Somatic and Dissociative Disorders Flashcards
Give three characteristics of somatic disorders.
Prominent somatic symptoms, causing significant distress of functional impairment; preoccupation or worry about an illness; and excessive help seeking behaviour.
What do both somatic and dissociative disorders have in common?
A dissociation or disconnect between mental awareness and another part of the usually integrated nervous system
In somatic disorders, what does the dissociation involve?
Sensory motor function.
In dissociative disorders, what does the dissociation involve?
Higher functions involved in identity.
Explain the term somatoform disorders.
Used by the DSM-4 referring to conditions involving physical manifestations of psychological disturbance.
Explain the term psychosomatic disorder.
Conditions with a known physical basis, that can be aggravated by psychological factors via known physiological mechanisms.
What does the DSM-5 refer to somatic disorders as?
Somatic symptoms and related disorders.
In order to qualify for a diagnosis of somatic symptoms, what did the DSM-5 reform, compared to the DSM-4?
The requirement for the symptoms to present “without medical explanation”.
Name some somatic symptom and related disorders. (5)
Somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder, and psychological factors affecting other medical conditions.
What are some common somatic symptoms of somatic symptom disorder?
Pain, gastrointestinal symptoms, and neurological symptoms.
How is the experience of pain different in somatic symptom disorder compared to conversion disorder?
In somatic symptom disorder, the pain focus causes excessive pain behaviours, and in conversion disorder, the pain focus results in a loss of function.
What number of somatic symptoms is required for a diagnosis of somatic symptom disorder?
One.
Give three reasons for the DSM-5’s removal of the need for somatic symptoms to present without medical reasons.
SDD can be diagnosed based on response to a physical illness, it encourages treatment for these psychosocial aspects of physical illness, and attempts to reduce mind-body dualism.
Define illness anxiety disorder.
A preoccupation with having or getting a serious illness.
Give some symptoms of ilness anxiety disorder.
Somatic symptoms are not prominent, high levels of health anxiety, excessive health-related behaviours, and illness preoccupation is present for at least 6-12 months.
What is the key feature of illness anxiety disorder?
Concern in the absence of prominent symptoms.
Define conversion disorder.
One or more symptoms of altered motor or sensory functioning which causes significant distress and impairment.
In conversion disorder, most symptoms are indicative of a neurological disease, like:
Paralysis, blindness, difficulty speaking, mutism, and seizures.
Define aphonia.
Difficulty speaking.
In conversion disorder, patients are unaware of ______.
Functional ability.
What percentage of neurology inpatients present with conversion disorder?
30%.
What is the decrease of incidence of conversion disorder likely due to?
Increased knowledge of the real causes of physical problems, eliminating the possibility of secondary gain.
Conversion disorder is primarily found in women but occurs relatively often in males at times of:
Extreme stress, like combat.
When is the usual onset of conversion disorder?
In adolescence.
What two kinds of disorders that are commonly comorbid with conversion disorder?
Mood and anxiety disorders.
Give another name for conversion disorder.
Functional neurological disorder.
Among which people does conversion disorder tend to occur?
The less educated, and poorer people with less knowledge about disease and medical illness.
What kind of symptoms do people, individually, develop in conversion disorder?
Symptoms that they are familiar with.
How many processes did Freud find in the generation of conversion disorder?
Four.
Give Freud’s first process of conversion therapy.
A traumatic event results in conflict and anxiety.
Give Freud’s second process of conversion therapy.
The conflict and anxiety is unacceptable and is so repressed.
Give Freud’s third process of conversion therapy.
An increase in anxiety that may cause the conflict to reach consciousness, so the person converts it into physical symptoms.
In conversion therapy, what is the primary gain?
The associated reduction in anxiety reinforces the conversion into physical symptoms.
Give Freud’s fourth process of conversion therapy.
Secondary gains.
Explain conversion therapy’s secondary gains.
Increased attention or avoidance of difficult situations.
Give two other diagnoses that conversion disorder is often confused with.
Real physical disorders, and malingering.
Conversion symptoms are precipitated by stress in __% to __% of clients.
52 to 93
What is malingering usually motivated by?
Trying to get out of something or by trying to gain something.
Give the main difference between malingering and conversion disorder.
Malingers are aware of what they are doing, while in conversion disorder, the symptoms are involuntary.
Define factitious disorder by proxy.
Purposely making a child sick for attention and pity.
Somatic symptom disorder occurs in to% of the general adult population.
5 to 7
Illness anxiety disorder occurs in _ to _% of the general population.
1.3 to 10
Factitious disorder occurs in _% of patients in hospital settings.
1
Up to __% of physical symptoms presented to GP’s remain unexplained.
30
What is the basis of the gate control theory of pain?
Neural gates in the spinal cord can be opened or closed which determines the amount of pain an individual experiences.
What does ‘somatoform’ mean?
Mental disorders that take the form of physical illness.
What are somatic disorders characterised by? (3)
Prominent somatic symptoms, preoccupation with getting an illness and excessive help seeking behaviour.
