week 4 somatic symptom and dissociative disorders Flashcards
describe the clinical features, causes and treatment of somatic symptom disorder
In this condition, patient experiences bodily symptoms which may or may not have medical explanation, but are unduly focussed upon and worried about. Causes distress and disruption to fn. More female than male and more often single from lower socioeconomic circumstances. often starts in adolescence but continues lifelong. history of many medical checks and negative findings.
Causes seem to be predisposition to anxiety, an increased awareness of physical sensations, tendency to stress, does run in families, and usually history of many of same symptoms in family members so possibly learnt behaviour. Often actually have an underlying stress. Increased comorbidity with anxiety or mood disorder.
Treatment possibly harder for v severe forms. May include explanation, focussing on bringing on symptoms but learning they are under patient’s control(cbt challenging and focussing on interpretation of symptoms and how to manage), managing and addressing other stress components in life, training to being able to divert attention elsewhere, reducing frequency of help-seeking behaviours, sometimes drugs for anxiety/depression eg paroxetine.cbt best.
Also learn to relate to significant others in ways other than getting symptom-related sympathy. Might also look at being able to work part-time and possibly come off disability support payments (which many are on).
describe the clinical features, causes and treatment of illness anxiety disorder
Patient extremely anxious about getting a serious illness but has no symptoms (or very mild).Anxiety is disproportionate. Many checks of self but might actually avoid doctor appointment because fear will be bad news, but some do seek doctor frequently.. Preoccupation with illness present at least 6 months.
Causes and tx seems likely similar to somatic symptom disorder.
describe the clinical features, causes and treatment of conversion disorder;
Also known as Functional Neurological Symptom Disorder). Old term of “conversion” popularised by Freud who said unconscious conflicts were converted into physical symptoms.
There is some form of physical malfunction such as blindness, paralysis, loss of sensation or inability to speak, but there is no medical explanation for it. (or rather the medical tests and symptoms are incompatible). Some may even have seizures yet no eeg abnormalities are found (unlike in true seizures).
Previously, “la belle indifference” was described as an essential part of the disorder where the patient is not actually bothered by the symptoms at all. But this has no proved incorrect-some patients are not worried by the symptoms (21%) and some are.
Often precipitated by some marked stressor (often child sexual abuse or severe trauma)which is sometimes a physical injury.
Some may years later have a proven neurological issue, but this is exceedingly rare.
In the case of the symptom being blindness, person somehow usually navigates ok but says cannot see.
Uusally affects women and usual onset is adolescence or slightly later. Symptom may disappear then reappear when there is another stressor. Children and those who accept the dx, do better with tx.
In some cultures, symptoms equating to conversion disorder may be what is occurring commonly during some religious or healing rituals. This is not deemed a disorder unless interfering with function.
Also more common with less education, and where multiple members of a family have it, their symptoms tend to be similar (because symptoms familiar).
discuss the difficulties involved in distinguishing conversion disorders from true
physical disorders, factitious disorder and malingering
Can be very difficult. Malingerers do know what they are up to and are seeking financial gain, reduction in work or responsibility and are seeking to manipulate others. Factitious disorder (falsification of symptoms)is in-between conversion disorder and malingering. Symptoms are under voluntary control but there seems no reason to need to resort to them (apart from assuming "the sick role"). Sometimes Factitious disorder is actually imposed upon someone else (often mother upon child) (previously known as Munchausen's by proxy) (this is a form of child abuse). To establish that eg Munchausen's is occurring, it is helpful for hospitals to have video surveillance, or sometimes to have a trial separation of parent and child etc. In the case of symptoms of blindness, it would be expected that on visual test, somatic disorder would perform ok but claim they couldn't, whereas a malingerer would perform worse than chance by knowingly being incorrect. The primary gain of having conversion disorder is to avoid anxiety re something. a secondary gain is the sympathy from others or avoidance of responsibility. Tx (CBT) involves identifying the stressor and attend to it (often catharsis) and avoid secondary gain reinforcements (ie whole family needs tx/program). Hyponosis of little to no benefit.
define the major features of depersonalization-derealization, dissociative amnesia, and dissociative fugue (a subtype of dissociative amnesia)
Depersonalization-sense of losing one’s own sense of self. Possibly like observing oneself. Can be normal if brief. More likely if tired or stressed etc.
Derealization-sense of losing the reality of the external world. others may seem dead or mechanical. Can also be briefly normal.
DEPERSONALIZATION-DEREALIZATION DISORDER;
symptoms of persistent or recurrent depersonalization/dealization are the primary concern and are severe.0.8-2.8% of population. (rare).equal men and women.
Reality testing remains intact (eg know what day it is etc). Av age onset 16 years. usually chronic.often comorbid with anxiety/mood disorder and personality disorders. Tests show more likely to have decreased attention, decreased ability to process information and some short term memory deficits and spatial reasoning deficits. Skin conductance in those with depersonalization disorder more likely to reflect reduced emotional response. Dysregulation in the hypothalamic-pituitary-adrenocortical axis has been demonstrated. Tx not evaluated well, prozac ineffective.
DISSOCIATIVE AMNESIA;unable to recall details of life or events.Usually appears in adulthood, well before 50 for first time. May have subsequent episodes. Prevalence 1.8-7.3%
May be GENERALISED-cannot remember anything
or LOCALISED/SELECTIVE-cannot recall specific events (usually traumatic) during a specified period. This is more common than generalised.
DISSOCIATIVE FUGUE-SUBTYPE OF DISSOCIATIVE AMNESIA;memory loss usually around period or trip. most often person just disappears for a while, then returns.often sparked by an intolerable stressor. Sometimes develop different persona on this trip. fugue states typically end abruptly with recollection of most.
describe the clinical features of dissociative identity disorder
Multiple personalities coexist, usually without full awareness of each other. typically at least 3 alters but may have many more. Typically seems to arise from extreme child abuse or suffering before the age of 9.
Recurrent day to day memory lapses (from when another alter was present). Might fine different handwitings etc
Usually it is the “host” alter which seeks tx, which is not the original personality. Switching from 1 personality to next is usually instantaneous.
discuss the various theoretical explanations posited for dissociative identity disorder;
- Have suffered terrible childhood abuse/trauma
2, are more susceptible to suggestion, and so might occur in response to a therapist’s query. - Some argue is possible to fake it.
discuss the treatment of the dissociative disorders.
Psychoanalytic has had some limited success for DID.
DID exceptionally hard to treat. Hypnosis and catharsis some success for DID.
For dissociative amnesia, need to focus on techniques to strengthen ability to manage and face stressors.
