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Psychiatric Disorders > Chapter 6 > Flashcards

Chapter 6 Flashcards

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1
Q

What are the Preoccupation and Obsession Disorders?

A

->Somatic Symptom and Related Disorders

->Previously called Somatoform Disorders (DSM-IV-TR)

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2
Q

What’s the difference Between DSM-IV-TR & DSM-5 TR definition of somatic symptom disorder?

A

->DSM-IV-TR: Emphasized that bodily symptoms are medically unexplained

->DSM-5 TR: Focuses on distress related to bodily concerns

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3
Q

What is Somatic Symptom Disorder (SSD)?

A

->Pierre Briquet (1859) – Briquet’s syndrome: Patients always feel sick or experience symptoms

->Definition: Preoccupation with health or the body (“soma” = body)

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4
Q

What are the key clinical features of SSD?

A

->Constantly feeling weak & ill

->Life revolves around symptoms

->Ex. Severe pain worsened by psychological factors → Leads to anxiety & distress

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5
Q

How is SSD diagnosed?

A

-> At least one symptom is present with intense rxn to symptoms

->Specifiers for severity & dominant symptom type

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6
Q

How does Somatic Symptom Disorder differ from Illness Anxiety Disorder?

A

Somatic Symptom Disorder:
->Physical symptoms due to stress & anxiety
->Symptoms affect daily life

Illness Anxiety Disorder:
->Minimal or no physical symptoms
->Fear of developing a serious illness (e.g., mild rash = skin cancer)

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7
Q

What is Illness Anxiety Disorder (IAD)?

A

->Persistent fear of serious illness despite few/no symptoms

->Categorical vs Dimensional approach → IAD is dimensional

->Physical symptoms are mild or absent

->Concern is about the idea of being sick

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8
Q

How do patients with IAD respond to medical reassurance?

A

->Doctor’s reassurance is not helpful → Patients go from doctor to doctor

->“Disease Conviction”: Firm belief that they have an illness despite medical evidence

->Focus on long-term process of illness and disease EX. cancer, autoimmune disease

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9
Q

What are the two types of Illness Anxiety Disorder?

A
  1. Care-seeking type: Frequently visits doctors/tests (more common)
  2. Care-avoidant type: Avoids doctors due to overwhelming anxiety
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10
Q

What are the key statistics for SSD & IAD? (prevelance, comorbidtiy, onset)

A

-> Lifetime prevalence: 1-5%

->Severe Illness Anxiety: Late onset (increases with age)

->SSD Onset: Adolescence
—>More common in unmarried women, low SES, low education
—>Culture-specific symptoms (e.g., burning sensations in hands & feet in Pakistan-India)

->Comorbidities: Anxiety & Mood Disorders

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11
Q

What are the causes of Somatic Symptom and Illness Anxiety Disorder?

A

->Cognitive factors are central (sometimes called Disorders of Cognition)

->”Catastrophic” misinterpretations of bodily sensations

->Strong beliefs that unexplained bodily changes = serious illness

->Dysfunctional mind-set leads to worry about health

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12
Q

What is the Cognitive Model of Health Anxiety?

A

->A model that explains how health anxiety develops

->Involves four contributing factors

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13
Q

What are the four contributing factors to health anxiety?

A
  1. Critical precipitating incident
  2. Previous experience of illness (e.g., “Mom had heart palpitations → cancer; I have it → cancer”)
  3. Inflexible or negative cognitive assumptions
  4. Severity of anxiety (depends on factors that increase or decrease health anxiety)
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14
Q

What factors influence the severity of health anxiety?

A

Increase health anxiety:
->Perceived likelihood of illness
->Perceived costs & burden of illness

Reduce health anxiety:
->Perceived ability to cope
->Presence of “rescue” factors (e.g., availability of medical help)

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15
Q

What is Enhanced Somatic Sensitivity? Possible reasons?

A

->Interpreting ambiguous stimuli as threatening

->Possible reasons:
—>Genetic causes (modest, nonspecific tendency to overreact to stress)
—>Stressful life events

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16
Q

How do people with illness anxiety disorder focus on physical symptoms?

A

->Disproportionate incidence of disease in the family

->Social & interpersonal factors:
—>Some may unconsciously seek attention through illness

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17
Q

What is the illness anxiety disorder cycle?

