LONG QUIZ [CHAPTER 6-8] Flashcards
Individuals are pathologically concerned with the functioning of their bodies; have an excessive or maladaptive response to physical symptoms or to associated health concerns.
5 basic disorders:
(i) Somatic Symptom Disorder
(ii) Illness Anxiety Disorder
(iii) Psychological Factors Affecting Medical Condition
(iv) Functional Neurological Symptom Disorder (Conversion Disorder)
(v) Factitious Disorder
These disorders are sometimes grouped under the shorthand label of “medically unexplained physical symptoms”
Somatic Symptom and Related Disorders
Individuals experience intense and extreme alterations, or detachments, in consciousness or identity (dissociation or dissociative experiences) that they lose their identity entirely and assume a new one, or they lose their memory or sense of reality and are unable to function.
Disorders:
(i) Depersonalization-Derealization Disorder
(ii) Dissociative Amnesia
(iii) Dissociative Identity Disorder
Dissociative Disorders
Somatic symptom and dissociative disorders are strongly linked historically and used to be categorized under one general heading, _________ _________.
Hysterical Neurosis
Soma means
Body
Soma means body, and the problems preoccupying these people seem, initially, to be ________ ________
Physical Disorders
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health
concerns as manifested by at least one of the following:
(1) Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
(2) Persistently high level of anxiety about health or symptoms
(3) Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
- Formerly known as Briquet’s syndrome
- An important feature of these physical symptoms, such as pain, is that it is real and it
hurts whether there are clear physical reasons for pain or not
SOMATIC SYMPTOM DISORDER
A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical
condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal
health status.
D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her
body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments
and hospitals).
- Formerly known as “hypochondriasis”
- Preoccupation with physical symptoms. Physical symptoms are either not experienced at
the present time or are very mild, but severe anxiety is focused on the possibility of having or developing a serious disease; the concern is primarily with the idea of being sick instead of the physical symptom itself; individual is preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease.
ILLNESS ANXIETY DISORDER
A difficult to shake belief
Disease Conviction
Requires the presence of medical conditions as well as psychological factors that adversely affect its course or interfere its treatment.
Example: Anxiety severe enough to clearly worsen an asthmatic condition.
Note: This diagnosis would need to be distinguished from the development of stress or anxiety in response to having a severe medical condition that would be more appropriately be diagnosed as an adjustment disorder.
A. A medical symptom or condition (other than a mental disorder) is present.
B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways:
1. The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.
2. The factors interfere with the treatment of the medical condition (e.g., poor adherence).
3. The factors constitute additional well-established health risks for the individual.
4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.
PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITION
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
FACTITIOUS DISORDER IMPOSED ON SELF
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.
B. The individual presents another individual (victim) to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
FACTITIOUS DISORDER IMPOSED ON ANOTHER (FORMERLY FACTITIOUS DISORDER BY PROXY)
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER (CONVERSION DISORDER)
➢ Severe and frightening feeling of unreality that they dominate an individual’s life and prevent normal functioning
A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
- Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
- Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains intact.
DEPERSONALIZATION/DEREALIZATION DISORDER
➢ Perception alters and temporarily loses the sense of one’s own reality, as if you were in a dream and you were watching yourself.
➢ A feeling of unreality or detachment from, or unfamiliarity with, the individual’s whole self or from aspects of the self
➢ The individual may feel detached from his or her:
- entire being (e.g., “I am no one,” “I have no self”)
- feelings (e.g., hypoemotionality: “I know I have feelings, but I don’t feel
them”)
- thoughts (e.g., “My thoughts don’t feel like my own,” “head filled with
cotton”)
- whole body or body parts, or sensations (e.g., touch, proprioception,
hunger, thirst, libido).
➢ There may also be a diminished sense of agency (e.g., feeling robotic, like an
automaton; lacking control of speech or movements).
➢ The unitary symptom of “_______________” consists of several symptom factors:
- anomalous body experiences (i.e., unreality of the self and perceptual alterations);
- emotional or physical numbing; and
- temporal distortions with anomalous subjective recall.
DEPERSONALIZATION
➢ Sense of the reality of the external world is lost
➢ A feeling of unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings
➢ Feel as if he or she were in a fog, dream, or bubble, or as if there were a veil or a glass wall between the individual and the world around.
➢ Surroundings may be experienced as artificial, colorless, or lifeless.
