Week Nine - Somatic Symptoms & Dissociative Disorders Flashcards
Somatic symptom disorders are characterised by
The prominence of somatic symptoms (bodily sensation) that are associated with distress and impairment.
Somatic Symptom Disorder DSM-5 Criteria?
A. One or more somatic symptoms that are distressing
or result in significant disruption of daily life
B. Excessive thoughts, feelings, or behaviours 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)
SSD has high rates of comorbidity with
– Medical disorders
– Anxiety disorders
– Depressive disorders
Illness Anxiety Disorder
Preoccupation with having a medical illness (despite no
medical symptoms), accompanied by behavioural change.
• Previously hypochondriasis in and referred to as ‘health
anxiety’ in the literature.
• Similar presentation to other obsessive compulsive and
related disorders (obsessive compulsive disorder and body
dysmorphic disorder)…
- Preoccupations cause anxiety to increase
- Checking behaviours cause anxiety to decrease
Illness Anxiety Disorder DSM-5 criteria
A. Preoccupation with having or acquiring a serious illness
B. Somatic symptoms are not present, or, if present, are only
mild in intensity. If another medical condition is present or
there is a high risk for developing a medical condition, the
preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the
individual is easily alarmed about personal health status.
D. The individual performs excessive health-related
behaviours (e.g., repeatedly checks body for signs of
illness) or exhibits maladaptive avoidance (e.g., avoids
doctor appointments and hospitals).
E. Illness preoccupation has been present for at least 6
months, but the specific illness that is feared may change
over that period of time.
F. The illness-related preoccupation is not better explained
by another mental disorder.
Illness Anxiety Disorder Specifiers
Care-seeking type: Medical care, including physician
visits or undergoing tests and procedures, is frequently
used.
Care-avoidant type: Medical care is rarely used.
Conversion Disorder DSM-5 Criteria
A. One or more symptoms of altered voluntary motor or
sensory function.
B. Clinical findings provide evidence of incompatibility
between the symptom and recognised neurological or
medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment or warrants medical evaluation.
Conversion Disorder Onset, Prev and Co-Morbid
Typically adolescence or early adulthood
– Often follows life stress
Prevalence <1%
– More common in women than men
Often co-morbid with:
– Other somatic symptom disorders
– Major depressive disorder
– Substance use disorder
Conversion Disorder more prevalent in?
– Rural areas
– Low SES communities
– Non western cultures.
Conversion Disorder symptom type specifiers
– With weakness or paralysis – With abnormal movement – With swallowing symptoms – With speech symptoms – With attacks or seizures – With anesthesia or sensory loss – With special sensory symptom (e.g., visual, olfactory, or hearing disturbance). – With mixed symptoms.
Factitious Disorder
Falsification of medical and/or psychological symptoms.
- Exact prevalence is unknown but thought to be around ~1%
Factitious Disorder can be diagnosed as
– Factitious disorder imposed on self
– Factitious disorder imposed on another
Factitious disorder imposed on self DSM-5?
A. Falsification of physical and psychological signs and
symptoms, or induction of injury or disease, associated
with identified deception.
B. The individual presents himself or herself as ill, impaired or
injured.
C. The deceptive behaviour is evident even in the absence of
obvious external rewards.
D. The behaviour is not better explained by another mental
disorder, such as delusional disorder or another psychotic
disorder.
Factitious disorder imposed on another DSM-5?
A. Falsification of physical and psychological signs and
symptoms, or induction of injury or disease in another,
associated with identified deception.
B. The individual presents another individual (victim) to
others as ill, impaired or injured.
C. The deceptive behaviour is evident even in the absence of
obvious external rewards.
D. The behaviour is not better explained by another mental
disorder, such as delusional disorder or another psychotic
disorder.
Note: The perpetrator, not the victim, receives the diagnosis.
Genetics and Neurology for somatic disorders?
No support for genetic influence
- Concordance rates between MZ and DZ twins do not
differ.
Attempt to understand why some people are more aware
and distressed by bodily sensations than others.
Hyperactivity:
• Anterior insula
• Anterior cingulate
Cognitive-behavioural theories for somatic disorders (COGNITIVE PROCESSES) 4
– Hypervigilance to somatic symptoms: Tend to notice
changes in body that other people don’t notice.
– Overestimation of dangerousness of symptoms: Think
that harmless somatic symptoms mean something awful
is going to happen
– Confirmatory bias: Clients attend to and encode
information that is consistent with their beliefs and
dismiss information that is inconsistent
– Intolerance of uncertainty: Unable to cope with
elements of uncertainty
Cognitive-behavioural theories for somatic disorders (BEHAVIOURAL PROCESSES) 3
– Avoidance and escape behaviours: Avoid doctors or
regular medical visits because of fears that something
‘awful’ will be found.
– Checking behaviour: Pulse, urine, body for signs of
change etc.
– Reassurance seeking: Asking others in their life and
medical professionals for reassurance (often go to
multiple doctors).
Treatment for Somatic Disorders?
Few controlled treatment studies (most relate to illness
anxiety disorder)
CBT is effective and involves:
- Changing maladaptive cognitive and behavioural
processes
Dissociation
Some aspect of cognition or experience becomes inaccessible to consciousness.
Sudden disruption in the continuity of: – Consciousness – Emotions – Motivation – Memory – Identity
Dissociative Identity Disorder (DID)
Experiencing two or more identity/personality states, which alternate in control of behaviour.
Typically there is a primary ‘host’ personality and one or more ‘alters’ that are often extremely different to the ‘host’ in traits and behaviours.
DID DSM-5 Criteria?
A. Disruption of identity characterised by two or more
distinct personality states, which may be described in
some cultures as an experience of possession.
- The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory motor functioning.
- These signs and symptoms may be observed by others or
reported by the individual
B. Recurrent gaps in the recall of everyday events, important
personal information, and/or traumatic events that are
inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or
impairment in social, occupational or other important area of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
E. The symptoms are not attributable to the physiological
effects of a substance or another medical condition.
DID clinical features
Prevalence ~ 1.5%
More common in women than men.
About 70% of outpatients with DID have attempted suicide
Often portrayed as having no shared memory or awareness, however this has been questioned.
Evidence of physiological changes (EEG variation, voice
patterns, handedness)
DID - Etiology
There are two explanations for DID:
- Post-traumatic Model
- Socio-cognitive Model
DID Post-traumatic Model
An early trauma such as abuse has led the person to develop
multiple personalities to cope with stress (eg mistreatment
happened to ‘someone else’)
• Some evidence that severe abuse occurred in up to 90% of
individuals with DID
