Somatic Symptom Disorder Flashcards
(26 cards)
DSM-5 Somatic symptom disorders
- All characterised by focus / physical concerns
- Conversion disorder: functional neurological symptom disorder
- Factitious disorder: imposed on self or others
- physical symptoms causing distress but without evident
medical explanation
DSM-5 Conversion Disorder
2 main criteria
A- One or more symptoms of altered voluntary motor/ sensory function
B- incompatibility between symptom + recognised neurological / medical conditions
Conversion Disorder - difficulty with diagnosis
- Anderson et al - 10% of diagnosis of psychogenic origin, 10% may actually have organic origin
conversion disorder : Neurological Evidence - Limb
- Ghaffar et al - 3 people with conversion disorder - stimulation of affected limb didn’t activate contralateral primary somatosensory region
- stimulation of unaffected did
- When both limbs stimulated both sides of brain are activated suggests affected limb not activated is due to suppression
Conversion Disorder : Psychogenic seizures
- progressed to full-blown seizures (pass out, eyes roll back)
- All tests came back neg
- Defence mechanism when in a stressful situation
Freudian Hysteria - case of Anna 0
- treated for paralysis with disturbances of sensation including vision + hearing
- diagnosed with hysteria (conversion disorder )
Freudian repression of memories - Think no think
- Anderson + Green - Think/ no think procedure
- ppts trained with word pairs then presented with 1 word from each pair + asked to recall associated word or suppress all conscious memory of it
- During suppression trials, increased activity in dorsolateral prefrontal cortex with decreased activity in hippocampus
- cortex suppressing hippocampal memory function
conversion disorder -atrophy
- increased activity in dorsolateral prefrontal cortex
- Decreased activity in hippocampus takes as evidence for suppression of traumatic memories
- increased activity in supplementary motor area is evidence for highly abnormal mental representations of body parts affected by the disorder
Out of body experience- Temporparietal Junction
- Blanke et al - 6 patients with epilepsy associated with out of body experiences + found in each case the focus of seizure centred in temporoparietal junction
- simulating temporoparietal junction elicited at of body experiences
conversion disorder : Treatment
- Hinson et al patients given Psycodynamic Psychotherapy focusing on early life experiences + linking to current experiences + emotional + beh issues
- Conversion, depression + anxiety symptoms all reduced
Munchausen’s Syndrome - DSM 5 factitious disorder
- Criteria A: falsification of physical or psychological signs or symptoms or induction of injury/disease
- Frequent hospitalisation + pathological lying
Munchausen’s syndrome profile
- Addicted to being hospitalised
- Hospital is comforting
Munchausen’s syndrome - treatment
- Depression/anxiety treated by medication + CBT talk therapy
- important psychiatrist helps primary treatment team manage patient in safest way
Muchausen’s syndrome by Proxy
- parent deliberately makes child Ill because parent craves attention
- proxy = authority to represent someone else
- Mum convicted of child abuse : kept her daughter ill for 8 years
Muchausens by proxy : attachment + loss
- mothers with syndrome also report disturbed attachments to own mothers + early life
- insecure mental representations of care giving
- unresolved distress in response to previous childhood ilIness
Muchausen by Proxy : unresolved loss
- 14 % experienced loss concerning children
- 11 % experienced loss of sig adult
- 32 % experienced loss of partner
Muchausern’s syndrome by Proxy: subtypes - Help seekers
Help seekers - make up child symptoms to help with own feelings of inadequacy as parent - gives up on symptoms once treated
- when offered psychotherapy or immediate placement of child Out of home= high cooperation in psychotherapy
Muchausens by proxy - subtypes - Doctor Addicts
- repeated presentation to doctors of medical condition in children but not physically inducing
- personally convinced child is ill
Muchausen’s by proxy : Subtypes -Active inducers
- Direct effort to cause dramatic symptoms of illness (suffocation, poisoning)
- Appear concerned + loving
- Resistant to therapeutic intervention
- flee from contact
Neurobiological factors contributing to somatic symptoms
- Rostral anterior insula + anterior cingulate cortex increases activity for pain + uncomfortable physical Sensations (craggs et al)
- regions have strong connections with somatosensory cortex
Learning to control anterior cingulate cortex to reduce pain
- deCharms et al
-Healthy indiVs completed brain scanning sessions viewing the graph showing changed ACC activity as they were exposed to uncomfortable sensations
-Told strategies for manipulating ACC activity - 3 sessions most indivs learned to control activity
cog Beh factors increase awareness of distress over somatic symptoms
- once somatic symptoms dev 2 cog variables are important: attention to body sensations + interpreting the sensations
- Bogaerts et al -> people with health worries overly focus on somatic symptoms
- Rief + Boradbent > once attended somaticp symptoms, interpret them in worst way possible
Neg thoughts triggering onset of somatic symptoms
- Randomly assign ppts to watch TV about effects of WIFI exposure on health or watch control film
- Witthofy + Rubin
-experimenters falsely stated they would expose ppts to new Wifi - doc ppts reported sig increase in symptom physicals after exposure
safety Beh
- try to reduce anxiety
- seeking reassurance from , doctors + internet
- counterproductive as it prevents people extinguishing fear
- In an experiment it was found that engaging in safety ben for 1 week dev new symptoms
