional neglect / changes in caregiver
PTSD and ASD treatment
psychotherapy
supportive therapy to express feelings
behavioral therapy to address behavior
medication:
antidepressants
anxiolytics
treatment or adjustment disorder
psychotherapy to learn coping mechanisms
involvement in support groups
severe!!!!!
psychotropics
hospitalization
Dissociative Amnesia
memory loss for autobiographical information not caused by another disorder
localized: total loss of memory during a specific time period
selective: limited recall of memories during a time period
generalized: loss of personal memory up till triggering event
fugue
Purposeful travel or bewildered wandering associated
with amnesia for identity or other autobiographical information
features:
brief (hours to days)
rarely recurs
spontaneous termination of amnesia
is the dissociative amnesia biological or psychological
biological:
anterograde memory loss
difficult learning new info
psychological:
learns new info well
retrograde memory loss
Dissociative Identity Disorder
Disruption of individual identity characterized by 2+ distinct personality states (the primary and an alter)
Inability to recall personal information
frequent memory gaps in primary while an alter takes control
Depersonalization/Derealization Disorder
Depersonalization: Experiences of unreality, detachment or being an outside observer of one’s thoughts, feelings, sensations, body or actions
Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., objects and/or environment seem unreal or dreamlike)
reality testing remains intact (they know it is a misperception)
function impairment due to symptoms not due to medical condition
Dissociative Disorders Etiology
currently not known
a last ditch effort to respond to an overwhelming environment
DID etiology
known to have smaller hippocampus, amygdala, parietal structures, and frontal structures
associated symptoms:
dissociation
neurotic defense mechanisms
Dissociative Disorders Treatment
Usually psychotherapy supported by a strong therapeutic alliance
Hypnosis may be used to help recover memories
Memory retrieval may trigger grief, rage, shame, guilt,
depression and inner turmoil
