Somatoform And Dissociative Disorders

Question 1

What are somatoform disorders

Answer 1

A group of conditions that involve physical symptoms and complaints suggesting the presence of a medical condition but without any evidence of physical pathology to account for them
The patient secretly induces symptoms
Related to false victimization syndrome where patient falsely claims some type of abuse e.g false rape
Munchausen’s syndrome: severe and chronic form of facticious disorder with physical symptoms
Hospital addiction or professional patient
Persons goal is to obtain and maintain personal benefits that playing the sick role may provide including. The attention and concern of family and medical personal.

Question 2

Hypochondriasis

Criteria for hypochondriasis

Answer 2

Preoccupation with fears of having a serious illness
1. Preoccupation with fears of having or the idea that one has a serious disease based on the persons misinterpretion of symptoms
2. Fears persists even after appropriate medical evaluation and reassuramce.
The belief in criterion A is not of a delusional intensity as in delusional disorder, somatic type and is not restricted to a circumscribed concern about appearance as in BDD
3. The preoccupation causes clinical distress or impairment in social occupational or other important areas of functioning
4. The duration of the disturbance is at least 6 months
5. The preoccupation is not better accounted for by GAD, OCD, panic disorder, a major depressive episode, separation anxiety or another somatoform disorder.

Question 3

Causes of hypochondriasis

Answer 3

Misinterpretion of bodily sensations

Thinking that athwy are weak and cannot exercise thereby exacerbating their anxiety about illness and symptoms

Question 4

Treatment of hypochondriasis

Answer 4

CBT

General stress management treatment

Question 5

Somatization

Answer 5

Earlier refered to as briquets syndrome
Recurrent multiple physical complaints that have no biological basis but still cause the person to have impairment and seek treatment

Question 6

Criteria for somatization disorder

Answer 6

A. A history of manjd physical complaints Beginning before age 30 years that occur over a period of several years and results in treatment being sought or significant impairment in social, occupational or other important areas of functioning.
B. Each of the following criteria must be met with individual symptoms occuring at any time during the course of the disturbance
1. Four pain symptoms: history of pain related to atleast four areas (e.g head, abdomen,
2. Two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g nausea, bloating,
3. One sexual symptom:
4. One psuedoneurological symptom e.g impaired coordination or balance, paralysis or localised weakness
C. Either 1 or 2
1. After appropriate investigation each of the symptoms in criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance e.g drugs
2. When there is a related general medical condition the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination or laboratory findings
D. The symptoms are not intentionally produced

Question 7

Treatment of somatization disorder

Answer 7

Difficulty to treat
Reassuramce, stress reduction more adoptive methods of interacting with family are encouraged
Medical management along with cognitive behavioral treatment
Consistent physician to validate symptoms

Question 8

Conversion disorder

Answer 8

Sensory or motor symptoms without any physiological cause
Malfunctioning persons show la belle indifference ( the beautiful indifference)
Retain most normal functions but without awareness of the disability

Question 9

Criteria for diagnosis of conversion disorder

Answer 9

A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition
B. Psychological factors are judged to be associated with the symptoms or deficits because the initiation of the deficit is preceded by conflict or other stressors
C. The symptoms or deficits is not intentionally produced or feigned
D. The symptoms or deficits cannot after appropriate investigation be fully explained by general medical condition or by the direct effects of a substance or as a culturally sanctioned behavior or experience
E. The symptoms or deficits cause clinically significant distress or impairment in social occupational or other inpry areas of fun toons or warrants medical evaluation
F. The symptoms or deficits is not better accounted for by another mental disorder.

Question 10

Treatment for conversion disorder

Answer 10

Attend to the trauma
Emphasis on role of trauma that caused the conversion
Remove sources secondary gains
Deal with primary and secondary gains

Question 11

Body dymorphic disorder

Answer 11

Previously known as dysmorphobia
Preoccupation with imagined deffect in appearance
Either fixation or avoidance of mirrors
Suicidal ideation and behaviour are common

Question 12

Criteria for BDD

Answer 12

A. Preoccupation with an imagined defect in appearance. If slight physical anomaly is present the persons concern is markedly excessive
B. The preoccupation causes clinically significant distress or impairment in social occupational or other important areas of functioning
C. The preoccupation is not better accounted for by another mental disorder e.g anorexia nervosa

Question 13

Treatment for BDD

Answer 13

Treatment parallels that for OCD
Medication e.g SSRI’s
Exposure and response prevention therapy

Question 14

Malingering

Answer 14

Malingering is diagnosed if the person is intentionally producing or grossly exaggerating physical symptoms and I’d motivated by external incentives usually material goals like avoiding work or responsibilities, obtaining financial compensation.
Often evasive and defensive and suspicious when asked about them.

