Trauma/Stressor-Related, Dissociative, and Somatic Symptom Disorders

Question 1

RAD criteria

Answer 1

1. Emotionally withdrawn from caregivers
2. 2+ symptoms
3. Etiology = extreme insufficient care
4. Onset < 5 yo
5. Onset > 9 months developmentally

Question 2

DSED criteria

Answer 2

1. Inappropriate interactions with strangers
2. 2+ symptoms
3. Etiology = extreme insufficient care
4. Onset > 9 months developmentally

Question 3

RAD symptoms

Answer 3

1. Minimal social responsiveness to others
2. Limited positive affect
3. Unexplained emotional responses

Question 4

DSED symptoms

Answer 4

1. Less inhibition in approaching strangers
2. Less checking in with adults after separation
3. Overly familiar with strangers
4. More willingness to go with strangers

Question 5

PTSD criteria

Answer 5

1. Duration > 1 month
2. Exposure to death, injury, violence
3. 1+ intrusive symptoms
4. 1+ avoidance symptoms
5. 2+ alteration in thought/mood symptoms
6. 2+ reactivity symptoms

Question 6

PTSD intrusive smyptoms

Answer 6

1+
1. Intrusive thoughts
2. Nightmares
3. Flashbacks
4. Psychological reactions
5. Physiological reactions

Question 7

PTSD avoidance smyptoms

Answer 7

1+
1. Avoiding internal cues (thoughts, emotions)
2. Avoiding external cues (people, places)

Question 8

PTSD alteration in thought/mood symptoms

Answer 8

2+
1. Persistent negative mood
2. Inability to feel positive mood
3. Negative thoughts about self, others
4. Distorted thoughts about cause (blame)
4. Detachment from others
6. Less interest in activities
7. Inability to remember events

Question 9

PTSD reactivity symptoms

Answer 9

2+
1. Irritability or anger
2. Reckless
3. Hypervigilance
4. Startle response
5. Concentration issues
6. Sleep disturbance

Question 10

Types of PTSD dissociation

Answer 10

1. Depersonalization (out of body)
2. Derealization (unreal surroundings)

Question 11

PTSD and brain structure

Answer 11

1. Hyperactive amygdala
2. Hyperactive anterior cingulate cortex
3. Hypoactive vmPFC
4. Reduced volume of hippocampus
5. Mixed findings on hippocampus activity

Question 12

PTSD and NTs

Answer 12

Low:
1. Serotonin
2. GABA

High:
1. Dopamine
2. Norepinephrine
3. Glutamate

Question 13

PTSD treatment

Answer 13

1. First line = CBT, TF-CBT (youth), CPT, CT, PE
2. Conditional = brief eclectic therapy, EMDR, narrative exposure therapy
3. Iatrogenic = debriefing

In-person = telehealth (less alliance)

Question 14

TF-CBT

Answer 14

1. 3-18 yo
2. Includes parent and family components

Question 15

PTSD medications

Answer 15

Conditional support

SSRIs:
1. Fluoxetine
2. Paroxetine
3. Sertraline

SNRI:
1. Venlafaxine

Question 16

Acute stress disorder criteria

Answer 16

1. Duration = 3 days to 1 month
2. Exposure to death, injury, violence
3. 9+ symptoms across PTSD categories

Question 17

Prolonged grief disorder criteria

Answer 17

1. Death 6+ (kids) or 12+ (adults) months ago
2. Yearning for deceased
3. Intrusive thoughts about deceased
4. 3+ symptoms nearly every day
5. Duration > 1 month

Question 18

Two dissociative disorders

Answer 18

1. Dissociative amnesia
2. Depersonalization/derealization disorder

Question 19

Dissociative amnesia

Answer 19

Inability to recall important information beyond forgetfulness

Question 20

Forms of amnesia

Answer 20

LoSe GeSyCo
1. Localized* = loss of all events in period
2. Selective = loss of some events in period
3. Generalized = loss of lifetime
4. Systematized = loss of certain category
5. Continous = loss of new/current events

Question 21

Dissociative fugue

Answer 21

Purposeful travel or wandering while dissociating

Question 22

Depersonalization/derealization disorder

Answer 22

1. Depersonalization and/or derealization
2. Intact reality testing

Question 23

Four somatic symptom disorders

Answer 23

1. Somatic Symptom Disorder
2. Illness Anxiety Disorder
3. Conversion Disorder (FNSD)
4. Factitious Disorder

Question 24

Somatic Symptom Disorder criteria

Answer 24

1. 1+ somatic symptoms
2. Excessive thoughts/emotions/behaviors related to symptoms
3. 1+ symptoms

Question 25

Somatic Symptom Disorder symptoms

Answer 25

1. Persistent thoughts about severity
2. High anxiety about severity
3. Excessive energy spent on symptoms

Question 26

Somatic Symptom Disorder specifiers

Answer 26

1. Severity
2. Pain
3. Persistence

Question 27

Illness Anxiety Disorder criteria

Answer 27

1. Preoccupation with illness without symptoms
2. Excessive anxiety about health
3. Excessive health-related behaviors OR avoidance of healthcare
4. Duration > 6 months

Question 28

Conversion Disorder criteria

Answer 28

1. 1+ motor or sensory symptoms

Question 29

Conversion disorder specifiers

Answer 29

1. Symptom type
2. Course (acute v. persistent with 6 month cutoff)
3. Psychological stressor (present v. absent)

Question 30

Types of Conversion Disorder symptoms

Answer 30

1. Weakness/paralysis
2. Abnormal movement (tremors, dystonia, myoclonus/twitching, gait)
3. Swallowing
4. Speech (dysphonia, slurred)
5. Attacks/seizures
6. Anesthesia/sensory loss
7. Special sensory (visual, olfactory, hearing)
8. Mixed

Question 31

Psychogenic non-epileptic seizures (PNES)

Answer 31

1. Video EEG can differentiate
2. Brain activity different than regular seizures

Question 32

Three types of Factitious Disorder

Answer 32

1. Imposed on self = deception, no reward
2. Imposed on others = deception, no reward, on behalf of other (parent-child)
3. Malingering = deception, reward

Question 33

Four common malingering scenarios

Answer 33

1. Medical evaluation for legal reasons
2. Differences in self-report and objectives
3. Treatment non-compliant
4. Antisocial PD

Question 34

Method to detect malingering

Answer 34

1. Forced choice (will answer incorrectly more than chance/50%)

Question 37

Detecting genuine memory loss

Answer 37

1. Often remember details during middle of event
2. Often believe clues will help them remember