W9: Somatic Symptoms & Dissociative Disorders Flashcards
What does somatic mean?
Pertaining to bodily sensations (internal and external)
What are some types of somatic symptom and related disorders
Somatic symptom disorder
Illness anxiety disorder
Conversion disorder
Factitious disorder
What is somatic symptom disorder?
When a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning.
What does the DSM say about somatic symptom disorder?
- 1 or more somatic symptoms that are distressing or cause disruption
- Excessive thoughts, feelings or behaviours related to the somatic symptoms or associated health concerns
- somatic symptom may not always be present, but state of being symptomatic is
Excessive focus on belief that there is something wrong with the body which may amplify normal somatic symptoms
What does somatic symptom disorder have high co-morbidity with?
Medical disorders
Anxiety disorders
Depressive disorders
What is illness anxiety disorder?
A preoccupation with having a medical illness (no symptoms) + behavioural change
May be interpreting benign symptoms as having a disorder
How is illness anxiety disorder similar to OCD
They are preoccupied which may cause anxiety to increase
Checking behaviours used to decrease anxiety
What are the two types of illness anxiety disorder?
Care-seeking type: medical care, including visiting GP, undergoing tests and procedures, is frequently used
Care-avoidant type: medical care is rarely used
What does the DSM say about illness anxiety disorder?
- preoccupation with having or acquiring a serious illness
- somatic symptoms = not present or only mild
- high anxiety around health. easily alarmed about personal health status
- performs excessive health behaviours or maladaptive avoidance
- present for at least 6 months but the feared illness can change over that time
- not better explained by other mental disorder (e.g. psychosis)
What is conversion disorder?
Functional neurologic disorders — conversion disorder — feature nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. However, the symptoms are real and cause significant distress or problems functioning.
What does the DSM say about conversion disorder?
- One or more symptoms of altered voluntary movement or sensory function (e.g. numbness or seizures)
- Clinical findings provide evidence of incompatibility between the symptoms and recognised neurological or medical conditions
- The symptom or deficit is not better explained by another medical or mental disorder
- The symptom or deficit causes clinically significant distress or impairment of warrants medical evaluation
When is typical onset of conversion disorder?
Typically onset is in adolescence or early adulthood - following life stress
What is the prevalence of conversion disorder?
<1%
Are there any gender differences in conversion disorder?
More common in women
What is conversion disorder often co-morbid with?
Other somatic symptom disorders
Major depressive disorder
Substance use disorder
Why might there have been a decrease in the prevalence of conversion disorder?
May not be well diagnosed
People who have seizures that don’t follow any medical patterns are said to have pseudo seizures but it is likely a portion of these have conversion disorder
Where is conversion disorder more prevalent?
Rural areas
Low SES communities
Non-western cultures
What are some symptom type specifiers of conversion disorder
With weakness or paralysis
With abnormal movement
With swallowing symptoms
With speech symptoms
With attacks or seizures
With anaesthesia or sensory loss
With special sensory symptoms (visual, olfactory or hearing)
With mixed symptoms
What is factitious disorder?
Includes the falsification of medical and/or psychological symptoms
Intentional falsification
What are the two kinds of factitious disorder?
Imposed on self: doing things to your body to seem to have illness
Imposed on another: indicating some sort of evidence that someone else has symptoms that they don’t (e.g. actively poisoning them)
What does the DSM say about factitious disorder imposed on self?
Falsification of physical and psychological signs and symptoms, or induction of injury or disease, associated with identified deception
Presents self as ill, impaired or injured
Deceptive behaviour is evident even in the absence of obvious external rewards
Not better explained by another mental disorder (delusional or psychotic)
What does the DSM say about factitious disorder imposed on another?
Falsification of physical and psychological signs and symptoms, or induction of illness or disease in another with identified deception
Presents another individual (victim) to others as ill, impaired or injured
The deceptive behaviour evident in absence of reward
The behaviour is not better explained by another mental disorder (psychotic and delusional)
Give a case study example of factitious disorder
Jennifer and Kathleen Bush
Initial presentation: ear infections, chronic diarrhoea, prolonged seizures
Kathleen left job to become the office manager at Jennifer’s paediatric place
Hospital raised concerns of factitious events but the parents sued the hospital
When Jennifer was taken into care four years later, there was an instant remission of her illness
Kathleen was found guilty of child abuse and sentenced to five years jail time
Is there a genetic role in somatic disorders?
No. No support.
Rates in MZ and DZ twins do not differ
What brain areas have been considered in understanding why some people are more aware of and distressed by bodily sensations than others?
Hyperactivity in the:
Anterior insula
Anterior cingulate
What cognitive processes may be at play in somatic disorders?
