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Clinical Psychology > W9: Somatic Symptoms & Dissociative Disorders > Flashcards

W9: Somatic Symptoms & Dissociative Disorders Flashcards

1
Q

What does somatic mean?

A

Pertaining to bodily sensations (internal and external)

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2
Q

What are some types of somatic symptom and related disorders

A

Somatic symptom disorder

Illness anxiety disorder

Conversion disorder

Factitious disorder

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3
Q

What is somatic symptom disorder?

A

When a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning.

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4
Q

What does the DSM say about somatic symptom disorder?

A
  • 1 or more somatic symptoms that are distressing or cause disruption
  • Excessive thoughts, feelings or behaviours related to the somatic symptoms or associated health concerns
  • somatic symptom may not always be present, but state of being symptomatic is

Excessive focus on belief that there is something wrong with the body which may amplify normal somatic symptoms

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5
Q

What does somatic symptom disorder have high co-morbidity with?

A

Medical disorders

Anxiety disorders

Depressive disorders

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6
Q

What is illness anxiety disorder?

A

A preoccupation with having a medical illness (no symptoms) + behavioural change

May be interpreting benign symptoms as having a disorder

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7
Q

How is illness anxiety disorder similar to OCD

A

They are preoccupied which may cause anxiety to increase

Checking behaviours used to decrease anxiety

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8
Q

What are the two types of illness anxiety disorder?

A

Care-seeking type: medical care, including visiting GP, undergoing tests and procedures, is frequently used

Care-avoidant type: medical care is rarely used

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9
Q

What does the DSM say about illness anxiety disorder?

A
  • preoccupation with having or acquiring a serious illness
  • somatic symptoms = not present or only mild
  • high anxiety around health. easily alarmed about personal health status
  • performs excessive health behaviours or maladaptive avoidance
  • present for at least 6 months but the feared illness can change over that time
  • not better explained by other mental disorder (e.g. psychosis)
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10
Q

What is conversion disorder?

A

Functional neurologic disorders — conversion disorder — feature nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. However, the symptoms are real and cause significant distress or problems functioning.

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11
Q

What does the DSM say about conversion disorder?

A
  • One or more symptoms of altered voluntary movement or sensory function (e.g. numbness or seizures)
  • Clinical findings provide evidence of incompatibility between the symptoms and recognised neurological or medical conditions
  • The symptom or deficit is not better explained by another medical or mental disorder
  • The symptom or deficit causes clinically significant distress or impairment of warrants medical evaluation
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12
Q

When is typical onset of conversion disorder?

A

Typically onset is in adolescence or early adulthood - following life stress

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13
Q

What is the prevalence of conversion disorder?

A

<1%

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14
Q

Are there any gender differences in conversion disorder?

A

More common in women

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15
Q

What is conversion disorder often co-morbid with?

A

Other somatic symptom disorders

Major depressive disorder

Substance use disorder

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16
Q

Why might there have been a decrease in the prevalence of conversion disorder?

A

May not be well diagnosed

People who have seizures that don’t follow any medical patterns are said to have pseudo seizures but it is likely a portion of these have conversion disorder

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17
Q

Where is conversion disorder more prevalent?

A

Rural areas
Low SES communities
Non-western cultures

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18
Q

What are some symptom type specifiers of conversion disorder

A

With weakness or paralysis

With abnormal movement

With swallowing symptoms

With speech symptoms

With attacks or seizures

With anaesthesia or sensory loss

With special sensory symptoms (visual, olfactory or hearing)

With mixed symptoms

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19
Q

What is factitious disorder?

A

Includes the falsification of medical and/or psychological symptoms
Intentional falsification

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20
Q

What are the two kinds of factitious disorder?

A

Imposed on self: doing things to your body to seem to have illness

Imposed on another: indicating some sort of evidence that someone else has symptoms that they don’t (e.g. actively poisoning them)

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21
Q

What does the DSM say about factitious disorder imposed on self?

A

Falsification of physical and psychological signs and symptoms, or induction of injury or disease, associated with identified deception

Presents self as ill, impaired or injured

Deceptive behaviour is evident even in the absence of obvious external rewards

Not better explained by another mental disorder (delusional or psychotic)

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22
Q

What does the DSM say about factitious disorder imposed on another?

