Somatic and Dissociative Disorders Flashcards
1
Q
Give three characteristics of somatic disorders.
A
Prominent somatic symptoms, causing significant distress of functional impairment; preoccupation or worry about an illness; and excessive help seeking behaviour.
2
Q
What do both somatic and dissociative disorders have in common?
A
A dissociation or disconnect between mental awareness and another part of the usually integrated nervous system
3
Q
In somatic disorders, what does the dissociation involve?
A
Sensory motor function.
4
Q
In dissociative disorders, what does the dissociation involve?
A
Higher functions involved in identity.
5
Q
Explain the term somatoform disorders.
A
Used by the DSM-4 referring to conditions involving physical manifestations of psychological disturbance.
6
Q
Explain the term psychosomatic disorder.
A
Conditions with a known physical basis, that can be aggravated by psychological factors via known physiological mechanisms.
7
Q
What does the DSM-5 refer to somatic disorders as?
A
Somatic symptoms and related disorders.
8
Q
In order to qualify for a diagnosis of somatic symptoms, what did the DSM-5 reform, compared to the DSM-4?
A
The requirement for the symptoms to present “without medical explanation”.
9
Q
Name some somatic symptom and related disorders. (5)
A
Somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder, and psychological factors affecting other medical conditions.
10
Q
What are some common somatic symptoms of somatic symptom disorder?
A
Pain, gastrointestinal symptoms, and neurological symptoms.
11
Q
How is the experience of pain different in somatic symptom disorder compared to conversion disorder?
A
In somatic symptom disorder, the pain focus causes excessive pain behaviours, and in conversion disorder, the pain focus results in a loss of function.
12
Q
What number of somatic symptoms is required for a diagnosis of somatic symptom disorder?
A
One.
13
Q
Give three reasons for the DSM-5’s removal of the need for somatic symptoms to present without medical reasons.
A
SDD can be diagnosed based on response to a physical illness, it encourages treatment for these psychosocial aspects of physical illness, and attempts to reduce mind-body dualism.
14
Q
Define illness anxiety disorder.
A
A preoccupation with having or getting a serious illness.
15
Q
Give some symptoms of ilness anxiety disorder.
A
Somatic symptoms are not prominent, high levels of health anxiety, excessive health-related behaviours, and illness preoccupation is present for at least 6-12 months.
16
Q
What is the key feature of illness anxiety disorder?
A
Concern in the absence of prominent symptoms.
17
Q
Define conversion disorder.
A
One or more symptoms of altered motor or sensory functioning which causes significant distress and impairment.
18
Q
In conversion disorder, most symptoms are indicative of a neurological disease, like:
A
Paralysis, blindness, difficulty speaking, mutism, and seizures.
19
Q
Define aphonia.
A
Difficulty speaking.
20
Q
In conversion disorder, patients are unaware of ______.
A
Functional ability.
21
Q
What percentage of neurology inpatients present with conversion disorder?
A
30%.
22
Q
What is the decrease of incidence of conversion disorder likely due to?
A
Increased knowledge of the real causes of physical problems, eliminating the possibility of secondary gain.
23
Q
Conversion disorder is primarily found in women but occurs relatively often in males at times of:
A
Extreme stress, like combat.
24
Q
When is the usual onset of conversion disorder?
A
In adolescence.
25
What two kinds of disorders that are commonly comorbid with conversion disorder?
Mood and anxiety disorders.
26
Give another name for conversion disorder.
Functional neurological disorder.
27
Among which people does conversion disorder tend to occur?
The less educated, and poorer people with less knowledge about disease and medical illness.
28
What kind of symptoms do people, individually, develop in conversion disorder?
Symptoms that they are familiar with.
29
How many processes did Freud find in the generation of conversion disorder?
Four.
30
Give Freud's first process of conversion therapy.
A traumatic event results in conflict and anxiety.
31
Give Freud's second process of conversion therapy.
The conflict and anxiety is unacceptable and is so repressed.
32
Give Freud's third process of conversion therapy.
An increase in anxiety that may cause the conflict to reach consciousness, so the person converts it into physical symptoms.
33
In conversion therapy, what is the primary gain?
The associated reduction in anxiety reinforces the conversion into physical symptoms.