➢ _____________ is commonly accompanied by subjective visual distortions, such as blurriness, heightened acuity, widened or narrowed visual field, two-dimensionality or flatness, exaggerated three-dimensionality, or altered distance or size of objects (i.e., macropsia or micropsia).
➢ Auditory distortions can also occur, whereby voices or sounds are muted or heightened.
DEREALIZATION
● Characterized by an inability to recall autobiographical information that is inconsistent with normal forgetting.
● Memory deficits are primarily retrograde and often associated with traumatic experiences.
DISSOCIATIVE AMNESIA
- characterized by apparently purposeful travel or bewildered wandering
- associated with amnesia for identity or other important autobiographical information.
- subtype of dissociative amnesia
- amnesia for travel
- commonly associated with generalized dissociative amnesia.
DISSOCIATIVE FUGUE
An individual enters a trancelike state and suddenly, imbued with a mysterious source of energy, runs or flees for a long time.
RUNNING DISORDERS
- Individuals in this trancelike state often brutally assault and sometimes kill people or animals.
- Apparently distinct dissociative state not found in Western cultures.
- Most people with this disorder are males.
AMOK
Types of Dissociative Amnesia
Localized
Selective
Systematized
Generalized
A failure to recall events during a circumscribed period of time.
LOCALIZED
The individual can recall some, but not all, of the events during a circumscribed period of time.
SELECTIVE
The individual fails to recall a specific category of important information.
SYSTEMATIZED
Involves a complete loss of memory for most or all of the individual’s life history.
GENERALIZED
➢ Characterized by a) the presence of two or more distinct personality states or an experience of possession and b) recurrent episodes of dissociative amnesia.
➢ May adopt as many as 100 new identities, all simultaneously coexisting, although the average number is closer to 15.
➢ Individuals with _________ _________ __________ experience recurrent, inexplicable intrusions into their conscious functioning and sense of self; alterations of sense of self; odd changes of perception; and intermittent functional neurological symptoms
A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition,and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgettin
DISSOCIATIVE IDENTITY DISORDER
The disorders described in this chapter used to be categorized under several general labels, such as “depressive disorders,” “affective disorders,” or even “depressive neuroses.” Beginning with the third edition of the Diagnostic and Statistical Manual (DSM-III), published by the American Psychiatric Association in 1980, these problems have been grouped under the heading _________ _____________ because they are characterized by gross deviations in mood.
MOOD DISORDERS
Individuals who experience either depression or mania are said to suffer from a ________ ________ _________, because their mood remains at one “pole” of the usual depression–mania continuum.
UNIPOLAR MOOD DISORDER
An individual can experience manic symptoms but feel somewhat depressed or anxious at the same time, or be depressed with a few symptoms of mania. This episode is characterized as having _______ ____________.
MIXED FEATURES
Include disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder, and premenstrual dysphoric disorder.
- The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by related changes that significantly affect the individual’s capacity to function
DEPRESSIVE DISORDERS
The most easily recognized mood disorder is ______ ___________ ___________, defined by the presence of depression and the absence of manic, or hypomanic episodes, before or during the disorder. An occurrence of just one isolated depressive episode in a lifetime is now known to be relatively rare.
A. Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feelings of restlessness or being slowed down). - Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
MAJOR DEPRESSIVE DISORDER
This disorder represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder.
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
- Poor appetite or overeating.
- Insomnia or hypersomnia.
- Low energy or fatigue.
- Low self-esteem.
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness.
PERSISTENT DEPRESSIVE DISORDER
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present:
- Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to
rejection). - Marked irritability or anger or increased interpersonal
conflicts. - Marked depressed mood, feelings of hopelessness, or
self-deprecating thoughts. - Marked anxiety, tension, and/or feelings of being keyed up or on edge.
PREMENSTRUAL DYSPHORIC DISORDER
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more
times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is
observable by others (e.g., parents, teachers, peers).
E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the
symptoms in Criteria A–D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
DISRUPTIVE MOOD DYSREGULATION DISORDER
Are found between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders in DSM-5-TR in recognition of their place as a bridge between those two diagnostic classes in terms of symptomatology, family history, and genetics.
This include bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder.
BIPOLAR RELATED DISORDERS
For a diagnosis of _________ ____ ___________, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.
BIPOLAR I DISORDER
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to
a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
MANIC EPISODE
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
HYPOMANIC EPISODE
