Lecture 9: Dissociative and Factitious Disorders

Question 1

Dissociation (3)

Answer 1

1. Psychological condition of detachment from normal state of consciousness
2. disconnection between thoughts, feelings, memories, surroundings
3. Assoc. with hx or psychical and psychological trauma

Question 2

Sx Dissociation (4)

Answer 2

1. gaps in memory or time loss
2. sense of detachment from self or emotions
3. distorted perceptions of persons or situations
4. blurred sense of identity

Question 3

Dissociative Responses (3)

Answer 3

1. increased stress in relationships, work
2. impaired coping skills
3. depression, anxiety, suicidal thoughts

Question 4

Dissociative Amnesia (4)

Answer 4

1. Episodes of amnesia, especially surrounding traumatic events and not due to other medical conditions
2. less commonly, intimate personal information or even identity can be impaired
3. may travel or take new identities (fugue state)
4. occurs suddenly and may last between a few minutes to few years

Question 5

Dissociative identity disorder (4)

Answer 5

1. switching between distinct personalities
2. “alter” personalities may not be are of each other and may be very distinctive “fragments” or primary personality
3. frequently comorbid with dissociative amnesia
4. severe trauma response

Question 6

Depersonalization and Derealization Disorders (3)

Answer 6

1. Feeling of detachment from identity or reality
2. surroundings seems unreal and indistinct
3. “out of body” experiences and changes in experience of time are common

Question 7

Tx of dissociation

Answer 7

1. long-term psychotherapy is key treatment
2. psychopharmacology can help with assoc symptoms
   - depression
   - anxiety
3. “integrative” therapy controversial

Question 8

Somatization (3)

Answer 8

1. concept of psychical complains arising from emotional conflicts
2. conversion
3. hysteria

Question 9

conversion

Answer 9

sudden physical disabilities thought to be caused by unresolved psychiatric conflicts

Question 10

Hysteria

Answer 10

traditional name for uncontrolled emotional symptoms accompanied by unexplained physical symptoms

Question 11

“studies in hysteria”

Answer 11

1. breuer and freud (1895)
2. based on treatment of bertha pappenheim (Anna O)
3. “talking cure”

Question 12

Somatic symptom disorder (3)

Answer 12

1. multiple, possible unexplained physical symptoms for at least 6 months
2. cause significant disruption in daily life and significant emotional distress
3. may be assoc. with chronic illness

Question 13

Faked illness syndrome (2)

Answer 13

1. factitious d/o

2. malingering

Question 14

factitious d/o

Answer 14

1. deliberately producing, feigning, or exaggerating symptoms to take on the role of a sick person
   - sympathy
   - nurturance
   - attention

Question 15

Malingering overview (1)

Answer 15

1. deliberately producing, feigning, or exaggerating symptoms for external gains
   - money
   - legal issues
   - escape from duties

Question 16

Munchhausen’s Syndrome

Answer 16

Factitious d/o

imposed on self

Question 17

Munchhausen’s by proxy

Answer 17

factitious d/o

imposed on another

Question 18

Contexts to consider malingering (4)

Answer 18

a. medical-legal referrals, jails, prisons
b. marked discrepancy between reported distress and objective findings
c. lack of cooperation with evaluation and treatment
d. presence of antisocial personality d/o

Question 19

Evaluation of Malingering (4)

Answer 19

1. malingerers are actors, playing a role based on their understanding of the illness
2. faked symptoms are hard to maintain for extended periods of time and may be inconsistent
3. usually lack nuance of symptoms
4. endorse unusual or contradictory symptoms
5. exaggerate deficits

Question 20

Motivations of factitious d/o

-malingering

Answer 20

1. in emergent settings, most common motivation to obtain drugs or housing
2. in office settings, common motivations include prescription medications by financial compensation
   - disability, etc