Somatic Symptom And Dissociative Disorders Flashcards
Define somatic
Related to the body , especially as instinct of the mind
What are the somatic symptom and related disorders?
- somatic symptom disorder
- Illness anxiety disorder
- Conversion disorder
- Factitious disorder
What are the somatic symptoms and related disorders common features?
Prominence of somatic /health related symptoms associated with significant distress or impairment
What is the epidemiology Somatic Symptom and related disorders ?
- 5-7% in the general population
- female to male ratio of 10:1
What is the onset and course somatic symptom and related disorders?
- Onset in childhood and teen years, but lifetime onset
- 20-25% acute symptom onset develop chronic somatic illness
- experience of fluctuates with stress
What are the associated features of somatic symptom and related disorders?
- Lengthy medical history with unremarkable exam findings
- Psychiatric co-morbidity (major depressive disorder, anxiety, drug dependence, histrionic trait )
What are the diagnostic criteria of Somatic Symptom disorder?
- 1+ distressing/disruptive somatic symptom
- Atleast one indicator of excessive thoughts/feelings/behaviors about the symptoms such as:
1. disproportionate thoughts about the seriousness of the symptom
2. High levels of anxiety about the symptom or health
3. Excessive time/energy devoted to the symptom
Persistent symptomatology(usually 6+ months)
Describe diagnostic criteria of Somatic Symptom disorder (not what it is, just describe)
- diagnosis of SSD focuses on the abnormal behaviors/thoughts/feelings in response to the distressing somatic symptom(s)
- Focus is NOT on whether there is a medical explanation for the somatic symptom(s)
- there could be a medical basis for their symptoms and still have SSD
What are the diagnostic criteria of Illness anxiety disorder?
- preoccupation with having/acquiring a serious illness
- Somatic symptoms are not present or, if present are mild
- Patient performs excessive health-related behaviors or shows maladaptive avoidance
Differentiate SSD and IAD
SSD: patient has a distressing physical complaint with an excessive response to that distressing physical complaint. Might be a medical basis for the illness
IAD: patient does NOT have a distressing physical complaint but nonetheless worries about one’s health and is preoccupied by this worry
What are the general multifactorial causes of SSD and IAD (etiology)?
- genetic predisposition (e.g. sensitivity to pain)
- Personality trait of negativity
- early life/family experiences (childhood physical, sexual, emotional abuse)
- Delayed development of emotional intelligence (emotional trauma manifests as physical pain - emotional neglect)
What are cognitive biases that contribute to IAD and SSD(etiology)?
Cognitive biases
- focus of attention on somatic symptoms
- Negative interpretation of somatic symptoms
- Negative feedback loop of interpretation and further anxious symptoms
What are behavioral biases that contribute to IAD a and SSD(etiology)?
- patient may take on a sick role, leading to worse illness
- reinforced sick role behavior (attention, tangible rewards, avoidance of unpleasant tasks)
How can SSD and IAD be treated?
- Medication -anti-anxiety/antidepressants in extreme cases, to assist with CBT
- CBT
- address delayed develop of delayed e,optional intelligence, especially for patients with long-standing paradigms
How can SSD and IAD be treated with CBT?
- reduce the stress “spiral”(to avoid intensifying systems)
- reduce excessive attention to bodily cues
- Correct cognitive distortions about physical symptoms
- reinforce “non-sick role”
- Reduce avoidance of activities due to uncomfortable physical sensations
- family therapy for dynamics and support
How can SSD and IAD treatment be found in medication?
Anti-anxiety/anti-depressants in extreme cases, to assist with CBT
What are the diagnostic criteria of Conversion disorder?
- Altered voluntary motor or sensory function.
- Symptom examples: weakness or paralysis, loss of balance, difficulty swallowing, abnormal movements, vision problems, hearing problems, speech problems, numbness
- evidence of incompatibility between the symptom and neurological findings
- incompatibility of the symptom with neurological disease a key feature of this diagnosis-rule our neurological cause
What are the conversion disorder subtype?
- with weakness or paralysis
- with abnormal movement
- with swallowing symptoms
- with speech symptoms
- with attacks or seizures
- with anesthesia or sensory loss
- with special sensory symptom (e.g., blindness)
- with mixed symptoms
What is the onset and course of conversion disorder?
Typically sudden, after a major psychological stressor
-Symptoms may be symbolically related to the stressor (e.g., unable to move legs after learning about a friends paralysis)
- Often a “la belle indifference” reaction to the disability that suddenly emerges - usually short duration without recurrence
Explain the etiology of Conversion Disorder
Neural basis: unknown. Perhaps somatosensory/ somatomotor cortex involvement
Psychological: Non-conscious transformation of psychological distress into neurological symptoms
Symptoms may appear suddenly following a stressful event, but not always identified
How can conversion disorder be treated?
CBT
-goal is to elucidate and acknowledge any emotional basis to the symptoms
- learn about conversion disorders in general, not caused by a neurological disorder or disease
- Stress reduction techniques
- Occupational therapies if paralysis, etc.
