Test 3: Somatic Symptom and Related Disorders & Dissociative Disorders Flashcards
What are somatic symptom disorders?
Excessive or maladaptive response to physical symptoms or health concerns
- Preoccupation with health or symptoms
- Physical complaints
- Usually no identifiable medical condition
What disorder is characterized by
- Presence of one or more somatic symptoms: symptom is often medically unexplained
- Excessive thoughts, feelings, and behaviors related to the symptoms (excessive thoughts about seriousness of the symptom, frequent complaints and requests for help, health related anxiety, excessive research)
- Substantial impairment in social or occupational functioning
Somatic symptom disorder
What are the statistics of somatic symptom disorder?
- relatively rare
- onset: usually adolescence
- more likely: unmarried, low socioeconomic status, women
- chronic
What disorder is characterized by
- severe anxiety about the possibility of having or acquiring a serious disease
- actual symptoms are either very mild or absent
- strong disease conviction
- medical reassurance does not seem to help
Illness anxiety disorder
What are the statistics of illness anxiety disorder?
- Effect: All ages equally
- Comorbid: anxiety and mood disorders
What causes somatic symptom disorders?
- Consistent overreaction to physical signs and sensations
- Cause is unlikely to be found in isolated biological or psychological factors
- Genetic component is present
- May have learned from family to focus anxiety on physical sensations
- Stressful life events
- Illness in family during childhood
- Benefits of illness (sympathy, attention)
What are the shared features of somatic symptom disorder and antisocial personality disorder?
- Often begin early in life
- Chronic and difficult to treat
- More common in lower socioeconomic status
- Linked to substance abuse and interpersonal problems
- Disinhibition/impulsivity: seeking sympathy & other benefits
What are different features of somatic symptom disorders and antisocial personality disorder?
SSD:
- Dependence manifestation of impulsivity
- More common in females
ASPD:
- Aggression manifestation of impulsivity
- More common in males
What are treatments for somatic symptom disorders?
- mild: detailed education and medical professional reassurance
- CBT (effective)
- Antidepressants (maybe helpful)
- Gatekeeper physician to limit excessive use of medical services
- Reduce supportive consequences of illness
Illness Anxiety Disorder vs. Somatic Symptom Disorder
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IAD:
- Fear of disease
- Scientific in reporting data
- Limited complaints - often a fear of one disease
SSD:
- Fear of symptoms
- Describes symptoms vaguely
- Varied complaints - often fear of many symptoms
What disorder is characterized by
- psychological variable may be impacting a general medical issues
Examples:
- PT concentration affect taking medication
- PT in denial about diagnosis does not comply with medical advice
Psychological Factors Affecting Medical Condition
What disorder is characterized by
- Altered motor or sensory function inconsistent with neural/medical conditions and not better explained by another disorder
- ie lump in throat
- Suggestive of neurological problem but not detected
- Cause significant distress/impairment
- May display indifferent attitude toward symptoms (“la belle indifference”)
- Functioning may be mostly normal
- NOT deliberately faking
Conversion Disorder (Functional Neurological Symptom Disorder)
What is the deliberate faking of a condition?
Malingering
What are the statistics for conversion disorder?
- Prevalence: Rare
- Course: chronic, intermittent
- Comorbid: Anxiety and mood disorders
- Onset: usually adolescence
- Primarily in females
- Common in some cultural and/or religious groups
What causes conversion disorder?
- Not well understood
- Freudian psychodynamic view (common, unsubstantiated): past trauma/unconscious conflict “converted” into more acceptable manifestation (physical symptoms)
- Primary gain: escape from conflict
- Secondary gain: attention, sympathy, etc
- Sociocultural factors: lower education/socioeconomic status, symptoms more familiar with
What is the treatment for conversion disorder?
- Trauma: process and treat symptoms
- remove sources of secondary gain
- reduce supportive consequences of talk about physical symptoms
What disorder is characterized by
- purposely faking physical symptoms
- Induce physical symptoms or just pretend
- No obvious external gains (benefit of sick role)
Factitious disorder
- NOT: malingering - faking to get concrete objective
What disorder is characterized by
- inducing symptoms in another person
- to receive attention or sympathy
Factitious Disorder imposed on another (Munchausen syndrome by proxy)
- typically a caregiver induces symptoms in a dependent (child)
How would you address a Christian with illness anxiety disorder or somatic symptom disorder?
Verses:
1 Peter 5: 7 - cast all your cares
Proverbs 3:5-6 - God is in control, trust Him not yourself
Isaiah 40:31 - Memorize and meditate on verses, run wing eagles
Philippians 4:8-9 - Set your mind on good things
- Writing down examples of God’s faithfulness
- Remember prayers and answers
- Practice thankfulness
- Verse meditation and memorization
What are dissociative disorders in general? What are the two types?