A
  1. Faulty interpretation of physical symptoms
  2. Additional physical symptoms appear
  3. Increased anxiety
  4. Intensified focus on symptoms
  5. Cycle repeats
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18
Q

Why is Somatic Symptom and Illness Anxiety Disorder difficult to treat?

A

->Patients firmly believe they are ill despite reassurance

->Medical tests don’t relieve their concerns

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19
Q

What are common treatments for SSD & IAD disorders?

A
  1. Explanatory Therapy

-> Education & reassurance (explain the disorder, show test results)

  1. Cognitive-Behavioral Therapy (CBT)

->Reduce stress
-> Minimize help-seeking behaviors
-> Broaden social relationships beyond symptoms

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20
Q

How does Exposure-Based Therapy work?

A

->Expose patients to their fears without allowing safety behaviors

Ex. Show them a documentary on skin cancer → Don’t let them check their body for signs

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21
Q

What are Psychological Factors Affecting Medical Condition?

A

-> A diagnosed medical condition (e.g., asthma, diabetes, severe pain)

->Negatively affected by psychological/behavioral factors (e.g., anxiety, denial)

Ex. A person denies high blood pressure and refuses medication, worsening their condition

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22
Q

What is Functional Neurological Symptom Disorder (Conversion Disorder)?

A

->Previously called Hysteria (originally used to describe what are now known as conversion disorders)

->Origin of term: Believed to be caused by a wandering uterus (presumed to symbolize the longing to produce a kid)

->Freud’s theory: Repressed conflict converts into physical symptoms

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23
Q

How did Freud explain Conversion Disorder?

A

->Energy from repressed instincts is diverted into sensory-motor channels

->Physical dysfunction occurs without an organic cause

->Symptoms are a way for the unconscious mind to express conflict

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24
Q

What are common symptoms of Conversion Disorder? Examples?

A

->People appear neurologically impaired, but tests show no organic cause

Examples:

