Lesson 9 (ch 8) Dissociative disorders and Somatic symptom disorders Flashcards
why are dissociative disorders and Somatic Symptom Disorders (Somatoform Disorders) grouped together?
-hypothesized to be triggered by stressful experiences
- but don’t involve direct expressions of anxiety
- often comorbid
3 types of Dissociative disorders
- depersonalization/ derealization disorder
- dissociative amnesia
- dissociative identity disorder (multiple personality disorder)
dissociative disorders (+ definition of dissociation
- dissociation: some aspect of cognition or experience becomes inaccessible to consciousness
- avoidance response
sudden disruption in the continuity of:
- consciousness
- emotions
- motivation
- memory
- identity
how does memory play into dissociation (theories)
how does memory work under stress?
considered avoidance response by psychodynamic and behavioral theory. sleep disruption also may play a role
psychodynamic theory
- traumatic events are repressed
cognitive theory
- extreme stress usually enhances memory than impairs it
interference memory formation
- memory not accessible to awareness later
Dissociative Amnesia
inability to recall important personal information
- usually about traumatic experience
- not forgetting, not due to injury
- may last hours or years
usually spontaneously comes back
Dissociative Amnesia: Fugue subtype
amnesia + flight and new identity
- latin “fugere:” to flee
sudden unexpected travel w/ inability to recall one’s past
- assume new identity (name, job, characteristics)
- often brief duration
- remits spontaneously
memory types
memory deficits in EXplicit not IMplicit
explicit:
- involves conscious recall of experiences (events)
implicit:
- underlies behaviors based on experiences that can’t be consciously recalled (things you do)
distinguishing other causes of memory loss from dissociative amnesia
dementia
- fails slowly over time
- linked to stress
- cognitive deficits like inability to learn new info
memory loss from brain injury
substance abuse
Depersonilization/Derealization Disorder
Perception of self/ surroundings are altered
- triggered by stress or trauma
- no disturbance in memory
- often comorbid w anxiety, depression
- onset typically adolescence
- chronic
- no psychosis (reality testing remains intact)
definitions: depersonalization vs derealization
depersonalization
- sense of being detached from self
- unusual sensory experiences (limbs, voice)
- feelings of detachment/ disconnection
- out of body
(also common during panic attacks and weed)
derealization
- world becomes unreal
- appears strange, dream-like, foreign, foggy
-objects appear smaller, sometimes flat
- incapable of emotions,
- feeling dead, lifeless, robot-like
alternative explanations- depersonalization/ derealization
- reality testing remains intact (not psychosis)
- DSM-5 destinguishes symptoms are not expained by substances, another dissociative disorder, another psychological disorder, or by a medical condition.
Dissociative Identity Disorder (DID)
two or more distinct fully developed personalities (alters)
- each has unique modes of being, thinking felling, acting, memories, relationships
- primary alter may be unaware of existence of other alters
most severe of dissociative disorders
- typically begins in childhood, not diagnosed till adulthood
- more common in women
- comorbid w ptsd, MDD, somatic symptom disorder, and personality disorders
- not a thought disorder, not related to schizophrenia, no behavioral disorganization
- alters may or may not be aware of one another
DSM-5 criteria for DID
- Disruption of identity, two or more alters, or an experience of possession
- altered cognition, behavior, affect, perceptions, consciousness, memories, sensory-motor function
- gaps in memory
- not part of broadly accepted cultural or religious practice, not due to drugs or medical condition
- in children, not explained by imaginary friend or play
Epidemiology of DID
- no reports of DID or dissociative amnesia before 1800
- major increases in rates since 1970s
- DSM- III (80’s)- DID criteria became more explicit
- DID in pop culture
- sybil
- three faces of eve
Etiology of DID- two major theories
both focus on physical and sexual abuse during childhood, and why only some people develop DID after abuse
- Posttraumatic model
- Sociocognitive model
Etiology of DID- Posttraumatic Model
- severe psychological and/or sexual abuse in childhood leads to dissociation
- dissociation is where alters come from
Etiology of DID- Sociocognitive Model
DID a form of role-play in suggestible individuals who have experienced abuse
- occurs in response to prompting from therapists or media
- iatrogenic: created within treatment
- hypnosis or sodium pentothal for false memories
- not a conscious deception
evidence raised in theory debate about DID
- DID can be role- played: hypnotized students prompted to reveal alters did so
DID patients show only partial implicit memory deficits
- alters “share” memories
DID diagnosis differs by clinician
- a few clinicians diagnose majority of DID cases
for many, symptoms emerge after therapy begins
treatment of DID (3 + psychodynamic)
Most treatments involve:
- empathic and supportive therapist
- integration of alters to one
- improvement of coping skills
psychodynamic approach adds:
- overcome repression
- use of hypnosis (can actually worsen symptoms)
- “age regression”: regressing back to when threat occurred
Somatic Symptom Disorders
all have excessive concerns about physical symptoms or health (soma= body)
In DSM- IV-TR symptoms had no physical cause
