Dissociative and Somatic Symptoms Flashcards Preview

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Flashcards in Dissociative and Somatic Symptoms Deck (64):
1

Sigmund Freud explanation of dissociation

Due to sexual trauma and impulses

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What is Dissociation

Lack of normal integration of thoughts, identity, memory and consciousness

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Defining symptom of Dissociative Disorders

Dissociation

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What are dissociative experiences linked to?

Trauma and Distress

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Types of Dissociative Disorders

Dissociative Amnesia (Dissociative fugue)
Depersonalization/ Derealization
Dissociative Identity Disorder

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Dissociative Amnesia

Can't recall significant personal info
There is no biological cause for memory issue

Sudden onset, related to trauma

5 patterns of memory loss

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5 patterns of memory loss

Localized Amnesia
Selective Amnesia
Continous Amnesia
Systematized Amnesia
Generalized Amnesia

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Localized Amnesia

Can't remember a specific time period (several hours to 1-2 days)

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Selective Amnesia

Only some parts of a trauma can be remembered.

A veteran of a war may recall some details, such as taking prisoners, but not others, such as seeing a good friend get hit.

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Continuous Amnesia

Can't remember from a specific date to present day.

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Systematized Amnesia

Certain categories of info are forgotten.

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Generalized Amnesia

Person forgets entire life.

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Dissociative Fugue

Forget identity and move away, assume new identity and start life over.

Sudden and unexpected travel away from home or work

Inability to recall past.

Must be differentiated from malingering

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Repressed Memories

Controversial
Certain life events are repressed to help coping

False memory syndrome

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False Memory Syndrome

People are made to remember events that never occurred, by therapists

Many people falsely accuse and imprison based on uncovered 'repressed' memories

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Depersonalization/ Derealization

Depersonalization: sense of unreality/detachment from self

Derealization: disconnect with surroundings

Chronic
No memory or identity impairment

May be due to brain abnormalities in perceptual pathways

17

Dissociative Identity Disorder (DID)

Multiple Personality Disorder

2 or more personalities take over person's behaviours.

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What triggers Switching between alters usually

Stressful event or cue.

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How many alters must be present for diagnosis of DID

At least 2

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Can alters be aware of each other?

Yes they can be but not necessarily

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How many alters does an average DID patient have

Host+ average of 13-16 'alters'

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Ethology of Dissociative Disorders

Trauma Model
Socio-Cognitive Model
Pseudogenic Theory

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Trauma Model

Diathesis-Stress Model

Result as a response to trauma and personality traits that predispose them to use dissociation as a defence mechanism

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Evidence to support trauma model

Patients report higher rate of sexual abuse

Higher rate of dissociation among traumatized individuals

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Socio-Cogniotive Model

Multiple personality is roleplaying due to selective reinforcement of symptoms

Leading questions and demand characteristics.

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Evidence for Socio-Cognitive Model

DID is usually diagnosed in adulthood, not childhood, when it supposedly starts

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Pseudogenic Theory

Occurs due to secondary gains

Financial gain
Legal benefits
Needy, attention-seeking behaviour

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Treatment

Try to cope with stress and trauma better

Psychotherapy
Hypnosis
Medication

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Psychotherapy

3 stages

Step 1: Build rapport
Step 2: Coping skills
Step 3: Reintegration of personalities

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Hypnosis

Popular but criticized

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Medication

Only helpful for comorbid disorders

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Somatic Symptom Disorders

Physical symptoms, usually no physical cause
Physical cause may be present but psychological stress must be more

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Conversion Disorder

Loss of functioning, despite no medical abnormality

Through medical examination needed prior to diagnosis to rule out a medical causes (Abnormal medical readings, inconsistencies and unusual symptom patterns. )

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Characteristics of Somatic Symptom Disorders (Long)

Usually no physical cause

Preoccupation with minor symptoms (physical) and normal bodily functioning

No control over symptoms
Many forms (sensory impairment, muscular issues)

5-20% of patients

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Prevalence of Conversion Disorder

0.4%

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Characteristics of Somatic Symptom Disorders (Short)

Cause
Preoccupation
Control
Forms

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Diagnosis of Somatic Symptom Disorder

One or more somatic symptom +

Distress
Impairment
Presence/absence of medical condition

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Etiology of SSD

High sensitivity to bodily sensations, blamed on disease
Not reassured by negative medical results

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Pain Subtype

Main Symptom is pain
May/may not have physical cause but worry is excessive

Mindfulness and CBT help

Can be come dependent of painkillers

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Illness Anxiety Disorder

Worry of disease despite negative results
Must last at least 6 months

No physical symptoms
Can be triggered by health information

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Factitious Disorder

Faking or generating to get medical attention

Can use dangerous methods to generate symptoms

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Common motivations of factitious disorder

Sympathy, care and attention.

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Diagnosis of Factitious Disorder

No evidence of a secondary/external reward for faking.

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Etiology of SSD, IAD and FD

Biopsychosocial Model
Biological and physiological factors
Psychological Factors
Social Factors

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Biopsychosocial Model

Interaction of different factors

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Biological and physiological factors

Chronic stress and HPA axis

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Psychological Factors

cognitive factors, emotions and personality

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Social Factors

early adversities and abuse

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Treatment

CBT (Most common)
Cognitive techniques
Emotional techniques
Behavioural techniques

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Cognitive Techniques

Cognitive restructuring

Changing automatic thoughts and preoccupations

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Emotional techniques

Coping strategies
Emotion regulation

Relaxation techniques
Identifying, understanding and regulating emotions/stress

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Behavioural Techniques

Behavioural activation
Reducing sick role behaviours

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Body Dysmorphic Disorder

Now a obsessive-compulsive disorder

Preoccupation with exaggerated defect in appearance
Repetitive checking behaviours

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Preoccupation with Defect

Intrusive, time consuming and hard to control
Specific or vague

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Repetitive checking behaviours

Time consuming

Common Behaviours
Mirrors
Comparisons with others
Camouflaging
Seeking reassurance

56

% of BDD patients that attempt suicide

25%

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When does BDD begin

Adulthood, teenage years
Tends to be chronic

58

BDD vs OCD

Similarity: obsessions and compulsive behaviour
Difference: obsessions focus on appearance and have greater severity in BDD

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BDD vs. Eating Disorders

Similarities: Obsessions and concern over appearance
Differences: BDD obsessions focus on more than just weight and fat.

60

BDD vs. psychotic Disorders

Similarities: Delusional Beliefs
Differences: no other positive or negative symptoms.

61

Prevalence of BDD

2-2.5%
Women have more comorbid eating disorder rates
Men have more genital and muscle preoccupation

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CBT for BDD

Thought restructuring
Exposure exercises
Ritual prevention
Perceptual retraining

63

Ritual prevention

Preventing compulsive behaviours

64

Perceptual retraining

focus on the 'whole', not a specific part