EXAM 2 - Somatic Symptom and RelatedDisorders and Dissociative Disorders Flashcards
(33 cards)
Somatic symptom disorders
excessive or maladaptive response to physical symptoms or health concerns
DSM-5 Criteria: Somatic Symptom Disorder
A. One or more somatic symptoms that are distressing and/or result in significant disruption of daily life.
B. Excessive thoughts, feelings, and behaviors 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. High level of health-related anxiety.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Specify if: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic complaints predominantly involve pain.
Specify current severity: Mild: Only one of the symptoms in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
Somatic Symptom Disorder - Statistics
Statistics Relatively rare condition Onset usually in adolescence More likely to affect unmarried, low SES women Runs a chronic course
Ilness Anxiety Disorder very similar to DSM 4 Hypochondriasis
Severe anxiety about the possibility of having or acquiring a serious disease
Actual symptoms are either very mild or absent
Strong disease conviction
Medical reassurance does not seem to help
DSM-5 Criteria: Illness Anxiety Disorder
A. Preoccupation with fears of 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 (e.g., strong family history is present), 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 behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctors’ 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, such as somatic symptom disorder, generalized anxiety disorder, or obsessive-compulsive disorder.
Specify whether: Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used. Care-avoidant type: Medical care is rarely used. From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
Statistics on Illness Anxiety Disorder
Affects approximately 1-7% of the general population
Affects all ages approximately equally
Often comorbid with anxiety and mood disorders
Causes of Somatic Symptom Disorders
Consistent overreaction to physical signs and sensations
Cause is unlikely to be found in isolated biological or psychological factors
Genetic component is likely present (they run in families)
May have learned from family to focus anxiety on physical sensations
Psychological Causes for Somatic Symptoms Disorders
Individuals with these diagnoses amplify somatic symptoms
They have a defect in expressing emotions signaled physiologically
They engage in misattributions of normal somatic symptoms
They are reinforced for physical symptoms
Causes of Somatic Symptom Disorders
Three additional factors that may contribute to etiology
Stressful life events
Illness in family during childhood
Benefits of illness (e.g., sympathy, attention)
Somatic Symptom Disorder and Antisocial Personality Disorder
Findings from family and genetic studies: Link between severe forms of somatic symptom disorder and antisocial personality disorder
Shared features
Often begin early in life
Chronic and difficult to treat
More common in lower SES
Linked to substance abuse and interpersonal problems
ASPD much more common in males
SSD more common in females
Shared feature: disinhibition/impulsivity
Individuals with somatic symptom disorder impulsively seek sympathy and other benefits of illness
Different manifestations of impulsivity
Somatic symptom disorder: Dependence
Antisocial personality disorder: aggression
Treatment for Somatic Symptom Disorders
Mild cases of illness anxiety disorder may benefit from detailed education and some reassurance from medical professionals
Consider the use of exposure and response prevention (reduce avoidance due to pain or other uncomfortable physical sensations)
Cognitive behavioral therapy can effectively treat illness anxiety disorder (e.g., functional pain programs)
Conversion Disorder
Altered motor or sensory function that is inconsistent with neural/medical conditions and not better explained by another disorder
Often suggestive of neurological problem, but no such problem is detected
Must cause significant distress/impairment
DSM-5 Criteria Summary: Conversion Disorder
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized 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 in social, occupational, or other important areas of functioning or warrants medical evaluation.
Conversion Disorder
Rare condition, with a chronic intermittent course
Often comorbid with anxiety and mood disorders
Seen primarily in females
Onset usually in adolescence
Common in some cultural and/or religious groups
Conversion Disorder: Causes
Primary/secondary gains
Freud thought primary gain was the escape from dealing with a conflict
Secondary gains: Attention, sympathy, etc.
Sociocultural factors
More common in lower education, lower SES
Patients likely to adopt symptoms with which they are already familiar
Conversion Disorder: Treatment
If onset after a trauma, may need to process trauma or treat posttraumatic symptoms
Remove sources of secondary gain
Reduce supportive consequences of talk about physical symptoms
Factitious Disorders
Purposely faking physical symptoms
May actually induce physical symptoms or just pretend to have them
No obvious external gains
Only external gain may be benefit of “sick role” (e.g., sympathy)
Distinguished from malingering, in which physical symptoms are faked for the purpose of achieving a concrete objective (e.g., getting paid time off, avoiding military service)
DSM-5 Criteria Summary: Factitious Disorder
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better accounted for by another mental disorder such as delusional belief system or acute psychosis.
Specify if: Single episode
Recurrent episodes:Two or more events of falsification of illness and/or induction of injury.
Factitious Disorder Imposed on Another
More commonly known as Munchausen syndrome by proxy
Inducing symptoms in another person
Typically a caregiver induces symptoms in a dependent (e.g. child)
Purpose = receive attention or sympathy
Depersonalization/Derealization Disorder
Recurrent episodes in which a person has sensations of unreality of one’s own body or surroundings
Feelings dominate and interfere with life functioning
Only diagnosed if primary problem involves depersonalization and derealization
Similar symptoms may occur in the context of other disorders, including panic disorder and PTSD
Other features
Cognitive deficits in attention, short-term memory, spatial reasoning
Easily distractible
Difficulty absorbing new information
Reduced emotional responding
May have dysregulation of the HPA axis in brain
Diagnostic Criteria for Depersonalization- Derealization Disorder
A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: Depersonalization: Experiences of unreality, detach-ment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing). Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
B. During the depersonalization or derealization experience, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medica-tion) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder, such as schizophrenia or panic disorder.
Dissociative Amnesia
Includes several forms of psychogenic memory loss
Generalized vs. localized or selective type
May involve dissociative fugue
During the amnestic episode, person travels or wanders, sometimes assuming a new identity in a different place
Unable to remember how or why one has ended up in a new place
DSM-5 Criteria: Dissociative Amnesia
A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, or other neurological condition).
D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.
Specify if: With dissociative fugue: Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.
Dissociative Amnesia and Fugue - Statistics
Prevalence: 2-7% Usually begin in adulthood Rarely appear in childhood or late adulthood Show rapid onset and dissipation Causes Little is known Trauma and stress can serve as triggers Most recover/remember without treatment