Hypnosis
Medications - no approved treatment for conversion disorder
What is fictitious disorder?
Feigning physical or psychological symptoms, in self or others, in the absence of obvious external motivation
- Primary gain is attention and being in the sick role
- Imposed on oneself(Munchausen’s Syndrome)
- Imposed on another (Munchausen’s Syndrome by proxy)
What is the typical profile of someone with factitious disorder?
Patient has a past connection to medicine or worked in a health care profession
What are the markers of factitious disorder?
Markers of factitious disorderm
- Unexplained Persistent /recurrent symptoms
- Inconsistent history
- Dramatic presentation of severe symptoms
- Symptoms influenced by observation
- Insistence on a particular treatment
What are treatment for Factitious disorder?
No specific treatment
- individuals usually resist seeking psychiatric help, even when caught
- Goal is to stop further unnecessary medical care and prevent iatrogenic problems
- report “by proxy” cases to child protective services
Important differential: malingering
What is Malingering disorder?
Individuals fakes/induces(feigns) physical or psychological symptoms in self/others for “external” rewards (e.g., avoiding work)
- known as secondary gain
- Complaints cease after gaining the reward
- Malingering: feigns symptoms in oneself
- Malingering by proxy: feigns symptoms in another individual
What is Malingering disorder classified as?
Classified under other conditions that may be a focus of clinical attention
What are the dissociative disorders?
- Dissociative amnesia
- Dissociative identity disorders
- Depersonalization/realization disorder
What are the common features of Dissociative disorders?
- Splitting off from conscious awareness an aspect of itself (e.g., a memory)
- Unconscious coping strategy fir stress
Evidence for the massive modularity hypothesis, limitation of conscious awareness, and reconstruction of memories
What are the diagnostic criteria of dissociative amnesia?
Memory loss for autobiographical information not caused by another disorder
- Localised: total loss of personal memory during a circumscribed period of time
- Selective: some limited recall of personal memories during a circumcised period of time
- Generalized: loss of personal memory of entire life up to and including triggering event
What is a fugue?
Purposeful travel or bewildered wandering associated with amnesia for identity or other autobiographical information
What must a doctor specify with dissociative amnesia?
Specify if a,media is with dissociative fugue
What are the features of fugue?
Typical features of fugue:
Sudden onset Brief(hours to days) Unobtrusive lifestyle during fugue Spontaneous termination of amnesia Rarely occurs
What is the key amnesia differential of dissociative amnesia?
Key amnesia differential: a mental status exam might help identify the type of memory problem exhibited
If biological : patient will have difficulty learning new information (anterograde memory loss) in addition to past memory loss
If psychological (dissociative): Patient learns new information well; only past memory loss (retrograde memory) will be present
What are the diagnostic criteria of Dissociative identity disorder?
Disruption of individual density characterized by 2+ distinct personality states:
- the primary (host)
- an alter
Inability to recall personal information (as evidenced by frequent memory gaps in the primary personality while an alter takes control)
What symptoms are associated with Dissociative identity disorder?
- Dissociation
- Nuerological defense mechanisms
DID is associated with smaller volumes of which functions?
- Hippocampus
- Amygdala
- Parietal structures (perception and personal awareness)
- Frontal structures (executive functioning)
What are risk factors of dissociative identity disorders?
Childhood psychological trauma, lack of social support, and poor coping skills
What are the neurobiological changes of dissociative identity disorder?
- None noted previously, but recent
- Research implicates hippocampus
How can dissociative identity disorder be treated?
Psychotherapy
-Long-term psychotherapy (CBT) to integrate personalities
- Strong therapeutic alliance is required
- Hypnosis May be used to help recover memories
- Memories retrieval May trigger grief, rage, shame, guilt, depression and inner turmoil
Pharmological: none proven to be effective
What are the diagnostic criteria of Depersonalization/Derealization disorder?
Depersonalization: Experiences of unreality, detachment or being an outside observer of one’s thoughts, feelings, sensations, body or actions
AND/OR
Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., objects and/or environment seem unreal or dreamlike)
What the additional (non-diagnostic ) criteria of Depersonalization/derealization disorder?
Reality testing remains intact (i.e., the person knows the perceptual experience is just a misperception)
Additional criteria:
- Symptoms result in functional impairment
- Symptoms are not due the physiological effects of a substance or another medical condition (e.g., seizures)
- Symptoms are not better explained by another mental disorder, such as panic disorder, acute stress disorder, PTSD, or another dissociative disorder
Explain the etiology of Depersonalization/Derealization
- Currently unknown
- No known structural brain damage accounting for feelings of unreality or detachment
- for dissociative disorders in general: primarily a dysfunction of memory retrieval
- A “last ditch” effort to respond to overwhelmed coping mechanisms
How can Dissociative Disorders be treated?
- Typically involves some type of psychotherapy
- Hypnosis May be used to help recover memories in a dissociative amnesia
- Use of hypnosis should be used cautiously to avoid creation of false memories
