Somatic and dissociative disorders

Question 1

types of somatic symptom disorders

Answer 1

somatic symptom disorder
illness anxiety disorder
conversion disorder
factitious disorder
psychological factors affecting mental conditions

Question 2

those who are primarily preoccupied by perceived physical symptoms

Answer 2

somatic symptom disorder

Question 3

those who are primarily focused on fear of illness in general

Answer 3

illness anxiety disorder

Question 4

what identifies somatic symptom disorder

Answer 4

DSM-5

Question 5

psychological or behavioral factors lead to:

Answer 5

Influence the course of the medical condition regarding development, exacerbation or delay recovery
The factors / behaviors interfere with treatment of medical condition (poor adherence/compliance)
Factors/behaviors can be well established health risks to the individual
Knowingly doing things that cause exacerbation of symptoms or necessitating medical attention

Question 6

Somatic Symptoms Disorder is present when:

Answer 6

an individual’s excessive focus on somatic symptoms is beyond any medical explanation and the symptoms cause significant distress and impairment in one’s functioning

Question 7

characteristics of somatic symptom disorder

Answer 7

Multiple complaints that can not be explained.
Psychosocial distress and frequent visits to healthcare professionals to seek assistance are common.
Chronic disorder with symptoms beginning usually before the age of 30
Periods of remission and exacerbation
Drug use disorder and dependence are common features.
Excessive time and energy devoted to these symptoms or health concerns

Question 8

common focus of diagnoses of somatic symptom disorder

Answer 8

distress

Question 9

prevalence of somatic symptom disorder:

Answer 9

11%

Question 10

the health anxiety cycle 1-5

Answer 10

1. sensation
2. meaning making
3. catastrophizing
4. reassurance seeking
5. temporary relief

Question 11

possible effects of conversion disorder

Answer 11

Likely psychological components involved with initial onset, exacerbation and perpetuation of symptoms though it may or may not be identifiable.
Affect voluntary motor or sensory functioning suggestive of neurological disease

Question 12

Prevalence of somatic symptom disorder in this lifetime

Answer 12

general population have ranged from 5% to 30%.
occurs more frequently in women than in men and more frequently in adolescents and young adults than in other age groups.
A higher prevalence exists in lower socioeconomic groups, rural populations, those with less education, and military personnel who have been exposed to combat situations

Question 13

diagnostic criteria for somatic symptom disorder

Answer 13

A. One or more somatic symptoms that are distressing or result in significant disruption in 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 symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Question 14

factors of illness anxiety disorder

Answer 14

Unrealistic or inaccurate interpretation of physical symptoms or sensations
Leads to preoccupation with and fear of having a serious disease.
Extremely conscious of bodily sensations and changes
Anxiety and depression are common features.
Symptoms may be minimal or absent but the individual is highly anxious about the suspicion of undiagnosed serious medical illness.
Obsessive-compulsive traits are common as is a long history of “Doctor Shopping” and being convinced they are not getting proper care.
Comorbid anxiety, depression, somatization and panic disorders are common, and these patients are 3x’s more likely to have a concurrent personality disorder.

Question 15

Loss or change in body function not explained by medical disorder or pathophysiological mechanism

Answer 15

conversion disorder

Question 16

possible functioning difficulties of conversion disorder

Answer 16

pseudo-seizures
paralysis
aphonia
seizures
coordination disturbance
difficulty swallowing
urinary retention
akinesia
blindness
deafness
double vision
anosmia (unable to smell)
loss of pain sensation
hallucinations
False pregnancy

Question 17

This term is used when a client displays an apparent indifference to symptoms that seem very serious to others. Example: The patient that wakes one day unable to walk and is calm about it and unconcerned about the dramatic and sudden change.

Answer 17

La Belle Indifference

Question 18

factors of factitious disorder

Answer 18

Conscious, intentional feigning of physical and/or psychological symptoms to gain emotional support
Used to be called Munchausen Syndrome
May be imposed on self or others under the care of the perpetrator – by proxy or imposed on others.
Although deliberate and intentional, there may be an unintentional compulsive element that diminishes personal control.
Clients with this can “present symptoms” skillfully and get admitted or undergo treatment often.
They often exaggerate existing symptoms, induce new ones and even inflict painful injury on themselves or others.
Diagnosis is difficult.

Question 19

falsification or profound exaggeration of illness (physical or mental) to gain external benefits such as avoiding work or responsibility, seeking drugs, avoiding trial (law), seeking attention, avoiding military services, leave from school, paid leave from a job, among other

Answer 19

malingering

Question 20

predisposing factors of somatic/ dissociative disorder

Answer 20

Genetics
Biological
Neuroanatomical
Learning Theory
Psychodynamic Theory
Family Dynamics
Transactional Model of Stress/Adaptation

Question 21

possible biochemical factors of factitious disorder

Answer 21

Decreased levels of serotonin and endorphins for somatic syndrome disorders have been noted in research

Question 22

neuronatomical factor of factitious disorder

Answer 22

Brain dysfunction – impairment in information processing is one theory

Question 23

learning theory for factitious disorder

Answer 23

May avoid stressful obligations or be excused from unwanted duties - PRIMARY GAIN
May become the prominent focus of attention because of illness – SECONDARY GAIN
May relieve conflict with family as concern is shifted to the ill person and away from real issues – TERTIARY GAIN

