Lesson 9 (ch 8) Dissociative disorders and Somatic symptom disorders

Question 1

why are dissociative disorders and Somatic Symptom Disorders (Somatoform Disorders) grouped together?

Answer 1

-hypothesized to be triggered by stressful experiences

• but don’t involve direct expressions of anxiety
• often comorbid

Question 2

3 types of Dissociative disorders

Answer 2

• depersonalization/ derealization disorder
• dissociative amnesia
• dissociative identity disorder (multiple personality disorder)

Question 3

dissociative disorders (+ definition of dissociation

Answer 3

• dissociation: some aspect of cognition or experience becomes inaccessible to consciousness
  
  • avoidance response

sudden disruption in the continuity of:
- consciousness
- emotions
- motivation
- memory
- identity

Question 4

how does memory play into dissociation (theories)

Answer 4

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

Question 5

Dissociative Amnesia

Answer 5

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

Question 6

Dissociative Amnesia: Fugue subtype

Answer 6

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

Question 7

memory types

Answer 7

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)

Question 8

distinguishing other causes of memory loss from dissociative amnesia

Answer 8

dementia
- fails slowly over time
- linked to stress
- cognitive deficits like inability to learn new info

memory loss from brain injury

substance abuse

Question 9

Depersonilization/Derealization Disorder

Answer 9

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)

Question 10

definitions: depersonalization vs derealization

Answer 10

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

Question 11

alternative explanations- depersonalization/ derealization

Answer 11

• 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.

Question 12

Dissociative Identity Disorder (DID)

Answer 12

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

Question 13

DSM-5 criteria for DID

Answer 13

• 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

Question 14

Epidemiology of DID

Answer 14

• 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

Question 15

Etiology of DID- two major theories

Answer 15

both focus on physical and sexual abuse during childhood, and why only some people develop DID after abuse

• Posttraumatic model
• Sociocognitive model

Question 16

Etiology of DID- Posttraumatic Model

Answer 16

• severe psychological and/or sexual abuse in childhood leads to dissociation
• dissociation is where alters come from

Question 17

Etiology of DID- Sociocognitive Model

Answer 17

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

Question 18

evidence raised in theory debate about DID

Answer 18

• 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

Question 19

treatment of DID (3 + psychodynamic)

Answer 19

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

Question 20

Somatic Symptom Disorders

Answer 20

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

Question 21

three major somatic symptom disorder

Answer 21

• somatic symptom disorder
• illness anxiety disorder
• conversion disorder (Functional Neurological Syndrome)

+ Factitious Disorder

Question 22

DSM-IV Diagnoses for Somatic Symptom Disorders and what they became

Answer 22

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)

Question 23

DSM-5 criteria for Somatic Symptom disorder

Answer 23

• 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

Question 24

Illness anxiety Disorder

Answer 24

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

Question 25

Conversion Disorder (Functional Neurological Symptom Disorder)

Answer 25

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

Question 26

Hysteria

Answer 26

hippocrates-
- believed it only occured in women
- attributed to wandering uterus

Freud-
- coined term “conversion”- anxiety and conflict converted into physical symptoms
- Anna O

Question 27

Epidemiology of Conversion Disorder (onset, prevalence, comorbidity)

Answer 27

• 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

Question 28

Factitious Disorder

Answer 28

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

Question 29

malingering

Answer 29

person intentionally fakes a symptom to avoid responsibility, or to achieve a reward

• symptoms are under voluntary control

Question 30

Etiology of Somatic Symptoms Disorder- Neurological Factors

Answer 30

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

Question 31

Etiology of Somatic Symptoms Disorders- Cognitive Behavioral Factors

Answer 31

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

Question 32

difference btwn panic disorder and somatic symptom disorder

Answer 32

-in panic disorder: believes symptoms are sign of immediate threat (heart attack)

• somatic symptom disorder: believes symptoms are sign of underlying longterm disease

Question 33

Etiology of Conversion Disorders: Psychodynamic Perspective

Answer 33

• 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)

Question 34

Etiology of Somatic Symptoms Disorder: Social and cultural factors

Answer 34

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

Question 35

treatment of Somatic Symptoms Disorder

Answer 35

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

Question 36

health care interventions for those w Somatic Symptoms Disorders

Answer 36

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

Question 37

treatment of somatic symptoms disorders that involve pain

Answer 37

• 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