- Severe alterations or detachments from reality
- Affect identity, memory, or consciousness
1) Depersonalization: distortion in perception of one’s body or experience
2) Derealization: losing a sense of the external world
What disorder is described as:
- Recurrent episodes in which a person has sensations of unreality of one’s own body or surroundings
- Feelings dominate and interfere with life funcitoning
- Only diagnosed if primary problem involves depersonalization and derealization
– Similar symptoms may occur in the context of other disorders, including panic disorder and PTSD
Depersonalization/Derealization Disorder
What are some features of depersonalization/derealization disorder?
- Cognitive deficits in attention, short-term memory, spatial reasoning
- Easily distractible
- Difficulty absorbing new information
- Reduced emotional responding
- May have dysregulation of HPA axis in brain
What ae facts a statistics of depersonalization/derealization disorder?
- High comorbidity with anxiety and mood disorders
- Onset: typically adolescents
- Couse: usually chronic
- Risk factor;: history of trauma
- (1-3% population)
What is the treatment of depersonalization/derealization disorder?
- Research scarce
- No systematic research on psychological treatments
- Trial of antidepressant (Prozac) showed no effect above placebo
What disorder is characterized by
several forms of psychogenic memory?
Two types?
Dissociative Amnesia
- Generalized type: inability to recall anything, including their identity
- Localized or selective type: failure to recall specific (usually traumatic) events
What are the five patterns of dissociative Amnesia?
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- Localized
- Selective
- Generalized
- Continuous
- Systematized
What is the definition of localized pattern of dissociative amnesia?
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All events from a certain time period are blocked out
What is the definition of selective pattern of dissociative amnesia?
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“spot erasures,” forgetting certain aspects/events during a specific time period
What is the definition of generalized pattern of dissociative amnesia?
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Forgetting one’s entire past life
What is the definition of continuous pattern of dissociative amnesia?
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Forgets events after a certain time period up to the present, including events occurring after onset of amnesia
What is the definition of systematized pattern of dissociative amnesia?
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Forgets only certain categories of information, while other memories remain intact
What are the types of memory that relate to amnesia?
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- Episodic memory
- Semantic memory
- Procedural memory
- Explicit memory
- Implicit memory
How is episodic memory affected by amnesia?
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(memory of personal experience) is lost
How is semantic memory affected by amnesia?
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(general knowledge) is spared
How is procedural memory affected by amnesia?
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(skills) is intact
How is explicit memory affected by amnesia?
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(intentional recollection of information) may be lost
How is implicit memory affected by amnesia?
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(memories not consciously aware of) affects behavior
Read diagnoses of each disorder
In the textbook
What disorder is characterized by
- During the amnestic episode, person travels or wanders, sometimes assuming a new identity in a different place
- Unable to remember how or why one has ended up in a new place
Dissociative fugue
What are the statistics of dissociative amnesia and fugue?
Onset: adulthood (rare in childhood)
Course: rapid onset and dissipation
What are the causes of dissociative amnesia and fugue?
- Little is known
- Trauma and stress can serve as triggers
- Most recover/remember without treatment
What disorder is characterized by
- Replacement of the customary sense of personal identity by a new identity, attributed to the influence of a spirit, power, deity and is associated with stereotypes involuntary movements of amnesia
- Dissociative symptoms and sudden changes in personality
- Change may be attributed to possession by a spirit
- Only considered a disorder if leads to distress or impairment
Dissociative trance
Nigeria: vinvusa
Thailand: phii pob
What disorder is characterized by
- Formerly known as MPD
- Dissociation of personality
- Adoption of several new identities (ave 15, up to 100) that display unique behaviors, voice, and postures
Dissociative Identity Disorder (DID)
What are the unique aspects of DID?
- Alters: different identities or personalities
- Host: the identity that keeps other identities
- Switch: Quick transition (instantaneously) from one personality to another, the person may exhibit physical transformations
Can DID be faked?
- some are faking: may “produce” an alter when suggested by therapist
- some are not: seen in physiological and brain functioning changes
What are the statistics of dissociative identity disorder?
- Prevalence not well known (1-2%)
- More common in females
- Onset: typically childhood/adolescence, due to abuse
- Comorbidity: other psychological disorders
- Dissociation
- Course: chronic
How can DID malingering be detected?
- Brainwaves
- Pain sensitivity
- Skin conductance
- Personality test
- Handedness
- Eyeglasses Rx
(malingering eager to demonstrate their symptoms)
What causes dissociative identity disorder?
- Typically: severe, chronic trauma - often childhood abuse (risk increases without support)
- Mechanisms: dissociation offers escape
- Closely related to PTSD
- Biological vulnerability possible but not well understood, almost all risk is environmental
How is dissociative identity disorder treated?
- Focus on identity reintegration
- Identify and neutralize cues/triggers
- Relive/confront trauma (hypnosis)
What is the problem, consequence, and conclusion of false memories?
- Problem: possible to create false memories of abuse by power of suggestion
- Consequence: some pts think they have repressed memories of abuse later shown to be false, can be damaging to pt & families
- Conclusion: therapists need to be well trained in memory function and be careful not to suggest an untrue history by mistake