Question 24

psychodynamic theory

Answer 24

Ego defense mechanism
Emotions associated with a traumatic event
Family Dynamics
Transactional Model of Stress and Adaptation

Question 25

possible nursing diagnoses of somatic and dissociative disorders

Answer 25

ineffective coping knowledge deficit fear or anxiety disturbed self image self care deficit disturbed sensory perception

Question 26

Outcome Criteria: Somatic Symptom Disorders

Answer 26

The client: Copes effectively without resorting to physical symptoms Has decreased frequency of physical complaints and interprets bodily sensations rationally Is free of physical disability

Question 27

Disruption in functions of consciousness, memory, and identity When anxiety becomes overwhelming When personality becomes disorganized

Answer 27

dissociative disorder

Question 28

That is about the best way to describe the feeling of dissociative disorder.

Answer 28

Clients often have a history of a single (sometimes several) brief instances of severe psychosocial stress or a trauma event that seems to precipitate initial alter. More prevalent in women than in men Symptoms usually begin in adolescence or early adulthood.

Question 29

Dissociative Disorders are a group of conditions defined as psychological disturbances that impact an individual’s ability to function and closely overlap with psychotic disorder. These include disturbances affecting:

Answer 29

Memory Motor Control Concept of Identity Behaviors Emotions Perceptions

Question 30

Inability to recall all incidents associated with a stressful period

Answer 30

localized amnesia

Question 31

recall only certain incidents associated with a stressful event for a specific period after the event

Answer 31

selective amnesia

Question 32

amnesia for his/her identity and total life history

Answer 32

generalized amnesia

Question 33

Sudden, unexpected travel away from customary places or by bewildered wandering Inability to recall some or all of one’s past Individual may not be able to recall personal identity or information Sometimes client even assumes a new ‘identity’.

Answer 33

dissociative fugue

Question 34

Existence of two or more personality states in a single individual Transition from one personality state to another may be sudden or gradual

Answer 34

dissociative identity disorder

Question 35

occurs when you persistently or repeatedly have the feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real, or both.

Answer 35

Depersonalization-derealization disorder 

Question 36

occurs when you persistently or repeatedly have the feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real, or both.

Answer 36

Depersonalization-derealization disorder 

Question 37

symptoms of Depersonalization-derealization disorder 

Answer 37

Temporary change in quality of self-awareness Feelings of unreality Changes in body image Feelings of detachment from the environment Sense of observing oneself from outside of the body Symptoms can include: Anxiety and depression Fear of going insane Obsessive thoughts Somatic complaints Disturbance in the subjective sense of time

Question 38

disturbance in perception of oneself

Answer 38

depersonalization

Question 39

disturbance in perception of external environment

Answer 39

derealization

Question 40

Statistics and facts on depersonalization-derealization disorder include:

Answer 40

Both depersonalization and derealization are triggered by episodes of severe stress About half of the population at large experiences depersonalization-derealization at least once in their lives Approximately 2% of the general population goes on to develop a depersonalization-derealization disorder

Question 41

predisposing factors of dissociative disorder

Answer 41

Neurobiological Dissociative amnesia: neurophysiological dysfunction Electroencephalogram abnormalities: DID Psychodynamic theory Dissociation: repression of distressing mental contents from conscious awareness Psychological trauma DID: set of traumatic experiences that overwhelm individual’s capacity to cope by any means other than dissociation Severe physical, sexual, or psychological abuse by significant other in the child’s life Survival strategy for child in traumatic environment Transactional model of stress/adaptation

Question 42

possible interventions for dissociative disorder

Answer 42

Care is aimed at restoring normal thought processes Efforts to determine strategies for coping with stress by means other than dissociation from the environment

Question 43

Outcome Criteria: Somatic Symptom Disorders

Answer 43

The client: Can recall events associated with stressful situations Can recall all events of past life Can verbalize anxiety that precipitates the dissociation Can demonstrate coping methods to avert dissociative behavior Verbalizes existence of multiple personalities Is able to maintain a sense of reality during stress events. Develops a safety plan in the event they experience fugue

Question 44

evaluation for dissociative disorder

Answer 44

Can the client recognize s/s of escalating anxiety? Can the client intervene with adaptive coping strategies to interrupt the escalating anxiety before physical symptoms are exacerbated? Can the client verbalize an understanding of the correlation between physical symptoms and times of escalating anxiety? Does the client have a plan to deal with increased stress to prevent exacerbation of physical symptoms?

Question 45

treatment modalities for somatic symptom disorders

Answer 45

Individual psychotherapy Group psychotherapy Cognitive behavior therapy (CBT) and psychoeducation Psychopharmacology

Question 46

treatment modalities for dissociative identity disorder

Answer 46

Individual psychotherapy Hypnosis Supportive care Cognitive therapy Group therapy Integration therapy (DID) Psychopharmacology

Question 47

treatment modalities of dissociative amnesia

Answer 47

Can resolve spontaneously when client is removed from stressful situation Psychotherapy is used as primary treatment Techniques of persuasion and free association help the client remember Hypnosis may be required to mobilize memories

Question 48

treatment modalities of depersonalization-derealization

Answer 48

Information about treatment is inconclusive Various psychiatric medications may help Antidepressants, mood stabilizers, anticonvulsants, and antipsychotics Results have been sporadic at best. Hypnotherapy CBT