Hyperigilance - tend to notice more than others
Overestimation - of dangerousness of symptoms (think something harmless is worse)
Confirmation bias - attend to and encode info consistent with beliefs
Intolerance of uncertainty
What behavioural processes may be at play in somatic disorders?
Avoidance and escape
Checking behaviour: pulse, urine, body
Reassurance seeking: asking others in life and medical professionals for reassurance
How can help-seeking and sick-role behaviours be reinforced?
By the attention and sympathy they may receive from others
Treatment for somatic disorders?
Few controlled studies but CBT is effective…
Involves changing maladaptive cognitive and behavioural resources similar to OCD and related disorders
What are the 3 kinds of dissociative disorders?
Dissociative identity disorder
Dissociation amnesia
Depersonalisation disorder
What is dissociation?
Some aspect of cognition or experience becomes inaccessible to consciousness
Sudden disruption to: consciousness, emotions, memory, motivation and identity.
What is dissociative identity disorder (DID)?
Formerly multiple personality disorder
When someone experiences two or more identity/personality states which alternate in control of behaviour - typically there is a host personality and one or more alters that are extremely different to the host
What does the DSM say about DID?
A disruption of identity characterised by two or more distinct personality states
- may have no memory of what happened like completely different person
Recurrent gaps in recall of everyday events, personal information and or traumatic events that are inconsistent with normal forgetting patterns
Cause significant distress or impairment in social, occupational or other important areas of functioning
Not a normal part of cultural or religious practice
Not due to substance use or another medical condition
Which is the most severe dissociative disorder?
DID
How common is DID? gender differences?
1.5%
More common in women
How many outpatients with DID have attempted suicide?
70%
Do people with DID really forget everything from the other personality/identity?
Often portrayed this way however this has been questioned as evidence from memory tests have shows that information from one ‘alter’ is available in the others
Is there any other evidence of change in DID?
There is evidence of physiological changes - EEG variation, handedness, voice patterns
What are the two explanations for DID?
1- post traumatic model
2- sociocognitive model
What is the post traumatic explanation of DID?
An early trauma such as abuse has led the person to develop multiple personalities to cope with stress (X happened to someone else not me)
Is there any evidence for the post traumatic explanation for DID?
Some evidence that severe abuse occurred in up to 90% of individuals with DID
- but subjective reporting
What is the socio-cognitive explanation of DID?
Suggests that DID results from psychotherapeutic techniques
Is there any evidence for the socio-cognitive model of DID?
Most cases show few if any signs prior to therapy with numbers of identities increasing with the length of time spent in therapy
- therapist may reinforce the idea that there are multiple personalities
- a small number of therapists are responsible for the majority of diagnoses
Sybil
- DID cases in 1970 - 79, then the best selling book and movie ‘Sybil’ was a story of a women with 16 personalities
- DID cases in 1986- 6000+ and now in the tens of thousands
(When we educate people about disorders there is a better understanding and they go to seek help but this level of increase is unheard of)
What is the treatment for DID?
Recommended to use a phase-oriented approach
- Establishing safety, stabilisation and symptom reduction
- Confronting, working through and integrating traumatic memories
- Identity integration and rehabilitation
What is dissociative amnesia?
The forgetting of personal information, particularly surrounding a stressful event
What does the DSM say about dissociative amnesia?
An inability to recall important autobiographical information. Usually of a traumatic or stressful nature that is inconsistent with ordinary forgetting
Causing distress or impairment
Not attributable to the effects of a substance, neurological or any other medical condition
What are some criticisms to the diagnosis of dissociative amnesia?
Intentional forgetting vs. amnesia
We have gaps in memory normally
Little empirical support - cases better attributed to organic brain damage, suppression of thoughts etc
Treatment for dissociative amnesia?
The disorder usually spontaneously remits
What is depersonalisation disorder (DD)?
Recurrent experience of derealisation and or depersonalisation
What is derealisation?
The feeling your surrounding are not real or that familiar places are new/unknown
What is depersonalisation?
The feeling you are not real, living in a dream or movie, or are watching yourself from the outside
What does the DSM say about depersonalisation disorder?
The presence of persistent or recurrent experiences of depersonalisation, derealisation or both
During these experiences, reality testing remains intact (awake and alert)
Significant distress and impairment
Not attributable to a substance or other medical condition
Not better explained by another mental disorder
How prevalent is DD?
Derealisation and depersonalisation are relatively common experiences (more than 50% of the general population, mainly adolescents)
BUT the disorder itself is not common (2%)
When is the typical onset of DD?
In adolescence
Are there any gender differences in DD?
No
Are there any memory deficit differences in the dissociative disorder?
Deficits in explicit (conscious recall of experience) but not implicit (hard to explain memories such as procedural, things that cannot be consciously recalled) memories
