Lecture 5b - Dissociative disorders and Somatic Symptom Related disorders

Question 1

Types of Dissociative and Somatic symptom disorders

Answer 1

1. Dissociative disorders

2. Somatic symptom and related disorders

Question 2

Description of Depersonalization / derealization disorder

Answer 2

Alteration in the experience of the self and reality

Question 3

Description of Dissociative amnesia

Answer 3

Lack of conscious access to memory, typically of a stressful experience. the fugue subtype involves travelling or wandering coupled with loss of memory for one’s identity or past.

Question 4

Description of Dissociative identity disorder

Answer 4

At least two distinct personalities that act independently of each other

Question 5

What is Dissociation?

Answer 5

Some aspect of cognition or experience becomes inaccessible to consciousness
Avoidance response
Some types of dissociation are harmless and common
Sudden disruption in the continuity of: consciousness, emotions, motivation, memory and identity.

Question 6

How does memory work under stress?

Answer 6

Psychodynamic
Traumatic events are repressed

Cognitive
Extreme stress usually enhances rather than impairs memory

Interference memory formation
No accessible to awareness later

Question 7

Memory deficits and Dissociation

Answer 7

Memory deficits in explicit but not implicit memory

Question 8

What is Explicit memory?

Answer 8

Involves conscious recall of experiences

Question 9

What is Implicit memory?

Answer 9

Underlines behaviors based on experiences that cannot be consciously recalled

Question 10

What is Dementia?

Answer 10

+Memory fails slowly over time
+ It is not linked to stress
+ Accompanied by other cognitive deficits
+Inability to learn new information

Question 11

What is Depersonalization / Derealization disorder?

Answer 11

\+Perception of self is altered
\+ Triggered by stress or traumatic event
\+No disturbance in memory
\+No psychosis or loss of memory
\+Often comorbid with anxiety, depression
\+Typical onset in adolescence
\+Chronic course
\+Symptoms are not explained by substances, another dissociative disorder, another psychological disorder, or a medical condition.

Question 12

What is the criteria for Depersonalization / Derealization disorder?

Answer 12

+Experiences of depersonalization or detachment from one’s mental processes as if one is in a dream.

+Experiences of derealization

Question 13

What is the characteristics of Depersonalization?

Answer 13

\+Unusual sensory experiences
\+Limbs feel deformed or enlarged
\+Voice sounds different or distant
\+Feelings of detachment or disconnection
\+Watching self from outside
\+Floating above one's body

Question 14

What are the characteristics of Derealization?

Answer 14

+ World has become unreal
+World appears strange, peculiar, foreign, dream-like
+Objects appear at times strangely diminished in size, at times flat
+Incapable of experiencing emotions
+Feeling as if they were dead, lifeless, mere automatons
+Experiences of unreality of surroundings
+Symptoms are persistent or recurrent
+Reality testing remains intact
+Symptoms are not explained by substance, another dissociative disorder

Question 15

What is dissociative amnesia?

Answer 15

+ Amnesia and flight and new identify
+ Sudden, unexpected travel with inability to recall one’s past
+Assume new identity
+May involve new name, job, personality characteristics
+ More often of brief education
+Remits spontaneously

Question 16

Criteria for dissociative Amnesia

Answer 16

+Inability to remember important personal information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness.
+The amnesia is not explained by substances, or by other medical or psychological conditions.
+Specify dissociative fugue subtype if:
the amnesia includes inability to recall one’s past, confusion about identity, or assumption of a new identify and
sudden, unexpected travel away from home or work

Question 17

What is a Dissociative Identity disorder (DID)?

Answer 17

+ Two or more distinct and fully develop personalities (alters)
Each has unique modes of being, thinking, feeling, acting, memories and relationships
Primary alter may be unaware of existence of other alters
+ Most severe of dissociative disorders - Recovery may be less complete
+Typical onset in childhood - rarely diagnosed until adulthood
+More common in women than men
+Often comorbid with:
PTSD, major depressionn, somatic symptoms
+Has no relation to schizophrenia
No thought disorders or behavioral disorganization

Question 18

Criteria for Dissociative identity Disorder (DID)?