Question 15

Factitious disorder

Answer 15

Person intentionally produces psychological or physical symptoms for purpose of emotional care and attention.

Question 16

Facticious disorder by proxy

Answer 16

A mother presents her own child for treatment of a medical condition she has deliberately caused disclaiming any knowledge of it’s origin

Question 17

Criteria for facticious disorder

Answer 17

A. Intentional production or feigning of physical or psychological sihngs or symptoms
B. The motivation for the behavyis to assume the sick role
C. External incentives for the behavior such as economic gain are absent

Question 18

Criteria for facticious diosory by proxy

Answer 18

A. Intentional production or feining of physical or patchy sings or symptoms in another person who is under the individual’s care
B. Motivation for the perpetrator is to assume the sick role by proxy
C. External incentives for the behaviour are absent

Question 19

Treatment for facticious disorder

Answer 19

Counseling and psychotherapy

CBT

Question 20

Dissociative disorders

Answer 20

Characteristic’s
Individuals feel detached from themselves or their surroundings and reality experience and identity may disintegrate
Associated with histories of trauma like sexual/ physical abuse in childhood
Abuse from care giver

Impaired caregiving
E.g insensitive / avoidant
Inconsistent / rejecting
Punitive

Sexual abuse creates confusing and competing feeling that may be aroused at the same time producing contradictory feelings
E.g pleasure / pain
Dependency / fear
Love / rage 
Shame / intimacy

Question 21

Types of dissociative disorders

Answer 21

Depersonalization disorder
Dissociative amnesia
Dissociative fague
Dissociative trance disorder
Dissociative identity disorder

Question 22

Depersonalization disorder

Answer 22

Severe feelings of depersonalization dominate the individual’s life and prevent normal functioning
Sense of one’s own self and own reality is temporarily lost
Feeling detached from their own bodies and mental processes
Floating above their physical bodies
Life is a dream
Related experience of derealization in which the external world is perceived as strange and new in various ways.
Others are perceived as automatons, behaving mechanically, lack initiative or self control.

Question 23

Criteria for diagnosis of depersonalization disorder

Answer 23

A. Persistent or recurrent experience of feeling detached from and as if one is an outside observer of one’s mental processes or body
B. During the depersonalization experience reality testing remains intact
C. The depersonalization causes clinii significant distress or impairment in social occupational or other important areas of functioning
D. The depersonalization experience does not occur exclusively during the course of another mental disorder such as schizophrenia panic disorder, acute stress disorder or another dissociative disorder

Question 24

Dissociative amnesia

Answer 24

Retrograde / anterograde amnesia
Limited to failure to recall previously stored personal information (retrograde amnesia) when that failure cannot be accounted for by ordinary forgetting.
Inability to recall personal information usually of a stressful or traumatic nature
- localised amnesia (a person remember ls nothing that happened during a specific period vary from few hours or days following some highly traumatic event.
Selective amnesia, a person forgets some but not all of what happened during a given period
Affects episodic and autobiographocal memory
Semantic and procedural memory remain intact

Question 25

Dissociative fugue

Answer 25

Fugue meaning flight
Retreat from one real life by going into amnestic state
Person departs from home
Sudden unexpected travel away from home along with inability to recall ones past
Individual is unaware of memory loss but fugue experience is intact and lifestyle usually different from original lifestyle
Can last for days, weeks, months even years. Such people can emerged from the fugue state and find themselves in a strange place working in a new occupation with no idea how they got there.
Individuals are usually faced with extremely unpleasant situations from which they see no acceptable way to escape

Question 26

Criteria for dissociative amnesia

Answer 26

A. Predominant disturbance in one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature that is too extensive to be explained by ordinary forgetfulness.

Question 27

Criteria for dissociative fugue

Answer 27

A. The predominant disturbance in sudden, unexpected travel away from home or ones customary place of work, with inability to recall ones past.
B. Confusion about personal identity or assumption of a new identity

Question 28

Dissociative trance disorder

Answer 28

Altered state of consciousness in which the person believes firmly that they are possessed by Spirits. Considered a disorder only where there is distress and dysfunction
Sudden changes in personality attributed to possession by Spirit and is important in that particular culture
Often this spirit demands and receives gifts or favors from family and friends of victims

Question 29

Dissociative identity disorder

Answer 29

Formerly known as multiple personality disorder
Dramatic dissociative disorders l in which patient manifests two or more distinct identities that alternate in some way in taking control of behavior
Each identity may appear to have a different persona
- many personalities or fragments of personalities coexist within one body
Host identity with real name.
Altered identies may diffwe in striking ways involving age, gender, handedness, handwriting sexual orientation, language spoken and genery knowledge.
Presents shifts in identity, severe self destructive behaviors