  1. Globus hystericus – Lump in throat, difficulty swallowing
  2. Astasia-abasia – Inability to stand/walk despite normal motor function
  3. Psychogenic seizures – Resemble epilepsy but EEG is normal
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25
What are the two main symptom categories of Conversion Disorder?
1. Motor Symptoms/Deficits (most common): ->Impaired coordination/balance ->Paralysis ->Abnormal limb posturing ->Muscle weakness (most frequent) 2. Anesthesia (Loss of Sensation) (less common): ->Sudden blindness or tunnel vision ->Aphonia (loss of voice, can only whisper) ->Anosmia (loss of smell) ->Psychogenic seizures (appear suddenly in stressful situations)
26
How do Conversion Disorder symptoms progress?
->Acute episode: Symptoms last less than 6 months, often disappear with stress relief ->Persistent: Symptoms last more than 6 month
27
What are two closely related disorders?
1. Malingering (faking symptoms for external gain) -> La belle indifférence: Emotional indifference to symptoms (e.g., someone paralyzed but unconcerned) 2. Factitious Disorder (faking illness for attention, not external reward) ->two types: 1. Factitious disorder imposed on self (fake own illness) 2. Factitious disorder imposed on another (e.g., often a mom making a child sick → previously called “Munchausen by Proxy”)
28
What are the key psychological processes in Conversion Disorder?
->Unconscious mental processes ->Dissociation of experiences from awareness ->Some may fake symptoms (malingering or factitious disorder)
29
What are the statistics on Conversion Disorder?
->Rare in mental health settings ->More common in neurological settings (30% prevalence) ->Primarily affects women, usually develops in adolescence
30
What are the biological causes of Conversion Disorder?
-> Weak evidence for biological causes ->Brain scans show: --->Left side of body more affected --->Failure to activate right inferior frontal cortex --->Increased amygdala-motor connectivity (linked to stress processing)
31
How does behavioral theory explain Conversion Disorder?
-> Symptoms persist due to attention and benefits received -> Can be a way to justify poor performance or avoid stress ->Illness behaviors learned from parents (e.g., exposure to parental illness)
32
What were Freud’s four stages of Conversion Disorder?
1. Trauma/conflict → Anxiety 2. Repression of conflict (unconscious) 3. Conversion to physical symptoms → Anxiety reduced (primary gain) 4. Social attention/support received (secondary gain)
33
What social and cultural factors contribute to Conversion Disorder?
-> Substantial stress (e.g., abuse, divorce) ->More common in less educated, lower socioeconomic groups ->Limited medical knowledge influences symptom selection
34
What treatments are available for Conversion Disorder?
->Difficult to treat ->Identify and reduce stress ->Minimize help-seeking behaviors ->Cognitive-Behavioral Therapy (CBT) --->Shifts focus away from symptoms --->Cognitive restructuring (changing how they interpret symptoms) ->Symptom-focused CBT: --->Teaching coping strategies --->Emphasizing psychological/social factors
35
What is Obsessive-Compulsive Disorder (OCD)?
Chronic disorder characterized by: 1. Unwanted intrusive thoughts (obsessions) 2. Repetitive behaviors or mental acts (compulsions) to reduce distress ->Causes significant distress & interference with daily life ->Not always logically connected to its purpose
36
What mental health conditions commonly co-occur with OCD?
->Generalized anxiety ->Recurrent panic attacks ->Debilitating avoidance ->Major depression ->Suicidal ideation & attempts ->Severe obsessions predict suicide risk more than compulsions
37
What does it mean that obsessions in OCD are ego-dystonic?
->Thoughts feel "out of line" with one’s identity and values ->Causes distress and discomfort because they contradict personal beliefs
38
How severe is OCD in terms of impairment?
->One of the top ten most impairing conditions (World Health Organization) ->More severe obsessions → poorer quality of life
39
What are the three main subtypes of OCD (include obsession and compulsion of each)?
1. Symmetry/Exactness ("Just Right") ->Obsession: Needing things to be perfectly symmetrical or aligned ->Compulsion: Ordering, arranging, repeating rituals 2. Forbidden Thoughts/Actions (Aggressive/Sexual/Religious) ->Obsession: Fears of harming self/others, offending God ->Compulsion: Checking, avoidance, seeking reassurance 3. Cleaning/Contamination ->Obsession: Fear of germs/contamination ->Compulsion: Excessive washing, wearing gloves/masks
40
What is the comorbidity of OCD?
Highly comorbid with: ->Anxiety disorders ->Mood disorders ->Impulse-control disorders ->Substance use disorders ->Leads to high impairment and difficulty in treatment
41
How are Tic Disorder and OCD related?
->Involuntary movements can co-occur with OCD ->Tourette’s syndrome is commonly linked ->Tic-related OCD: Obsessions almost always about symmetry ->movements may not be tics but compulsions
42
What are the statistics on OCD? (prevalence, onset, common in)
->Lifetime prevalence: 1%–3% ->More common in boys during childhood, but equalizes in adolescence ->Onset: Early adolescence to mid-20s ->Rarely develops after early 30s ->Chronic once it develops
43
How does culture influence OCD?
->The content of obsessions and type of compulsions may vary Ex. Middle Eastern cultures → obsessions related to cleanliness & religion
44
What are examples of intrusive harming thoughts in OCD?