34
Give Freud's fourth process of conversion therapy.
Secondary gains.
35
Explain conversion therapy's secondary gains.
Increased attention or avoidance of difficult situations.
36
Give two other diagnoses that conversion disorder is often confused with.
Real physical disorders, and malingering.
37
Conversion symptoms are precipitated by stress in __% to __% of clients.
52 to 93
38
What is malingering usually motivated by?
Trying to get out of something or by trying to gain something.
39
Give the main difference between malingering and conversion disorder.
Malingers are aware of what they are doing, while in conversion disorder, the symptoms are involuntary.
40
Define factitious disorder by proxy.
Purposely making a child sick for attention and pity.
41
Somatic symptom disorder occurs in _to_% of the general adult population.
5 to 7
42
Illness anxiety disorder occurs in _ to _% of the general population.
1.3 to 10
43
Factitious disorder occurs in _% of patients in hospital settings.
1
44
Up to __% of physical symptoms presented to GP's remain unexplained.
30
45
What is the basis of the gate control theory of pain?
Neural gates in the spinal cord can be opened or closed which determines the amount of pain an individual experiences.
46
What does 'somatoform' mean?
Mental disorders that take the form of physical illness.
47
What are somatic disorders characterised by? (3)
Prominent somatic symptoms, preoccupation with getting an illness and excessive help seeking behaviour.
48
Dissociative disorders involve the loss of the normal integration of: (4)
Identity, memory, perception, or consciousness.
49
What is dissociation?
A process where different facets of an individual's sense of self, memories or consciousness become split off from one another.
50
Why are somatic and dissociative disorders considered together?
They have a similar underlying mechanism, where there is a dissociation between mental awareness and the normally integrated mental system.
51
Give another name for dissociative disorders.
Psychoform dissociation.
52
Explain psychosomatic disorders.
Disorders characterised by identifiable physical illness or defect caused at least partly by psychological factors.
53
What does the Greek word 'hysterikós' mean?
Suffering in the womb.
54
What were somatoform and dissociative disorders previously known as?
Hysteria.
55
Who first came up with hysteria?
Hippocrates.
56
During the nineteenth century, what was hysteria attributed to?
Sexual deprivation.
57
Explain hypochondriasis.
A disorder involving intense anxiety regarding the belief that they have a serious medical condition that they clearly don't have.
58
Who discovered hypochondriasis?
Sydenham.
59
What does hypochondrium describe?
The part of the abdomen just below the ribs, which the Greek's believed to produce black bile, a substance that caused depression or melancholy.
60
_____ investigated hypnosis as a cure for hysteria.
Charcot.
61
What did Pierre Janet interpret the phsyical symptoms of as hysteria as resulting from?
Representations of traumatic events.
62
To explain Anna O's symptoms, Freud and Breuer adopted the term _____, to signify the transformation of psychical excitement into chronic somatic symptoms.
Conversion.
63
What did Freud believe hysteria was caused by?
Unpleasant infantile sexual experiences, though not necessary actual ones. Unacceptable childhood fantasies from childhood could result in hysteria.
64
What is Freud's theory of hysteria called?
Seduction theory of hysteria.
65
How is Freud's theory of hysteria similar to Janet's?
Freud believed the was a dissociative mechanism where hysterical symptoms were reliving early sexual trauma.
66
How did Freud believe hysteria could be cured?
Transforming the unconscious memory of the assault into conscious ones.
67
Give the DSM-5's three abnormal reactions to the somatic symptoms.
Disproportionate and persistent thoughts about the seriousness of symptoms, high levels of anxiety about health or symptoms, and spending excessive time and energy devoted to symptoms.
68
What is somatic symptom disorder accompanied by, according to the DSM-5?
Abnormal thoughts, feelings, and behaviours in response to somatic symptoms.
69
Give some examples of somatic pain symptoms.
Pain, gastrointestinal symptoms and neurological symptoms.
70
What does somatic symptom disorder with predominant pain refer to?
Individuals for whom pain is the primary symptom.
71
_____ and _____ are almost always present with chronic pain and may make pain sensations worse.
Depression and anxiety.
72
How is somatic symptom disorder with predominant pain similar to conversion disorder, and how is it different?
