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PSC 168 > Chapter 7: Somatoform & Dissociation Disorders > Flashcards

Chapter 7: Somatoform & Dissociation Disorders Flashcards

1
Q

What defines a somatoform disorder?

A
  • Physical symptoms are the focus of client’s attention
  • Physical symptoms have little to no medical basis
  • Symptoms are judge to be associated with psychological conflict or stress
  • Symptoms aren’t intentionally produced or feigned
  • Symptoms cause significant distress or impairment
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2
Q

What are the different kinds of somatoform disorders as distinguished by the DSM-V?

A
  • Conversion disorder
  • Somatic symptom disorder
  • Illness anxiety disorder
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3
Q

What is a hysterical somatoform disorder?

A

Somatoform disorder in which people suffer actual changes in their physical functioning

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4
Q

What is the DSM-V criteria for conversion disorder?

A
  • Dramatic loss of function resembling a serious neurological disorder
  • No medical cause for loss of function
  • Symptoms emerge in context of conflicts or stressful life experiences
  • Symptoms not intentionally produced or feigned
  • Symptoms cause clinically significant distress or impairment
  • May be associated with “la belle indifference” (indifference to symptoms)
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5
Q

What are examples of conversion symptoms?

A
  • Impaired coordination or balance
  • Paralysis or weakness
  • Inability to swallow
  • Loss of touch or pain sensation
  • Blindness
  • Mutism
  • Deafness
  • Psychogenic seizures or convulsions
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6
Q

Onset and course of conversion disorder?

A
  • Symptoms appear suddenly and dramatically

- Symptoms may disappear suddenly or switch to a new symptom

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7
Q

What is the recovery rate of conversion disorder?

A

90% recovery within one month

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8
Q

What is the gender ratio of conversion disorder?

A

-2:1 (female: male)

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9
Q

What is the psychodynamic explanation for conversion disorder?

A
  • Trauma/conflict in childhood that is repressed, dissociated
  • Reactivated by current severe stressor
  • Repressed memory is converted into physical symptom
  • Often metaphorical connection between conflict and symptom
  • Often odd indifference for serious symptoms
  • Disconnect; incongruent affect
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10
Q

What are the treatment methods of conversion disorder?

A
  • Insight therapy to make conflicts conscious
  • Teach coping skills to deal with stressful life situations
  • Treat comorbid anxiety and depression with antidepressants
  • Placebo meds
  • Hypnosis or healing ritual
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11
Q

What is the DSM-V criteria for somatic symptom disorder?

A
  • Pattern of abnormal behaviors, thoughts, feelings related to physical symptoms
  • Individual may or may not have a diagnosed medical condition
  • Symptoms cause significant distress or dysfunction
  • Excessive focus on physical symptoms with reluctance to talk about psychological issues
  • Symptoms prompt frequent medical visits
  • Conditions mostly seen in medical settings
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12
Q

Onset and course of somatic symptom disorder?

A
  • May have childhood onset
  • Pain conditions may develop after injury
  • Chronic course with fluctuations
  • Psychological investment into physical symptoms
  • Difficult to treat –> poor prognosis if poor insight
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13
Q

What is the etiology of somatic symptom disorder?

A
  • Constitutional differences in pain tolerance
  • History of injuries and inadequate pain management
  • History of childhood abuse with weakening of immune system and pain tolerance
  • Pervasive feelings of helplessness, victimization, guilt
  • Intense emotional conflicts are repressed and expressed physically
  • Negative, self-defeating thinking style
  • Ineffective problem-solving ability and withdrawal from conflicts
  • Long-term stressors
  • History of illness in family members (role models)
  • Reinforcement of illness behavior by others
  • Cultural standards that stigmatize mental disorders
  • Lack of medical knowledge and psychological sophistication
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14
Q

What are the treatment methods of somatic symptom disorder?

A
  • Cognitive-behavior therapy
  • Empathize with psychological distress
  • Ignore illness-related behavior –> reinforce other interests
  • Explore benefits from symptoms (secondary gains)
  • Teach self-hypnosis and distraction techniques
  • Yoga, dance, massages, moderate exercise
  • Body therapies to positively reconnect with body
  • Treat any comorbid conditions and deficits (depression, poor social skills, etc.)
  • Antidepressants (help with pain, sleep, anxiety)
  • Placebos
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15
Q

What is the DSM-V criteria for illness anxiety disorder?

A
  • Preoccupation with the belief that one is seriously ill
  • Fear of illness persists despite medical reassurances to the contrary
  • Tendency to interpret physical sensations or minor aches as signs of serious illness
  • No actual medical condition
  • Symptoms cause significant distress or dysfunction
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16
Q

Onset and course of illness anxiety disorder?

A

May start at any time but usually early adulthood

17
Q

What is the gender ratio of illness anxiety disorder?

A

1:1

18
Q

What is the etiology of illness anxiety disorder?

