Somatic disorders Flashcards
What are the key features of DISSOCIATIVE disorders?
- disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.
- can potentially disrupt every area of psychological functioning.
Why study SOMATIC and DISSOCIATIVE together?
- Both involve ‘splitting off’
- Somatic splits off sensory or motor system
- Dissociative splits off memory or identify (higher order suctions)
- Maybe under the same underlying mechanism
Who usually first encounters parents with Somatic Symptoms
Primary care (eg GP)
Who was Anna O
Freud’s first patient - example of a somatoform disorder - ‘Conversion’
Was caring for her father, experienced a range of physical symptoms with no medical explanation
What is ‘Somatisation’
Mental distress experienced as physical ailments
What is the general aetiology of somatic disorders?
Almost always SOMETHING TO DO WITH TRAUMA.
But beyond that, very poorly understood, but here are some dot points
- Hypothalamic-Pituitary-Adrenal axis involvement?
- Neurobiological factors
- Gate-control theory (a model of pain)
Environmental factors too, as usual
What are the cognitive dimension of SOMATIC SYMPTOM DISORDER (SSD)?
People with these disorders…
- experience somatic sx as intense (somatosensory amplification)
- are more sensitive to physical sensation
- are more likely to attribute the cause to a physical thing (other than psychological etc)
- abnormal illness behaviour
What is the impact of SOMATIC SYMPTOM DISORDER (SSD)?
- major disability
- big cost to community
- compensation seeking
- burden on health care system
What is the key thing about the diagnostic criteria for SOMATIC SYMPTOM DISORDER (SSD)?
One or more somatic symptoms causing significant impact on life
Things associated with SOMATIC SYMPTOM DISORDER (SSD)
- Being female
- Being older
- Being less education
- Lower SES
- Childhood adversity (inc sexual abuse)
- Concurrent chronic physical illness or psychotic disorder
- Social stress
- Reinforcing factors - illness benefits
What is ILLNESS ANXIETY DISORDER (IAD)?
Preoocupation with acquiring a physical illness
How is ILLNESS ANXIETY DISORDER (IAD) different from GAD?
Sole focus on health
how is ILLNESS ANXIETY DISORDER (IAD) deferent from OCD?
Sole focus on health
How is IILLNESS ANXIETY DISORDER (IAD) different from MDD?
It’s about the level of overlap.
One would diagnose IAD if excessive illness worry persists after remission of a MDE (but not if concerns occur only during an MDE)
What is CONVERSION DISORDER?
This is the classic type of somataform disorder (soldier who can’t use their legs)
Restricted to motor or sensory function
Does CONVERSION DISORDER often remit relatively quickly?
Yep
What are the specifiers for CONVERSION DISORDER?
- With weakness or paralysis
- With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait disorder)
- With swallowing symptoms
- With speech symptom (e.g., dysphonia, slurred speech)
- With attacks or seizures
- With anaesthesia or sensory loss
- With special sensory symptom (e.g., visual, olfactory, or hearing disturbance)
- With mixed symptoms
What is FACTITIOUS DISORDER (imposed on self)
Hint: this used to be Munchausen syndrome
The falsification of physical symptoms - deception identified
It is deliberate, but not for money or external motivation. Rather, for attention and care.
What is FACTITIOUS DISORDER (imposed on another)
Falsification of physical symptoms (for someone else) - deception identified
Again, not for money
Are FACTITIOUS DISORDER often comorbid with personality disorders?
Yes
What is the aetiology of FACTITIOUS DISORDER?
Often early experience of trauma, heightened illness experiences
When do DISSOCIATIVE Disorders often occur
In the aftermath of trauma
How do we assess DISSOCIATIVE disorders?
Using the Dissociative Experiences Scale (DES)
Example axes
- Amnesia
- Depersonalisation
- Absorption
What is the screen cut off of Dissociative Experiences Scale (DES)
30
What would someone with DISSOCIATIVE IDENTITY DISORDER (DID) score on the Dissociative experiences scale (DES)?
45
DISSOCIATIVE IDENTITY DISORDER (DID) used to be called…
Multiple personality disorders
What is the key quality that defines DISSOCIATIVE IDENTITY DISORDER (DID)?
Two or more personality states
In DISSOCIATIVE IDENTITY DISORDER (DID), can different alters have different handwriting and handedness?
Yes
What is the aetiology of DISSOCIATIVE IDENTITY DISORDER (DID)?
Severe childhood trauma (90% of cases, at least)
How many people wth DISSOCIATIVE IDENTITY DISORDER (DID) meet for PTSD?
The vast majority
What is the theory behind DISSOCIATIVE IDENTITY DISORDER (DID)?
Dissociation = hypnotic defence in which consciousness is split
What are the typical DISSOCIATIVE IDENTITY DISORDER (DID) proximal trigger/risk factors?
Number of possible triggers:
- removal from the traumatic situation
- the individual’s child reaching the same age at which the individual was originally abused
- later traumatic experiences, even if they appear inconsequential (eg minor car accident)
- death of their abusers
Why is DISSOCIATIVE IDENTITY DISORDER (DID) controversial?
Only first described in the 1950s, people argue we’ve made it up
What is meant by the ‘iatrogenic/sociocognitive theory of DISSOCIATIVE IDENTITY DISORDER (DID)?
The condition is therapist led
What is DISSOCIATIVE AMNESIA (DA)?
When you can’t remember autobiographical information
What are the DISSOCIATIVE AMNESIA (DA) subtypes
- LOCALISED amnesia - a failure to recall events during a time.
- SELECTIVE amnesia - the individual can recall some, but not all, of the events during a period
- SYSTEMISED amnesia - the individual loses memory for a specific category of information (e.g., all memories relating to one’s family).
- CONTINUOUS amnesia - an individual forgets each new event as it occurs.
- GENERALISED amnesia - a complete loss of memory for one’s life history (rare)
What things are associated with DISSOCIATIVE AMNESIA (DA)?
- History of trauma common
- Difficulty forming and maintaining relationships
- Dissociative flashbacks
- Suicidality/self-harm
- Depression
- High levels of hypnotisability
What do we know about the course of DISSOCIATIVE AMNESIA (DA)?
- Usually sudden onset
- Multiple episodes
- Can occur at any age
What is at the heart of treating DISSOCIATIVE AMNESIA (DA)?
Confronting the trauma
What’s the important thing when identifying DEPERSONALISATION / DEREALISATION DISORDER?
The person’s ‘reality testing’ is still intact
What is the aetiology of DEPERSONALISATION / DEREALISATION DISORDER?
- Substantial proportion report trauma in childhood (but tends not to be as extreme as the trauma underlying the other dissociative disorders)
- Proximal precipitants commonly = severe stress, anxiety, depression, illicit drug use