Both involve a neurological symptom, while pain is an additional experience, unlike conversion disorder, which usually involves a loss of function.
73
Most individuals experiencing abnormal levels of anxiety regarding their health meet criteria for:
Somatic symptom disorder.
74
What does an individual need to experience in order to be diagnosed with illness anxiety disorder?
Preoccupation with having or getting a serious illness in the absence of somatic symptoms.
75
Give diagnostic criteria for illness anxiety disorder (2).
Concerns persist for more than six months despite reassurance, and must not be explained by another mental disorder.
76
Give some elements of illness anxiety.
Disturbances in perception, affect, cognition, and behaviour.
77
In the context of illness anxiety, give an example of disturbances in perception.
Hypersensitivity regarding bodily sensations.
78
Define affect.
Experience of feeling or emotion.
79
In the context of illness anxiety, give an example of affect.
Anxiety regarding illness.
80
In the context of illness anxiety, give an example of cognition.
Beliefs regarding the threat or reality of serious disease.
81
In the context of illness anxiety, give an example of behaviour.
Excessive help and reassurance seeking.
82
What is conversion disorder?
A disorder marked by a sudden loss of functioning in a part of the body without an identifiable medical cause.
83
Give another name for conversion disorder.
Functional neurological symptom disorder.
84
Define la belle indifference.
A common feature of conversion disorder involving an odd lack of concern regarding loss of bodily function.
85
Give the diagnosic criteria for conversion disorder (3).
The disturbance in motor or sensory functioning cannot be explained by another mental or medical illness, the disturbance causes significant distress or impaired functioning in daily life, though the patient may be less concerned than expected.
86
In which group of people is conversion most common?
People who have, or have had, a physical disease.
87
When and where does mass hysteria occur?
In schools or workplaces where there has been a degree of stress and physiological arousal.
88
What is mass hysteria?
An epidemic of conversion, where large numbers of people in a particular setting develop the same symptom.
89
Define factitious disorders.
Disorders characterised by deliberately faking physical or mental illness in order to gain medical attention.
90
What did Asher name factitious disorder and why?
Munchausen's syndrome after Baron von Munchhausen.
91
Give the specifications of somatic symptom disorder. (3)
With predominant pain, persistent, or mild, moderate or severe.
92
Give the specifications of conversion disorder. (3)
Acute (less than 6 months) or persistent (more than 6 months), with or without psychological stressor, or specific symptom type.
93
Give some examples of self-induced or falsified symptoms in factitious disorder. (3)
Contaminating urine, injecting themselves with faeces to induce infection, or burning themselves to feign skin disease.
94
Why do people with factitious disorder fake illness?
The reason is unclear, but they do not do it for an external reward like compensation payments.
95
What is the psychological explanation of factitious disorder?
A disturbed, dependent or needy personality that seeks the security and comfort of medical care.
96
Give another name for factitious disorder imposed on another.
Munchausen's by proxy.
97
What does factitious disorder imposed on another involve? (3)
A individual will falsify another's medical history, induce illness in someone or tamper with laboratory tests to confirm an illness.
98
Explain malingering.
Feigning of a symptom or a disorder for the purpose of gaining a favourable situation or avoiding an unwanted one.
99
How is factitious disorder distinguished from somatic symptom disorder?
People with somatic symptom disorder do not consciously produce symptoms.
100
How is factitious disorder different from malingering?
The malingering person has a recognisable, external incentive, like financial compensation.
101
What is the prevalence of somatic symptom disorder?
5-7% of the general adult population.
102
What is the prevalence of illness anxiety disorder?
1.3-10% of the general population.
103
What is the prevalence of conversion disorder?
5% of neurology patients.
104
What is the prevalence of factitious disorder?
1% of patients in hospital settings.
105
Which somatic disorder has equal prevalence in women and men?
Illness anxiety disorder.
106
In Australian general practice, the prevalence of patients presenting with numerous somatic symptoms and illness anxiety is __%.
18
107
It is estimated that close to __% of symptoms reported to general practitioners remain unexplained from a medical perspective yet persist over time.
30
108
The proportion of patients with _____ and _____ increases as the number of unexplained somatic symptoms increases.
Depression and anxiety.
