Somatic Symtom Disorders and Dissociative Disorders Flashcards
What is Hypochondriac?
Somatic disorder - excessive health care use with no physical symptoms
How are somatic disorders diagnosed?
By exclusion
What age is onset for Somatic Symptoms Disorder?
30 to 40 years
What is specified with Somatic Symptoms Disorder?
with predominant pain
What are the DSM-V criteria for Somatic Symptoms Disorder?
- Excessive thoughts, feelings and behaviours related to health that result in:
- Disproportionate and passionate thoughts
- Persistent high anxiety about health and symptoms
- Excessive time and energy related to symptoms - Exists for more than 6 months
- Excessive medical history
Is Somatic Symptoms Disorder higher in males or females?
Females
Is there a family history?
Yes - considered female version of antisocial personality disorder
What are the DSM-V criteria for Illness Anxiety Disorder?
- Somatic symptoms not present or mild
- Perform excessive and maladaptive health related behaviour
- Must be present for 6 months
- Previously called hypochondriac
- Somatosensory amplification - more aware of body sensations
Define Illness Anxiety Disorder?
Preoccupation with having or acquiring illness
Define Conversion Disorder
Symptoms mimic neurological or medical conditions even though there are no physical cause eg eyes don’t work
What percentage of Conversion Disorder patients are later diagnosised with medical condition?
10 to 15%
What are the DSM-V criteria for Conversion Disorder?
- Disconnect between emotional and physical feelings/pain
- Inconsistencies between symptoms and anatomical symptoms
- Unexpected course of development eg paraplegia results in muscle tone loss
- Selective symptomatology eg blind can still avoid walking into things
What is Fractious Disorder?
Deliberately creating symptoms on self or others for attention eg Munchhausen
What is Malingering Disorder?
Deliberately creating symptoms for compensation (usually financial) or to avoid a negative event.
What is the Biological Aetiology of Somatic Disorders?
- Antisocial personality disorder in males is the flip of somatic disorders in females (neuro inhibition problem)
- Begins early in life
- Chronic
- Predominate among lower SES groups
- Difficult to treat
- Marital discord, substance abuse, suicide attempts
What are the Psychodynamic views of the aeitology of Somatic Disorders?
Negative feelings are repressed and converted to physical symptoms
What are the Cognitive views of the aeitology of Somatic Disorders?
- Symptoms are a form of communication
- Correlated with Alexithymia
- Misinterpretation of body sensations
- Negative affect - worry and pessimism predicts somatisation
- Family or personal history - illness attracts rewards
What is Alexithymia?
- Can’t identify or express emotions
- Poor capacity for fantasizing
How do stressors could cause Somatic Disorders?
- Traumatic event is experienced
- Conflict is repressed and made unconscious
- Anxiety increases and converted into physical pain (primary gain)
- Increased attention and sympathy received (secondary gain)
Is there any evidence of child abuse and somatisation?
No
What cultures have more Somatoform disorders?
Those that discourage open discussion of psychological problems
What is the best treatment for Somatic Disorders?
Kroenke CBT:
1. exposure and response prevention
2. reinforcement strategies to increase functioning
3. relaxation training
4. cognitive restructuring
Controlled treatment study where patients coached to seek less treatment
What is a Dissociative Disorder?
Disruption of functioning of consciousness, memory, identity or perception of environment
What is depersonalisation?
Feeling detached from your body
What is derealisation?
Feelings of unfamiliarity about physical and interpersonal environment
What is amnesia?
Inability to remember personal details or specific time periods
What is identity confusion?
Confused about personal identity
What is identity alteration?
Assumed alternate personality
What is Dissociative Amnesia?
Sudden inability to recall personal information that is not due to organic mental disorder
What is localised disturbance recall?
Inability to recall an event or period of time
What is Selective disturbance recall?
Inability to recall a specific aspect of an event
What is generalised disturbance recall?
Inability to recall identity or life history
What is retrograde disturbance recall?
Inability to recall information before an event
What is anterograde disturbance recall?
Inability to transfer new information from short to long term memory
What is post traumatic disturbance recall?
Inability to recall information about a traumatic event
What are the clinical symptoms of Dissociative Amnesia?
Ends abruptly, recovery is complete and reoccurances are rare
What is Dissociative Fugue?
Unexpected travel with new identity and inability to recall personal information. No memory of fugue is present after recovery
What is the difference between Dissociative Amnesia and organic amnesia?
- Dissociative loss of both recent and past memories, organic only recent.
- Dissociative loss of personal knowledge, organic personal and general
- Dissociative events after amnesia remembered, organic they are lost
- Dissociative reverses abrupty, organic may have gradual return but generally permanent loss
What is Dissociative Identity Disorder?
Presence of 2 or more distinct personalities with difference personalities, demographics, abilities, preferences and physiological differences.
What are the clinical features of Dissociative Identity Disorder?
- Recurrent episodes of amnesia
- Transition between personalities is sudden and usually due to stress
What is Multiple Personality Disorder?
Dissociative Identity Disorder
When does diagnosis of Dissociative Identity Disorder usually occur?
Late adolescence to early adulthood usually due to abuse
What percentage of Dissociative Identity Disorder patients attempt suicide?
70%
How many personalities do Dissociative Identity Disorder patients have?
2 to 60 (average 13)
What is Depersonalisation/Derealisation Disorder?
Feelings of being detached from mind or body. “as if” an observer.
- Transient depersonalisation
- Occurs frequently in adolescents
- Sudden onset by extreme stress (eg fatigue, pain or trauma)
What is the main cause of Dissociative Disorders?
Percipitated by extreme stress and used as a way to avoid anxiety and painful reality
What is the Psychodynamic view of the aetiology of Dissociative Disorders?
Accidental defence against painful events (purposeful)
What is the Behavioural view of the aetiology of Dissociative Disorders?
Learned social role (Modelling, exposure to disorder, operant conditioning)
What is the Self hypnosis view of the aetiology of Dissociative Disorders?
Material is forgotten then recalled later but forgetting is done without insight and events are forgotten not the general knowledge.
What is the Biological view of the aetiology of Dissociative Disorders?
Fragmented sleep leads to dissociative symptoms
What is the Social view of the aetiology of Dissociative Disorders?
Iatrogensis - manufacture of disorder by its treament BUT cases exist in countries where disorder doesn’t.
What is the Psychodynamic view of the treatment of Dissociative Disorders?
Help to recover lost memories
What is abreaction?
Emotional reliving of past traumatic experiences
What is the Biological view of the treatment of Dissociative Disorders?
- Sodium Amobarbital (Amytal) and Sodium Pentobarbital (Pethothal) truth syrum and stress reduction medications
What is the most common treatment for Dissociative Identity Disorder?
- Intergrate personalities into one
- Promote co-operation amongst the personalities
- Recover gaps in memories