- but its not really possible to know if theres a cause
- DSM-5 removed requirement
three major somatic symptom disorder
- somatic symptom disorder
- illness anxiety disorder
- conversion disorder (Functional Neurological Syndrome)
+ Factitious Disorder
DSM-IV Diagnoses for Somatic Symptom Disorders and what they became
DSM-5 places more emphasis on distress and behavior accompanying somatic symptoms rather than # or range of symptoms
somatic symptom disorder<
- somatization
- pain disorder
- hypochondriasis
illness anxiety disorder<
- hypochondriasis
Conversion Disorder (functional neurological Symptom disorder) <
- Conversion disorder
- body dysmorphic disorder (now part of obsessive compusive and related)
DSM-5 criteria for Somatic Symptom disorder
- atleast one somatic symptom that is distressing or disrupts daily life
- excessive thoughts, feelings, behaviors related to health concern/ symptom
- health related anxiety, disproportionate and persistent concerns about seriousness of symptoms, excessive time/energy devoted
- duration at least 6 months
- specify if predominant pain
Illness anxiety Disorder
preoccupation w and high level of anxiety about having/acquiring serious disease
- excessive behaviors (checking for signs, seeking reassurance) or maladaptive avoidance (avoiding medical care or ill relatives)
- no more than mild somatic symptoms present
- not explained by other psychological disorders
- lasts at least 6 months
DSM-IV-TR criteria for hypochondriasis specify preoccupation must continue despite medical reassurance
Conversion Disorder (Functional Neurological Symptom Disorder)
Sensory or motor function impaired, no known neurological cause
- visual impairment, tunnel vision
- partian/complete paralysis arms/legs
- seizures, coordination problems
- aphonia: whispered speech
- anosmia: loss of smell
symptoms must be inconsistent w recognized neurological disorders
Hysteria
hippocrates-
- believed it only occured in women
- attributed to wandering uterus
Freud-
- coined term “conversion”- anxiety and conflict converted into physical symptoms
- Anna O
Epidemiology of Conversion Disorder (onset, prevalence, comorbidity)
- onset adolescence/. early adulthood
- often follows life stress
- prevalence less than 1%
- More common in women
Often comorbid w/
- other somatic symptom disorders
- MDD
- substance use disorder
Factitious Disorder
Includeds imposed on self and imposed on another
DSM-5 Criteria
- Fabrication of physical or psychological symptoms/disease
- deceptive behavior is present in absence of obvious external rewards
- imposed on self, person presents themself as ill/impaired/injured
- Factitious Disorder Imposed on Another, fabricates symptoms in another person, presents them as ill/impaired/injured
malingering
person intentionally fakes a symptom to avoid responsibility, or to achieve a reward
- symptoms are under voluntary control
Etiology of Somatic Symptoms Disorder- Neurological Factors
no support for genetic influence
why are some people more aware/distressed by bodily sensation?
- parts of the brain that are connected to the SOMATOSENSORY CORTEX, which processes sensations, like the rostral anterior insula and anterior cingulate hyperactive
- somatic symptoms influenced by emotions and stress
- those w somatic symptom disorders show elevated rates of trauma, anxiety, depression
Etiology of Somatic Symptoms Disorders- Cognitive Behavioral Factors
two important cognitive variables:
1) attention to bodily sensations
- automatic focus on physical health cues (especially during neg mood)
2) attributions (interpretation) of those sensations
- overreact w overly negative interpretations
two important consequences:
- sick role limits healthy life alternatives
- help-seeking behaviors reinforced by attention or sympathy
difference btwn panic disorder and somatic symptom disorder
-in panic disorder: believes symptoms are sign of immediate threat (heart attack)
- somatic symptom disorder: believes symptoms are sign of underlying longterm disease
Etiology of Conversion Disorders: Psychodynamic Perspective
- unconscious psychological factor cause
blindsight
- not consciously aware of visual input
- failure to be explicitly aware of sensory info (they should be able to physically see, nothing wrong medically)
Etiology of Somatic Symptoms Disorder: Social and cultural factors
Decrease in incidence of conversion disorders since last half of 19th c
- higher incidence may have been due to more repressed sexual attitudes or low tolerance for anxiety symptoms
- prevalence higher now among rural areas and lower socioeconomic status, also non-western cultures
treatment of Somatic Symptoms Disorder
few controlled treatment outcome studies
CBT treatment
- identify and change triggering emotions
- change cognitions about symptoms
- replace sick role behaviors w more appropriate social interactions
sometimes also family interventions
antidepressants
- Tofranil- effective even at low dosages that don’t alleviate depressive symptoms
health care interventions for those w Somatic Symptoms Disorders
not good for provider to try to convince patient it’s just psychological
- reminder of mind-body connection
- establish trust and comfort
- alerting physicians when patient is intensive user of healthcare services
treatment of somatic symptoms disorders that involve pain
- low dose anti-depressants
- CBT
- Acceptance and Commitment therapy (ACT)
- encourages client to adopt more accepting attitude towards pain, suffering, moments of depression/anxiety, view as natural part of life