109
Why is the comborbidity of depression and anxiety with somatic disorders noteworthy?
It challenges the view that somatic disorders are a conversion of psychological distress into somatic symptoms.
110
How can the comorbidity of depression with somatic disorders be understood? (2)
A consequence of demoralisation associated with persisting illness, or physical symptoms being another way of expressing stress and signalling a need for help.
111
What does HPA axis stand for?
Hypothalamic-pituitary-adrenal axis.
112
What is the HPA axis?
Three components of the neuroendocrine system that work together in a feedback system interconnected with the brain's limbic system and cerebral cortex.
113
What is cortisol?
A hormone produced by the adrenal cortex that helps the body respond to stressors, inducing the fight or flight response.
114
How does the HPA axis relate to somatic disorders?
Underactivity of the HPA axis produces medically unexplained symptoms like fatigue, which then interacts with environmental factors to trigger symptoms.
115
What do neurobiological models seek to understand and how?
The occurrence of symptoms without an identifiable medical cause, by uncovering the manner in which sensory and motor information is processed at a neurological level.
116
What neurobiological model did Damasio propose?
Body maps.
117
What are body maps?
The neural representations of the internal state of the body that give rise to subjective experience.
118
What did Kozlowska theorise about body maps?
Temporary false body maps may develop and give rise to the experience of somatic symptoms.
119
What do false body maps cause? (3)
They fail to encode information coming from the body, may be distorted with incorrect information regarding the state of the body, and motor symptoms may be the product of innate or previously learned responses being falsely triggered.
120
What does the failure of a false body map to encode information result in?
The individual will experience deficits in sensory function (blindness, numbness).
121
What does the distortion of a false body map with incorrect information result in?
Sensory symptoms, like pain.
122
What do confused motor symptoms result in?
Pseudoseizures, which commonly occur in people with epilepsy are the result of the individual's body map for seizures being inappropriately activated.
123
What is the predominant neurobiological model of pain?
Gate Control Theory.
124
What is the basis of Gate Control Theory?
Neural gates in the spinal cord can be opened and closed to varying degrees to control the flow of impulses from peripheral receptors around the body to the central nervous system, thereby determining the amount of pain someone experiences.
125
The degree to which neural gates are open or closed is believed to be determined by three mechanisms:
Activity in the pain fibres opens gates, activity in peripheral fibres that convey information regarding stimuli around the body closes gates, and messages descending from the brain can open or close the gates.
126
What type of memory does early trauma in childhood become encoded as?
Unconscious memory, not declarative, and therefore it manifests as emotions, reflex action or bodily sensation.
127
How do somatic symptoms stem from early trauma?
They may be the result of unconscious memories of trauma manifesting as bodily sensation.
128
What is alexithymia?
Diminished capacity to consciously experience or describe emotions.
129
Why do patients with somatic disorders have higher rates of alexithymia? (3)
Difficulties in identifying emotions may stem from childhood experiences where distress was not acknowledged or responded to appropriately, resulting in minimising expression of emotion, not linking bodily sensation and emotion, and misinterpreting the bodily sensations of emotion as signs of physical illness.
130
Which disorder is seen as a disorder of affect regulation stemming from attachment difficulties with early caregivers?
Somatic disorder.
131
The process of somatisation involves the: (3)
Experience, conceptualisation and communication of mental states and distress as physical symptoms or altered bodily function.
132
What do cognitive-behavioural models of the somatisation process focus on?
The individual's experience and perception of physical symptoms, beliefs regarding the cause of these symptoms, associated concern or anxiety, and help-seeking behaviour.
133
What happens when an individual becomes locked into a cycle of increasing somatosensory amplification?
Somatic symptoms become more intense and distressing.
134
Give the four factors influencing somatosensory amplification.
Perception of symptoms, attribution regarding symptoms, anxiety about the illness, and illness behaviour.
135
What did Witthoft, Gerlach, and Bailer find about attention in people with somatic disorders.
They had a higher focus on bodily sensations than controls.
136
What is attribution?
An explanation a person forms about why an event occurred.
137
Attribution theory suggests three possible attributions for bodily symptoms:
Psychological causes, physical causes, and situational explanations.
138
What is the basis of attribution theory?