A
  • Family history of anxiety disorders or actual illness

- Overlap with GAD and OCD

19
Q

What are some treatments of illness anxiety disorder?

A
  • SSRI meds for obsessions and compulsive reassurance seeking
  • Cognitive therapy
  • Prognosis is poor if insight remains poor
20
Q

What is factitious disorder? (Munchausen disorder)

A
  • Symptoms of physical or mental illness are deliberately simulated or induced without an apparent incentive
  • Presumably done for psychological gain (attention)
21
Q

What is factitious disorder by proxy?

A
  • Physical symptoms are induced in a child, typically by a parent
  • Psychological gain is the recognition for the sacrifice the parent is making
  • Often history of similar childhood abuse in abusing parent
22
Q

Define malingering.

A

Faking a disorder to achieve some external reward (disability status, insurance settlement, insanity plea)

23
Q

How does culture play a role in dissociation?

A
  • Cultures differ in their tolerance for dissociation and altered states of consciousness
  • In some cultural contexts, dissociation is induced for spiritual or healing purposes
24
Q

What defines a dissociative disorder?

A
  • Disruptions or gaps in the normal integration of subjective experiences resulting in discontinuities in affect, memory, and behavior
  • Causes clinically significant distress or impairment
  • All assumed to be trauma-based disorders
25
Q

What are the different dissociative disorders?

A
  • Depersonalization/Derealization disorder
  • Dissociative amnesia
  • Dissociative identity disorder
26
Q

What is the criteria for depersonalization/derealization disorder?

A
  • Depersonalization (episodes of feeling detached from one’s self or body) OR derealization (feelings of having a sense of unreality about one’s surroundings)
  • Episodes are persistent or recurrent and cause significant distress or dysfunction
  • Person may feel as if he were living in a dream or acting like a robot
  • Person tends to engage in self-ruminations, thinking in circles
  • Feelings exhausted and anxious
  • Person is NOT psychotic and “looks normal”
  • Often a history of trauma or neglect
27
Q

Depersonalization states can be found with what other disorders?

A
  • PTSD
  • Panic disorders
  • Depression
  • Schizophrenia
  • Borderline personality disorder
  • Medical conditions (seizures, head injury, dementia)
  • Drug-induced states (especially with hallucinogens)
28
Q

What does the diagnosis of depersonalization disorder depend on?

A

Can only be made if symptoms occur in absence of another diagnosis

29
Q

What is the criteria for dissociative amnesia?

A
  • Inability to recall info about oneself, usually of traumatic or stressful nature
  • Amnesia is of psychological origin, not caused by brain injury
  • Memory presumably is “split off” b/c it’s emotionally painful, traumatic
  • Memories are repressed
  • Symptoms are causing significant distress or impairment in life functioning
30
Q

What is the specifier of dissociative amnesia?

A

With dissociative fugue

31
Q

What is dissociative fugue? Cause? Onset? Recovery?

A
  • Sudden, unexpected travel or wandering away from home
  • Associated with amnesia for identity or important autobiographical info
  • Often following a natural disaster or in wartime
  • Onset and recovery are sudden
32
Q

What is the criteria for dissociative identity disorder?

A
  • Existence of 2 or more distinct personalities, each with its own memories, attitudes, perceptions
  • Person switches back and forth between personalities
  • There’s at least partial amnesia of these personalities for each other
  • Experience of possession can be an alternate personality
33
Q

What is the psychodynamic dissociation-trauma model for dissociative identity disorder?

A
  • Severe trauma in early childhood (physical, sexual, witnessing)
  • Child escapes psychologically through imagining a new identity and self-hypnosis
  • Dissociative experience leads to distinct memories, unique feelings, and the beginnings of a new identity
  • Dissociated identities first formed in childhood reappear as alter personalities within the same person
  • Disorder triggered by stressors occurring in adulthood
34
Q

What is the iatrogenic perspective on dissociative identity disorder?

A
  • Disorder created by the therapist
  • Distressed, suggestible individuals with poor sense of self can be made to believe they have multiple personalities
  • Facilitated by hypnosis and other suggestive techniques to recover memories
  • Multiple personality hype in the 1980s-90s
35
Q

What is the diatheses etiology of dissociative disorders?

A
  • Ability to psychologically remove oneself from traumatic situation
  • High levels of imaginative involvement and fantasy proneness
  • High hypnotizability
  • History of childhood trauma
36
Q

What is the stressor etiology of dissociative disorders?

A
  • Sudden unexpected trauma at present time

- Strong emotional conflict

37
Q

What is the main treatment of dissociative disorders?

A

Psychological

38
Q

What are the treatment methods of dissociative disorders?

A
  • Antidepressants are helpful
  • Create safe space and trusting rapport
  • Teach stress management skills
  • Facilitate talk about trauma/childhood while staying present
  • Facilitate integration of split-off memories or sub-personalities
  • Psychodynamic framework

PSC 168 (18 decks)

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