Impulses to: ->Jump out of a window ->Jump in front of a car ->Push someone in front of a train ->Drop a baby ->Wish someone would die
45
What brain structures are linked to OCD?
1. Frontal lobes → Increased activation (overconcern with thoughts) 2. Basal ganglia → Linked to motor behavior & tics (a set of subcortical structures caudate, putamen (smaller in people with OCD), globus pallidus, and amygdala) --->Smaller putamen in people with OCD --->PET scans show increased activation --->Connection to Tourette’s syndrome
46
What is Freud’s psychoanalytic explanation for OCD?
->Fixation at anal stage due to harsh toilet training Reaction formation: ->Resisting the urge to soil → compulsively neat and clean
47
What is Rachman & Shafran’s theory of obsessions?
->Inflated sense of personal responsibility for preventing harm Ex: Seeing a sharp object on the road and feeling responsible if someone crashes ->Thought-action fusion: 1. Thinking about something makes it more likely to happen 2. Thinking about something is as bad as doing it
48
What are the most effective treatments for OCD?
->SSRIs (help 40-60% but relapse is common) ->Exposure & Response Prevention (ERP) → Most effective --->Expose person to fear without allowing compulsion --->High dropout rate Cognitive Behavioral Therapy (CBT) ->Psychosurgery (Cingulotomy) → Last resort ->Deep Brain Stimulation → Reversible but invasive
49
What is Body Dysmorphic Disorder (BDD)?
->Preoccupation with an imagined defect in appearance --->“Imagined ugliness” despite looking normal ->Ritualistic/compulsory behaviors: --->Mirror checking, excessive grooming, skin picking --->Some avoid mirrors entirely ->Co-occurs with OCD ->High suicide risk
49
What areas of concern are common in BDD?
With muscle dysmorphia clarify: 1. Good/Fair insight ->(know your imagining it)= more likely to respond to treatment then poor ->(know what your feeling about self is it’s probably true) 2. Absent insight ->100% convinced that body dysmorphia is true
50
What are statistics for BDD? (prevalence, onset, common)
* Prevalence- Difficult to estimate- tends to be kept secret * Affects 1.7-2.4% people worldwide * Strong interest in art and design * Onset in early adolescence through the 20s * High degree of stress, reduced quality of life, and impairment common
51
What are the causes of BDD? (bilogical, cognitive, & psychoanalytic)
1. Biological: ->Reduced brain volume in: --->Right orbitofrontal cortex (self-image processing) --->Left anterior cingulate cortex (emotional regulation) 2. Cognitive factors: ->Catastrophic thinking about appearance ->Maladaptive coping (ex: mirror checking, avoiding social situations) 3. Psychoanalytic explanation: ->Displacement of anxiety onto physical appearance
52
What are effective treatments for BDD?
->SSRIs (Fluvoxamine - specific for OCD/BDD) ->CBT (focuses on stopping compulsive behaviors) ->Exposure & Response Prevention (ERP) Ex: Prevent mirror checking or encourage social interactions
53
Why is plastic surgery NOT an effective treatment for BDD?
->It is avoidance behavior, not a real solution ->Most patients seek repeated surgeries ->8%-25% of plastic surgery patients have BDD ->Plastic surgeons should screen for BDD before operating
54
When does hoarding typically start, and when do people seek treatment?
->Starts early in life and worsens over time ->Patients usually seek treatment after age 50
55
What are the three major characteristics of hoarding disorder?
1. Excessive acquisition of items 2. Difficulty discarding anything 3. Extreme clutter and disorganization
56
What is unique about animal hoarding?
-> It’s not about the number of animals but how they are treated Ex. A person keeps a dead pet’s body because they can’t part with it
57
What are the possible causes of hoarding disorder?
->Genetic factors may contribute ->Cognitive factors: --->Erroneous beliefs about the importance of possessions --->Emotional attachment to objects due to lack of emotional attachments with people
58
What are the treatments for hoarding disorder?
-> SSNRI (venlafaxine) ->Cognitive-Behavioral Therapy (CBT) → Focuses on faulty thoughts about attachment to objects
59
What is Trichotillomania (Hair-Pulling Disorder)?
->Compulsive pulling of hair, leading to hair loss ->Common areas: Scalp, eyebrows, eyelids ->Affects 1%–5% of college students, more common in females ->Intense shame → People try to hide it with hats, wigs, etc.
60
What is Excoriation (Skin-Picking Disorder)?
->Compulsive picking of the skin → Leads to scabs, scars, and open wounds ->Affects 1%–5% of the population ->Common areas: Face, hands, arms ->Tools used: Fingernails, tweezers, needles ->Must be chronic and cause skin lesions to qualify as a disorder
61
What are the two main causes of Trichotillomania and Excoriation? (trigger and behavior for each model)
1. Emotion Regulation Model Trigger: Negative emotions (stress) Behavior: Hair-pulling or skin-picking reduces stress (negative reinforcement) 2. Frustrated Action Model Trigger: Boredom or frustration Behavior: Hair-pulling or skin-picking relieves boredom
62
What is the most effective treatment for Trichotillomania and Excoriation?
->Habit Reversal Training (HRT) → Helps replace behavior with a competing response 1. Self-monitoring: Track frequency/intensity of behavior 2. Awareness training: Identify triggers 3. Competing response: Replace behavior with a different action Ex: Instead of picking skin, sit on hands or use a stress toy

Psychiatric Disorders (7 decks)

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