People initially use situational explanations and only seek other explanations when these are insufficient to account for the symptom.
139
What did Kirmayer and Robbins find regarding a physical attribution style? (3)
It predicts more obscure somatic complaints reported to the doctor, less reporting of emotional problems, and less use of mental health services.
140
What did Greer, Halgin, and Harvey find about doctor's methods of diagnosis?
Doctors were more likely to diagnose a psychological problem if patients attributed their problems to psychological causes, but if patients believed their symptoms were physical, they would be more likely to have their emotional problems recognised and treated.
141
What can illness concern manifest as?
A trait phenomenon, as in hypochondriacal personality.
142
What may illness concern be specific to?
The time, situation or symptom.
143
What is illness behaviour largely motivated by? (3)
Individual attributions and level of concern or anxiety for symptoms.
144
Give a common form of illness behaviour for people who believe their symptoms are physical.
Seeking medical attention.
145
How can medical treatment result in more physical symptoms?
Searching for a physical disease may increase anxiety, which increases physiological arousal and muscular tension, resulting in physical symptoms.
146
How do somatic disorders and childhood learning experiences interconnect?
Exaggerated illness behaviour is an outcome of childhood learning experiences, like parental illness anxiety and behaviour, where the child learns that they are rewarded with increased attention when ill.
147
What is a secondary gain of being sick?
Attention and potential financial compensation.
148
How can the health system contribute to somatic disorders? (3)
The structural divide between biological and psychological disorders, the stigma of mental illness, and the certainty of a physical diagnosis.
149
Give the general principles that underlie the treatment of somatic disorders. (5)
Conducting a comprehensive assessment that gives equal importance to physical and psychological factors; minimising the number of clinicians involved; recognising the patients symptoms regardless of predominant physical or psychological causation; identifying and minimising any reinforcers that may be maintaining the problem; and treating any comorbid medical or psychological disorders that may be impacting on the patient's functioning.
150
Name five culture-bound syndromes of uncertain origin.
Falling out, shenjing shuairuo, dhat, koro, and hwa-byung.
151
Describe falling out.
Seen in African-Americans, Bahamians, and Haitians in Miami, involving collapse without convulsion, hyper-salivation, and hearing and understanding but are powerless to move.
152
Describe shenjing shuairuo.
Common in China and other Asian and Eastern European countries, involving weakness, emotional symptoms, excitement, nervous pain, and sleep disturbance.
153
Describe dhat.
Localised to India, and characterised by a preoccupation with semen loss and symptoms of fatigue, sleeplessness and heart palpitations.
154
Describe koro.
Originated in China, and is charactered by a delusional concern that the penis is shrinking and disappearing into the body, accompanied by panic and a fear of death.
155
Describe hwa-byung.
From Korea, including physical symptoms and a fear of impending death, occurring during interpersonal conflict.
156
What do chronic somatic disorders involve?
Multiple somatic symptoms and strong illness conviction.
157
When is reattribution used?
In the treatment of acute somatisation.
158
Give the three steps of reattribution.
Conducting a thorough history and physical examination, suggesting that the pain may be caused by psychosocial factors, and making the link between psychological factors like stress and physical symptoms.
159
What is reattribution.
Moving the person from a somatic illness attribution to a psychological attribution.
160
Give the stages of managing a chronic somatic disorder.
Thorough assessment, medical tests, identifying possible contributing factors, making a psychiatric diagnosis, assessing the patient's level of motivation for recovery, and factors that may undermine this.
161
What are the factors in making a thorough medical assessment? (8)
Understanding what the patient thinks about the illness and its cause, and assessing the degree of illness, medical tests, identifying possible contributing factors, making a psychiatric diagnosis, assessing the patient's level of motivation for recovery, and factors that may undermine this.
162
What happens after a medical assessment in the treatment of chronic somatic symptom disorder?
Identifying a single case manager who can oversee the patient's management.
163
What kind of intervention is vital to the management of chronic somatic disorders?
Psychological, especially CBT.
164
What is self-monitoring?
A method of assessment where the client records the number of times per day that they engages in a specific behaviour and the circumstances in which the behaviour occurs.
165
Give four treatments for the perception of physical symptoms.
