Session Sixteen (Dissociative and Functional Disorders) Flashcards
What is a Functional Disorder?
A functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts. The brain of a patient with functional neurological symptom disorder is structurally normal, but functions incorrectly.
Poorly understood, most patients require years of treatment before diagnosis
What is a Dissociative Disorder?
Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation as a defense mechanism, pathologically and involuntarily.
Possibly the conversion of affect or stress into physical symptoms
What are some other names given to F&D disorders?
Commonly called Catatonia or Resignation Syndrome
How are dissociative disorders classified in DSM-5?
- Have their own category which includes; Dissociative Identity Disorder, Dissociative Amnesia, Depersonalisation disorder etc…
- However tricky to classify as significant overlap with the Trauma/Stress Disorders as well as the Somatic disorders
- Shares some notable elements with PTSD, Somatisation disorder, Acute stress disorder etc…
- Some have suggested dissociation is less a symptom and more a common mechanism between a number of disorders (inc. PTSD, DD…)
Explain the terms primary and secondary gain in the context of F/D Disorders?
Primary gain = A decrease in anxiety from an unconscious operation which causes a physical symptom e.g. a person once used an arm to hurt someone, therefore that arm becomes functionally paralysed
Secondary gain = Gain achieved from the symptoms, which enables the patient to get support or avoid an activity, somehow to their benefit.
Malingering = Intentional production of false or exaggerated physical or psychological symptoms motivated by external incentives (secondary gain) e.g. avoiding military service or receiving medications
What is Dissociative Identity Disorder?
- AKA Multiple Personality Disorder
- Complex, chronic, post-traumatic, dissociative psychopathology
- Characterised by disturbances in identity and memory
- Controversial diagnosis, much disagreement as to how real it is.
- Requires ongoing coexistence of relatively consistent yet alternating separate identities AND recurrent episodes of memory disruption
- Basically needs to be Dr Jeckyl and Mr Hyde for diagnosis to apply, which is unlikely
- However cases that are confirmed almost certainly related to overwhelming childhood experiences
What is Dissociative Amnesia?
- Inability to access memories
- That isn’t explained by normal memory issues, dementia.
- Stress or trauma induced
- Specific focus on important personal information
- If paired with purposeful travel or bewildered wandering its called a “fugue state”.
What is Depersonalisation/Derealisation disorder?
- Condition marked by a state of unreality and detachment
- Patients describe using phrases such as “it’s as if…”
- Often triggered by adverse life events, severe anxiety, cannabis use
- Often state is secondary to an underlying psych diagnosis
- Can be a Primary disorder, although rarer
“I feel as if I’m living in a dream”, “I feel like I don’t exist anymore”, “it’s like I’m watching life behind glass”
What are MUS?
Physical symptoms disproportionate to pathology.
Medically unexplainable, could potentially be explained:
- Psychologically
- Sociologically
- Behaviourally
How can MUS be sub-divided?
1) The genuinely unexplainable
2) Functional, psycho-somatic, non-organic conditions
- Multi system (somatisation)
- Single system (CF, IBS, FND…)
3) Simulated
- Malingering
- Facticious
Overall, 50% of primary care appointments, however psychiatry only cares about number 2, which actually makes up a very small proportion of people.
What are the different forms of simulated/feigned illnesses?
Malingering = feigning illness for external motivation e.g. money. Not a psych diagnosis.
Munchausen’s syndrome = a factitious disorder, a mental disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick. Munchausen syndrome is considered a mental illness because it is associated with severe emotional difficulties
Factitious syndrome = Factitious disorder is a mental disorder in which a person acts as if he or she has a physical or mental illness when, in fact, he or she has consciously created the symptoms. These people are willing to undergo painful or risky tests to get sympathy and special attention
What is the difference between Munchausen and Factitious disorder?
In Munchausen the patient believes they have a disease, is deeply convinced they are ill when they aren’t.
FD is similar but the patient also takes the step of creating the symptoms themselves
What is Hypochondriasis?
- Persistent preoccupation with having one specific illness
- Obsessional, anxious, perfectionist personality traits are super common
- Marked by catastrophic thinking
- Normal sensations become amplified
- CBT normally effective
What is Somatic Symptom Disorder?
- AKA Briquet’s
- Physical symptoms that suggest illness or injury, cannot be explained through a medical condition
- Must be excessively worried about their condition
- Requires somatic complaints for at least six months
Give some examples of Functional Somatic Syndromes (symptoms experienced by those with a Somatic Symptom Disorder)
- Seizures
- IBS
- Atypical chest pain
- Fibro
- PMS
- CFS
- Lyme
