Somatic Syptoms and Dissociative disorders Flashcards
what is a hypocondriac
someone who exaggerates the slightest physical symptom which is normally harmless
what are somatic symptom disorders overview
excessive or maladaptive response to physical symptoms or associated health concerns
accompanied by distress and impairment
medical explanations not necessary or important
typiclaly presents medically
name the 7 DSM-5 classifications of somatic disorders
somatic symptom illness anxiety conversion psychological factors affecting other medical condition factitiuous other specified unspecified
somatic symptom disorder clinical description
somatic symotom that is distressing or significantly disrupts daily life
excessive thoughts, feelings or behaviours related to symptoms or concerns such as
-persistent thoughts about seriousness
-persistently high illness of sympptom anxiety
-excessive time and energy spent on helath or concern
persistent (6 months)
simple absence of medical diagnosis is not enough
missattribution of bodly sensations
repeated checking / seeking help - medical reassurance doesnt help
somatic symptom disorder statsq
prevalence around 5-7% chronic can occur at any age but usually adolescence diagnosis in eldery = tricky depression is common
risk factors for developing somatic symptom disordeR
negativity depression anxiety low SES low education female
somatic symptom disorder causes
familial history of illness
stressful life events
sensitivity to physical sensations
secondary reinforcement
treatment of somatic symptom disorder
CBT best
limit hospital visits through assigning gatekeeper physician
behavioural approaches
illness anxiety disorder description
preoccupied with having or catching a serious illness
physical symptoms absent of very mild
disease conviction
repeated helth-related behaviours or avoidance
6 month duration
illness anxiety stats
most prior cases of hypocondriasis = somatic symotom dis, only 25% were illness anxiety
so prevalence = 1.3-10%
chronic and relapsing
risk factors for developing illness anxiety disorder
exposure to major stressor or scare
history of child abuse
history of childhood illness
what is disease conviction
i have this specific diseasw
what is illness conviction
disproportionate preoccupation with physical symptoms
belief i am sick, not what is causing it
causes of illness anxiety
cognitive perceptual distrotions - unpredictable and uncontrollable world
overly attentive to physical sensations
misinterpretation of sensations
interpersonal influences - trigger event, family history of illness
illness anxiety treatment
change illness-related misinterpretations
substantial and sensitive reassurance
stress management and coping strategies
antidepressants (SSRIs) offer some help, but typically CBT = more lasting gains
integrativemodel of causes of hypocondriasis
trigger leads to perceived threat
perceived threat is part of vicious circle
increased body focus, physiological arousal and checking behaviour
preoccupation with perceieved bodily state and sensations
misinterpretation od bodily sensations as indicating severe illness
clinical description of conversion disorder
1 or more symptoms altered voluntary motor or sensory function
findings incompatible with medical conditions
la belle indifference
retain most normal functions but unaware
stats of conversion disorders
rare
chronic intermittent course
2 to 3 times more liekly in women
onset at any time
causes of converstion disorder
psychodynamic view
trauma, conversion and secondary gain
detatchment from the trauma and negative reinforcement
treatment to conversion disorder
similar to somatic symptom
attend to the trauma
behavioural approaches
citeria for psychological factors affecting other medical conditions
medical symptom or condition
psychological or behavioural influences - interpersonal coping, denial, no treatment
influence condition - course, treatment interference, increasing health risk
stats of psychological factors affecting other medical conditions
prevalence not known, less than somatic symptom
can occur at any time
treatment of psych factors affecting other medical conditions
similar to somatic symptom disorder
CBT
factitious disorder features
falsification of physica or psych symptoms
induction of injury or disease
deception
presents patient as ill, injured, impaired
no evidence of external rewards
patient my be self or another
statistics on factitiout disorder
prevalence unknown. perhaps 1% in hospital setting
intermittent course
onset in ealry adulthood
treament of facticious disorder
not well identified
similar to somatic symptom
what is conversion hysteria according to freud
unexplained physcial symptoms = conversion of unconscious emotional conflicts into a more acceptable form
what is neurosis by psychoanalytic theory
specific but unproven cause - we dont use this anymore
somatic disorder cognitive features
disorder of cognition or perception with strong emotional contributions
very act of forming attention to bodily sensations increases aruosal aand makes physical sensations more intense
stroop test - enhanced perceptual sensitivity to illness cues
ambigious stimuli as threatening