Pain relief medication, relaxation, distraction, and attention training.
166
Give four treatments for attribution or disease conviction.
Reattribution, challenging thoughts, education and explanation, and behavioural experiments.
167
Give five treatments for concern, illness worry, or preoccupation.
Reassurance, education and explanation, pharmacological treatment of depression and anxiety, CBT, and distraction.
168
Give two treatments for illness behaviour.
Coordination between all health professionals, and secondary consultations by psychologists.
169
Give five treatments for social and occupational functioning.
Graded activity, exposure, early return to work, couple or family therapy, and assistance with rapid resolution of compensation claims.
170
Somatic symptom disorder of short duration and with a small number of somatic symptoms is generally managed in:
Primary care.
171
What pharmaceutical intervention is effective against hypochondriasis?
SSRIs
172
What is depersonalisation?
A change in the individual's sense of their physical self.
173
What is depersonalisation?
A change in the individual's sense of their physical self.
174
Give the five primary experiences associated with pathological dissociation.
Amnesia, depersonalisation, derealisation, identity confusion, and identity alteration.
175
Define amnesia.
Impairment in the ability to learn new information or to recall previously learned information or past events.
176
Define derealisation.
A change in the individual's sense of the world.
177
Define identity conflict.
Feelings of uncertainty, puzzlement or conflict regarding identity.
178
Define identity alteration.
Objective behaviours indicating that the individual has assumed alternative identities at different times.
179
Which experience of pathological dissociation is most sever?
Identity alteration.
180
Which experience of pathological dissociation is most sever?
Identity alteration.
181
Give the main features of depersonalisation/derealisation disorder.
Persistent depersonalisation or derealisation.
182
Give the main features of dissociative amnesia.
The predominant symptom is one or more episodes of inability to recall important personal information, usually of a traumatic of stressful nature, that is too excessive to be explained by ordinary forgetfulness; and dissociative fugue.
183
Define dissociative fugue.
A dissociative experience in which a person undergoes a sudden, unexpected journey away from home and assumes a new identity, with amnesia for the previous identity.
184
How is depersonalisation experienced in depersonalisation/derealisation disorder?
Feelings of detachment of estrangement from the self (feeling like a robot or in a dream).
185
How is derealisation experienced in depersonalisation/derealisation disorder?
Surroundings are unreal.
186
What does a diagnosis of depersonalisation/derealisation disorder require?
Experiences of depersonalisation or derealisation are persistent and cause significant distress and impairment in functioning.
187
What does a diagnosis of depersonalisation/derealisation disorder require?
Experiences of depersonalisation or derealisation are persistent and cause significant distress and impairment in functioning.
188
Give another name for dissociative amnesia.
Psychogenic amnesia.
189
Episodes of dissociative amnesia can be: (5)
Localised, selective, generalised, systematised, or continuous.
190
Explain localised amnesia.
Forgetting what happened during a certain period although remembering previous and subsequent events.
191
Explain selective amnesia.
The individual may recall some but not all features of an event.
192
Explain generalised amnesia.
Amnesia for all or most personal information, including name, history, and the identity of friends and family.
193
Explain continuous amnesia.
The inability to recall events after a specific time.
194
Explain systematised amnesia.
An inability to remember certain categories of experiences.
195
Give the main features of dissociative identity disorder.
The presence of one or more distinct identity states that take control of behaviour, accompanied by an inability to recall important personal information.
196
Give another name for dissociative identity disorder.
Multiple personality disorder.
197
Define dissociative identity disorder.
A dissociative disorder where the individual develops more than one distinct identity.
198
What did David Spiegel believe the essential feature of dissociative identity disorder to be?
The lack of integration between identity, memory, and consciousness.
199
Give some symptoms of dissociative identity disorder. (6)
Amnesia, depersonalisation, derealisation, post-traumatic stress symptoms, disturbances in identity, and auditory hallucinations.
200
What is a structured interview?
A meeting between a client and a clinician where the clinician asks questions that are standardised, written in advance and asked of every client.
201
Which disorder has the most overlap with dissociative identity disorder?
PTSD.
202
How do meta-memory problems play a role in dissociative identity disorder?
Individuals with DID will often claim that certain identities are unaware of what happens when other disorders are out, but really they just have issues with meta-memory.
