week 9 - somatoform Flashcards
Somatic Symptom & related disorders (include:)
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder
Somatic Symptom & Related Disorders
previously referred to as..
central feature
focus on…
Previously referred to as “Somatoform Disorders” Somatic – relating to the body.
Central feature is of prominent somatic symptoms associated with significant distress and impairment.
Focus is on the presence of symptoms and signs, rather than the absence of medical causes.
“A distinctive characteristic of many individuals with somatic symptom disorder is not the somatic symptoms per se, but instead the way they present and interpret them.” (p.309)
Medically Unexplained Symptoms
the percentage of common symptoms presenting to general practitioners that remain medically unexplained
menstrual problems - 33% fainting ~33% headache ~ 30% chest pain ~27% dizziness ~27% palpitations ~26% sexual problems ~25% nausea,vomiting, indigestion ~23% constipation, diarrhoea ~22% abdominal pain ~21% dyspnoea (difficulty breathing) ~19% fatigue ~19% joint or limb pain ~17% Back pain ~16%
Somatic Symptom Disorder
A.One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B.Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
–1.Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
–2.Persistently high level of anxiety about health or symptoms.
–3.Excessive time and energy devoted to these symptoms or health concerns.
C.Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Illness Anxiety Disorder
Preoccupation with having or acquiring a serious illness.
Somatic symptoms are not present or, if present, are only mild in intensity.
High level of anxiety about health.
Excessive health-related behaviors or maladaptive avoidance.
Present for at least 6 months
—Specific illness that is feared may change over this time
Not better explained by another mental disorder.
Conversion Disorder
One or more symptoms of altered voluntary motor or sensory function.
Clinical findings provide evidence of incompatibility between the symptom and recognized 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 in social, occupational, or other important areas of functioning or warrants medical evaluation.
Conversion Disorder:
Examples of Functional Neurological Symptoms
Weakness or paralysis
Abnormal movement (tremor, dystonia, gait, etc.)
Swallowing symptoms
Speech symptoms
Attacks or seizures
Anasthesia or sensory loss
Sensory symptoms (e.g., vision, olfaction)
https://www.youtube.com/watch?v=AkYHwXV-jWs
eg neuro test for CD
response in conversion reaction:
arm extension is followed by involuntary flexion of the stretched muscle, indicating resver strength
Respoinse in organic paralysis
Arm is easily extended by examiner’s force
Factitious Disorder (2 types)
imposed on self
imposed on another
Factitious Disorder Imposed on Self
Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
The individual presents himself or herself to others as ill, impaired, or injured.
The deceptive behavior is evident even in the absence of obvious external rewards.
The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
Factitious Disorder Imposed on Another
Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.
The individual presents another individual (victim) to others as ill, impaired, or injured.
The deceptive behavior is evident even in the absence of obvious external rewards.
The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
https://www.youtube.com/watch?v=KBNRt60sagY
Note: The perpetrator, not the victim, receives this diagnosis.
Prevalence
somatic symptom disorder ( not known, estimated 5-7%)
health anxiety disorder : between 1.3% and 10%
conversion disorder - incidence = 2-5/100000/year
factitious disorder = uknown, ~% of hospital presentaitons
Cognitive Behavioural Model
Somatosensory amplification
Perception of symptoms
Attributionregarding symptoms
concern/anxiety about illness
illness behaviour
psychological factors (of somatic disorders)
physiological disturbance leads to emotional arousal
which leads to more attn to body
attribution of sensaitons to ilnnes
illness worry
communication of distress & help-seeking
avoidance and disability
social response
Treatment of Somatization Disorders
perception of pysical symptoms = pain relief meds, relaxation distratiction, attn training
attribution/disease-conviction = reattribution, challenge thoughts, education, explanation, behavioural experiments
Concern, illness-worry, preoccupation = reassurance, education, pharma tx of depression anxiety, cbt , distraction
Illness behaviour - coordination betwenn all health profs
secondary consultatioins
social and occupational funcitoning = graded activity, exposure, early return to work, couple or fam therapy, assitance with rapid resolution of compo claims
Dissociative Disorders
Hysteria
Dissociative disorders were previously labeled as ‘hysteria’
Disorders predominantly seen in women
Historically extremely rare
N = 76 cases from 1791-1944
Explosion of diagnoses in 1970s and 1980s
Popular media attention
DSM-5 Dissociative Disorders
3 of them
Dissociative Amnesia
Dissociative Identity Disorder
Depersonalization/Derealization Disorder
dissociation
can relate to hpynosis/ be induced by ?
Dissociative Disorder Symptoms
Positive:
Unbidden intrusions into awareness and behjaviour, accompanying losses of continuity of subjective experience
(eg, fragmentaiton of id, depersonalisation, derealisation)
Negative Dissociative Symptoms
Inability to access information or control mental functions normally are readily amneable to acess or control
(eg, amnesia)
Dissociative Amnesia
An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
—Note: Most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.
Clinically significant distress or impairment.
Not attributable to intoxication or other medical condition.
Not better explained by other DSM disorder.
Specify if: With Dissociative Fugue
Dissociative Identity Disorder
Disruption of identity characterized by two or more distinct personality states.
–Marked discontinuity in sense of self and sense of agency, accompanied by related alterations in…
—-affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.
Recurrent gaps in the recall, inconsistent with ordinary forgetting.
Clinically significant distress or impairment.
Not a normal part of a broadly accepted cultural or religious practice, or child fantasy play.
Not attributable to intoxication or another medical condition.
Iatrogenesis of DID
Iatrogenesis is the creation of an illness through the intervention of medical / health professionals
Some suggest that DID is an iatrogenic illness
Expectancies of therapists
Expectancies of patients / clients
Suggestibility of patient / clients
Reasons to Doubt DID
Most cases of dissociative disorders are diagnosed by a handful of ardent advocates.
The frequency of the diagnosis of dissociative disorders in general and DID in particular increased rapidly after release of the very popular book and movie Sybil.
The number of personalities claimed to exist in cases of DID has grown rapidly, from a handful to 100 or more.
Dissociative disorders are rarely diagnosed outside of the United States and Canada; for example, only one unequivocal case of DID has been reported in Great Britain in the last 25 years (Casey, 2001).
Other Problems with DID
Attribution of etiology to repeated abuse in childhood
Little evidence that childhood sexual assault is associated with amnesia
Gradual increase in number of alters per case
Explosion in DID Diagnosis
1791 - 1944 = 76 cases 1944 - 1962 = 1 case (eve) 1976 1 case (evelyn) 1970-1979 - 36 new cases (after sybil 1982 - 100 cases 1984 = Kruft ~ 171 cases
Depersonalization/Derealization Disorder
Recurrent experiences of depersonalization and/or derealization:
Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).`Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
During the depersonalization or derealization experiences, reality testing remains intact
.
Clinically significant distress or impairment.
Not attributable to intoxication or another medical condition.
The disturba
nce is not better explained by another mental disorder.