better safe than sorry
restrictive concept of health as symptom free
unspecified genetic personality tendencies
koro
belief / fear genitals are retracting into abdomen
chinese male
central imporatnce of sexual functioning
typical sufferes = guilty about excessive masturbation, unsatisfactory sex, promiscuity
pa-leng
chinese
fear about cold wind in ones body
context ying and yang
dhat
indian
losing semen
disiness, weakness and fatigue
kyol gocu
cambodia
wind overload
closely resembles
panic disorder
shinkeishitsu
japan
resembles western anxiety
headaches, blushing
worry about symptoms hurting others
what does functioning
symptom without an organic course
malingering
deliberate faking of a physical pr psych disorder motivated by gain
- so how can we tell the difference
freud’s 4 basic processes in development of conversion disorders
traumatic event = unacceptable unconscious conflict
conflict repressed as unacceptable
anxiety increases and threatens to emerge into consciousness so person “converts” into physical symptoms = presence of dealing with conflict relieved. this is primary gain or reinforcing event that maintains the symptom
attention and sympathy = secondary gain
overview of dissociative disorders
severe alterations or discontinuities in identity, memory or consciousness fragmentations of identity depersonlizations derealization amnesia reality testing intact variations of normal to be a disorder = experiences are distressing or interferences with life functioning
what is depersonalization
distortion in perception of one’s mind, self or body
derealization
detachment from one’s surroundings
depersonalization disorder facts and stats
prevalence 2%
comorbidity with anxiety and mood disorders is extremely high
onset is typically around age 16, rare after 40
usually runs lifelong course
causes of depersonalization disorder
childhood trauma
severe stress
show cognitive deficits in attention, short term memory and spatial reasoning
cognitive deficits correspond with reports of tunnel vision and mind emptiness
treatment of depersonalization disorder
attend to the trauma
integrate the personalities
key features of dissociative amnesia
psychogenic memory loss
generalized = inability to recall anything including their identitiy
localized or selective = failure to recall specific (usually traumatic) events
define dissociative fugue
purposeful travel or wondering associated with amnesa
such presons may assume a new identity
stats on dissociative amnesia
sudden onset progressive prevalence - 1.8% more common in women all ages, kids more difficult typically rapid onset and dissipation
causes of dissociative amnesia
violent/ abusive childhood trauma
dissociation in general may have genetic diathesis
DID clinical description
adoption of 2 or more identities
identities display unique behaviours voice and posture
gaps in memory
dissociation of certain aspects of personality
three unique things of DID explained
alters - different identities
host - identitiy that seeks treatment and tries to keep fragile elements together
switch - often instantaneous from one personality to another
prevalence od DID
3-6%
average number of identities around 15
female : male 9:1but DSM says almost equal
onset is almost always in childhood
high comorbidity rates with a lifelong course
70% attempt suicide
DID causes
child abuse
PTSD relation
most are highly sugestible - genetic
treamtnet of DID
reintegration of genetics
identify and neutralize cues/ triggers
false memories and therapists
can be very easy to suggest during therapy
therapist must be aware of this
depersonalization - derealization disorder
individuals lose sense of reality to both their external world and their own body
intense panic attacks - 50% of people will experience feelings of unreality
chronic course
DDD = distinct cognitive profile with deficits in attention, information processing, short term memory, spatial reasoninig
= easily distracted and slow to process new info
deficits in perception, emotion and HPA axis
amok
transitive state often brutally attack/ assault sometimes killing humans and animals
if alive at the end of state dont remeber
dissociative trance disorder
altered state of consciousness in which people fimly believe they are possessed by spirits; considered a disorder only where there is distress and dysfunction
how to test faking of DID
transient microstrabismus that are not observed in other personalities difficult to fake for exmaple
physiological responses different to emotionally laden words - eg sweat glands and eeg
fMRI = change at the switch
malingerers tend to be eager to demonstrate their symptoms and do so in a fluid fashion
autohypnotic model
people who are suggestible may use dissociation as a defense against extreme trauma
bio contribution to dissociatoin
definite link
heritable traits - tension, responsiveness, like PTSD
genital exam in 3yo girsl example
girls given medical, half = genital exam, other half no
children were inaccurate in reporting where doctro touched them
60% of those touched in the genitals refused to indicate this
60% in control indicated genital insurtions where none had occured