Answer 18

+Disruption of identity characterized by two or more distinct personality states (alters) or an experience of possession as evidenced by discontinuities in sense of self as reflected in altered cognition, behavior, affect, perceptions, consciousness, memories, or sensory-motor functioning.
+Recurrent gaps in recalling events or important personal information that are beyond ordinary forgetting
+Symptoms are not part of a broadly accepted cultural or religious practice
+Symptoms are not due to drugs or a medical condition in children ,symptoms are not better explained by an imaginary playmate or by fantasy play

Question 19

2 theories of Dissociative Identity disorder

Answer 19

1. Posttraumatic Model

2. Sociocognitive Model

Question 20

Posttraumatic model of dissociative identity disorder

Answer 20

DID results from severe psychological and /or sexual abuse in childhood

Question 21

Sociocognitive model of Dissociative Identity disorder (DID)

Answer 21

A form of role-play in suggestible individuals
+It could be iatrogenic - occurs in response to prompting by therapists or media
+No conscious deception

Question 22

Treatment of dissociative identity disorder (DID)

Answer 22

+ Empathic and supportive therapist
+Integration of alters into one fully functioning individual
+Improving of coping skills
+Psychodynamic approach - overcome repression
+Use of hypnosis - age regression - can actually worsen symptoms

Question 23

What are the main somatic disorders?

Answer 23

1. Somatic symptom disorder
2. Illness anxiety disorder
3. Conversion disorder
4. Malingering
5. Factitious disorder

Question 24

What is Somatic Symptom disorder/

Answer 24

Excessive thought, distress, and behaviour related to somatic symptoms

Question 25

What is Illness anxiety disorder?

Answer 25

Unwarranted fears about a serious illness in the absence of any significant somatic symptoms

Question 26

What is Conversion disorder?

Answer 26

Neurological symptoms that cannot be explained by medical disease or culturally sanctioned behavior

Question 27

What is Malngering?

Answer 27

Intentionally faking psychological or somatic symptoms to gain from those symptoms

Question 28

What is factitious disorder?

Answer 28

Falsification of psychological or physical symptoms, without evidence of gains from those symptoms

Question 29

Criteria for Somatic symptoms disorder

Answer 29

+ One somatic symptom that is distressing or disrupts daily life
+Excessive thoughts, feelings and behaviors related to somatic symptoms or health concerns as indicated by at least one of the following;

+health related anxiety
+disproportionate concerns about the medical seriousness of symptoms
+Excessive time and energy devoted to health concerns

+Duration of at least 6 months
+Predominant

Question 30

Criteria for Illness Anxiety disorder

Answer 30

+Preoccupation with with high level of anxiety about having or acquiring a serious disease
+Excessive behaviors of illness, or maladaptive avoidance
+No more than mild somatic symptoms are present
+Not explained by other psychological disorders
+Preoccupation lasts at least 6 months

Question 31

What is Conversion disorder?

Answer 31

Sensory or motor function impaired but no known neurological cause

+vision impairment or tunnel vision
+Partial or complete paralysis of arms or legs
+Seizures or coordination problems
+Anosmia - Loss of smell

Question 32

Criteria for Conversion disorder

Answer 32

+ One or more symptoms affecting voluntary motor or sensory function
+The symptoms are incompatible with recognized medical disorders
+Symptoms cause significant distress or functional impairment or warrant medical evaluation
+Onset adolescence or early adulthood
+Prevalence less than 1%
+ More common in women than men
+Often comorbid with :

other somatic symptoms disorders
major depressive disorder
substance use disorders

Question 33

What is Factitious disorder?

Answer 33

+Fabrication or induction of physical or psychological symptoms, injury or disease.
+Deceptive behavior is present in the absence of obvious external rewards
+Behavior is not explained by another psychological disorder
+The person presents himself or herself to others as ill, impaired or injured
+ The person fabricates or induces symptoms in another person and then presents that person to others as ill, impaired or injured.

Question 34

What are some people more aware and distressed by bodily sensation?

Answer 34

+Anterior insula and anterior cingulate hyperactive

+ Somatic symptoms influenced by emotions and stress

Question 35

Cognitive behavioral factors of Somatic symptoms disorders

Answer 35

+Attention to bodily sensations
+ Automatic focus on physical health cues
+Attributions (interpretation ) of those sensations
+Overreact with overly negative interpretations
+Sick role limits healthy life alternatives
+Helf-seeking behaviors reinforced by attention or sympathy

Question 36

What does unconscious psychological factors cause in conversion disorder?

Answer 36

Blindsight

+ Not consciously aware of visual input
+Failure to be explicitly aware of sensory information

Question 37

Why is a decrease in conversion disorders since half of the 19th century?

Answer 37

Less repressed sexual attitude

High tolerance for anxiety symptoms

Question 38

What is the treatment for Somatic symptoms disorders

Answer 38

1. Cognitive behavioral treatment

+identify and change triggering emotions
+Change cognitions about symptoms
+ Replace sick role behaviors with more appropriate social interactions

2. Antidepressants
   +Tofranil