Dissociative disorders involve the loss of the normal integration of: (4)
Identity, memory, perception, or consciousness.
What is dissociation?
A process where different facets of an individual’s sense of self, memories or consciousness become split off from one another.
Why are somatic and dissociative disorders considered together?
They have a similar underlying mechanism, where there is a dissociation between mental awareness and the normally integrated mental system.
Give another name for dissociative disorders.
Psychoform dissociation.
Explain psychosomatic disorders.
Disorders characterised by identifiable physical illness or defect caused at least partly by psychological factors.
What does the Greek word ‘hysterikós’ mean?
Suffering in the womb.
What were somatoform and dissociative disorders previously known as?
Hysteria.
Who first came up with hysteria?
Hippocrates.
During the nineteenth century, what was hysteria attributed to?
Sexual deprivation.
Explain hypochondriasis.
A disorder involving intense anxiety regarding the belief that they have a serious medical condition that they clearly don’t have.
Who discovered hypochondriasis?
Sydenham.
What does hypochondrium describe?
The part of the abdomen just below the ribs, which the Greek’s believed to produce black bile, a substance that caused depression or melancholy.
_____ investigated hypnosis as a cure for hysteria.
Charcot.
What did Pierre Janet interpret the phsyical symptoms of as hysteria as resulting from?
Representations of traumatic events.
To explain Anna O’s symptoms, Freud and Breuer adopted the term _____, to signify the transformation of psychical excitement into chronic somatic symptoms.
Conversion.
What did Freud believe hysteria was caused by?
Unpleasant infantile sexual experiences, though not necessary actual ones. Unacceptable childhood fantasies from childhood could result in hysteria.
What is Freud’s theory of hysteria called?
Seduction theory of hysteria.
How is Freud’s theory of hysteria similar to Janet’s?
Freud believed the was a dissociative mechanism where hysterical symptoms were reliving early sexual trauma.
How did Freud believe hysteria could be cured?
Transforming the unconscious memory of the assault into conscious ones.
Give the DSM-5’s three abnormal reactions to the somatic symptoms.
Disproportionate and persistent thoughts about the seriousness of symptoms, high levels of anxiety about health or symptoms, and spending excessive time and energy devoted to symptoms.
What is somatic symptom disorder accompanied by, according to the DSM-5?
Abnormal thoughts, feelings, and behaviours in response to somatic symptoms.
Give some examples of somatic pain symptoms.
Pain, gastrointestinal symptoms and neurological symptoms.
What does somatic symptom disorder with predominant pain refer to?
Individuals for whom pain is the primary symptom.
_____ and _____ are almost always present with chronic pain and may make pain sensations worse.
Depression and anxiety.
How is somatic symptom disorder with predominant pain similar to conversion disorder, and how is it different?
Both involve a neurological symptom, while pain is an additional experience, unlike conversion disorder, which usually involves a loss of function.
Most individuals experiencing abnormal levels of anxiety regarding their health meet criteria for:
Somatic symptom disorder.
What does an individual need to experience in order to be diagnosed with illness anxiety disorder?
Preoccupation with having or getting a serious illness in the absence of somatic symptoms.
Give diagnostic criteria for illness anxiety disorder (2).
Concerns persist for more than six months despite reassurance, and must not be explained by another mental disorder.
Give some elements of illness anxiety.
Disturbances in perception, affect, cognition, and behaviour.
In the context of illness anxiety, give an example of disturbances in perception.
Hypersensitivity regarding bodily sensations.
Define affect.
Experience of feeling or emotion.
In the context of illness anxiety, give an example of affect.
Anxiety regarding illness.
In the context of illness anxiety, give an example of cognition.
Beliefs regarding the threat or reality of serious disease.
In the context of illness anxiety, give an example of behaviour.
Excessive help and reassurance seeking.
What is conversion disorder?
A disorder marked by a sudden loss of functioning in a part of the body without an identifiable medical cause.
Give another name for conversion disorder.
Functional neurological symptom disorder.
Define la belle indifference.
A common feature of conversion disorder involving an odd lack of concern regarding loss of bodily function.
Give the diagnosic criteria for conversion disorder (3).
The disturbance in motor or sensory functioning cannot be explained by another mental or medical illness, the disturbance causes significant distress or impaired functioning in daily life, though the patient may be less concerned than expected.
In which group of people is conversion most common?
People who have, or have had, a physical disease.
When and where does mass hysteria occur?
In schools or workplaces where there has been a degree of stress and physiological arousal.
What is mass hysteria?
An epidemic of conversion, where large numbers of people in a particular setting develop the same symptom.
Define factitious disorders.
Disorders characterised by deliberately faking physical or mental illness in order to gain medical attention.
What did Asher name factitious disorder and why?
Munchausen’s syndrome after Baron von Munchhausen.
Give the specifications of somatic symptom disorder. (3)
With predominant pain, persistent, or mild, moderate or severe.