203
What is meta-memory?
An individual's knowledge, beliefs and feelings about their memory.
204
Give some childhood risk factors for depersonalisation/derealisation disorder.
Sexual, emotional and physical abuse.
205
What are the most common precipitants for depersonalisation/derealisation disorder?
Extreme stress, depression, anxiety and substance use (particularly marijuana or hallucinogens).
206
Why did Hunter, Phillips, Chalder, Sierra and David propose about the connection between anxiety disorders and depersonalisation/derealisation disorder?
Individuals with both disorders make catastrophic interpretations of what would normally be transient feelings of depersonalisation and derealisation, which increases anxiety and therefore depersonalisation and derealisation.
207
How does the hippocampus account for dissociative amnesia?
It shuts down, so the spatiotemporal context of a memory is not connected to the emotional component.
208
What is the hippocampus?
A cortical structure located in the temporal lobe of the brain and believed to be involved in the ability to learn and control impulses.
209
What is the amygdala?
Part of the brain's limbic system that is thought to regulate emotions.
210
What does the failure of the hippocampus during dissociative amnesia do to individual memory?
The amnesia only applies to declarative memories, so an individual may experience feelings and sensations from an experience but not the experience itself.
211
What did Kikuchi find regarding dissociative amnesia?
Increased activity in the prefrontal cortex and decreased activity in the hippocampus.
212
Staniloiu and Markowitsch found that dissociative amnesia may be associated with:
Overall reductions in brain metabolism or more selective alterations in the right temporo-frontal cortices.
213
Give two psychological explanations for dissociative amnesia.
Post-hypnotic amnesia and state-dependent memory.
214
What is post-hypnotic amnesia?
Memory loss after being in a hypnotic state for events that occurred during hypnosis or for information designated by the hypnotist.
215
What is state-dependent memory?
Improved memory in situations or states that are similar to the situation or state in which the information was learned.
216
Give an example of state-dependent memory.
Betrayal Trauma Theory, where there is social utility in remaining unaware of abuse when the perpetrator is a caregiver since it allows the child to maintain attachment bonds and access to basic needs.
217
What is the dominant aetiological theory for dissociative identity disorder?
Severe trauma in childhood is a trigger.
218
Give some dissociative symptoms of PTSD.
An inability to recall aspects of trauma, flashbacks and emotional numbing.
219
Name Kluft's factors involved in the development of dissociative identity disorder. (4)
The capacity to dissociate, experiences that overwhelm the child, and elaboration of alternate identities with individualised characteristics, and a lack of soothing experiences after overwhelming events during childhood.
220
Name three theories of dissociative identity disorder than do not focus on trauma.
Iatrogenic theory, sociocognitive model, and the fantasy model.
221
Define iatrogenesis.
A process by which an adverse effect is caused by treatment.
222
What is the basis of iatrogenic theory?
Dissociative identity disorder is the product of therapy or the media.
223
How do therapists influence their patients according to iatrogenic theory?
They suggest the concept of dissociative identity disorder, teach them how to behave with the condition, and reinforce the behaviour with attention.
224
Give two pharmaceutical interventions for depersonalisation/derealisation disorder.
Naltrexone and lamotrigine.
225
In dissociative amnesia, which treatment is optimal for those whose amnesia relates to PTSD?
Imaginal exposure to the traumatic memory.
226
Give the three phase approach as published by the International Society for the Study of Trauma and Dissociation.
Establishing safety, stabilisation and symptom reduction; confronting, working through, and integrating traumatic memories; and finally, integration and rehabilitation.
227
What does the International Society for the Study of Trauma and Dissociation's Establishing safety, stabilisation and symptom reduction phase entail? (2)
Developing a trusting relationship with the patient, and teaching the patient cognitive-behavioural strategies to face the distress rather than dissociating.
228
What does the International Society for the Study of Trauma and Dissociation's Establishing confronting, working through, and integrating traumatic memories phase entail?
Exposure-based techniques similar to those used with PTSD are used, like talking about their traumatic experiences and re-evaluating them.
229
What does the International Society for the Study of Trauma and Dissociation's Establishing integration and rehabilitation phase entail?
Separate identities are resolved into one.