A

Falsification of physical and psychological signs and symptoms, or induction of illness or disease in another with identified deception

Presents another individual (victim) to others as ill, impaired or injured

The deceptive behaviour evident in absence of reward

The behaviour is not better explained by another mental disorder (psychotic and delusional)

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23
Q

Give a case study example of factitious disorder

A

Jennifer and Kathleen Bush

Initial presentation: ear infections, chronic diarrhoea, prolonged seizures

Kathleen left job to become the office manager at Jennifer’s paediatric place

Hospital raised concerns of factitious events but the parents sued the hospital

When Jennifer was taken into care four years later, there was an instant remission of her illness

Kathleen was found guilty of child abuse and sentenced to five years jail time

24
Q

Is there a genetic role in somatic disorders?

A

No. No support.

Rates in MZ and DZ twins do not differ

25
Q

What brain areas have been considered in understanding why some people are more aware of and distressed by bodily sensations than others?

A

Hyperactivity in the:
Anterior insula
Anterior cingulate

26
Q

What cognitive processes may be at play in somatic disorders?

A

Hyperigilance - tend to notice more than others

Overestimation - of dangerousness of symptoms (think something harmless is worse)

Confirmation bias - attend to and encode info consistent with beliefs

Intolerance of uncertainty

27
Q

What behavioural processes may be at play in somatic disorders?

A

Avoidance and escape

Checking behaviour: pulse, urine, body

Reassurance seeking: asking others in life and medical professionals for reassurance

28
Q

How can help-seeking and sick-role behaviours be reinforced?

A

By the attention and sympathy they may receive from others

29
Q

Treatment for somatic disorders?

A

Few controlled studies but CBT is effective…

Involves changing maladaptive cognitive and behavioural resources similar to OCD and related disorders

30
Q

What are the 3 kinds of dissociative disorders?

A

Dissociative identity disorder
Dissociation amnesia
Depersonalisation disorder

31
Q

What is dissociation?

A

Some aspect of cognition or experience becomes inaccessible to consciousness

Sudden disruption to: consciousness, emotions, memory, motivation and identity.

32
Q

What is dissociative identity disorder (DID)?

A

Formerly multiple personality disorder

When someone experiences two or more identity/personality states which alternate in control of behaviour - typically there is a host personality and one or more alters that are extremely different to the host

33
Q

What does the DSM say about DID?

A

A disruption of identity characterised by two or more distinct personality states
- may have no memory of what happened like completely different person

Recurrent gaps in recall of everyday events, personal information and or traumatic events that are inconsistent with normal forgetting patterns

Cause significant distress or impairment in social, occupational or other important areas of functioning

Not a normal part of cultural or religious practice

Not due to substance use or another medical condition

34
Q

Which is the most severe dissociative disorder?

A

DID

35
Q

How common is DID? gender differences?

A

1.5%

More common in women

36
Q

How many outpatients with DID have attempted suicide?

A

70%

37
Q

Do people with DID really forget everything from the other personality/identity?

A

Often portrayed this way however this has been questioned as evidence from memory tests have shows that information from one ‘alter’ is available in the others

38
Q

Is there any other evidence of change in DID?

A

There is evidence of physiological changes - EEG variation, handedness, voice patterns

39
Q

What are the two explanations for DID?

A

1- post traumatic model

2- sociocognitive model

40
Q

What is the post traumatic explanation of DID?

A

An early trauma such as abuse has led the person to develop multiple personalities to cope with stress (X happened to someone else not me)

41
Q

Is there any evidence for the post traumatic explanation for DID?

A

Some evidence that severe abuse occurred in up to 90% of individuals with DID
- but subjective reporting

42
Q

What is the socio-cognitive explanation of DID?

A

Suggests that DID results from psychotherapeutic techniques

43
Q

Is there any evidence for the socio-cognitive model of DID?

A

Most cases show few if any signs prior to therapy with numbers of identities increasing with the length of time spent in therapy

  • therapist may reinforce the idea that there are multiple personalities
  • a small number of therapists are responsible for the majority of diagnoses

Sybil
- DID cases in 1970 - 79, then the best selling book and movie ‘Sybil’ was a story of a women with 16 personalities
- DID cases in 1986- 6000+ and now in the tens of thousands
(When we educate people about disorders there is a better understanding and they go to seek help but this level of increase is unheard of)

44
Q

What is the treatment for DID?

A

Recommended to use a phase-oriented approach

  1. Establishing safety, stabilisation and symptom reduction
  2. Confronting, working through and integrating traumatic memories
  3. Identity integration and rehabilitation
45
Q

What is dissociative amnesia?

A

The forgetting of personal information, particularly surrounding a stressful event

46
Q

What does the DSM say about dissociative amnesia?

A

An inability to recall important autobiographical information. Usually of a traumatic or stressful nature that is inconsistent with ordinary forgetting

Causing distress or impairment

Not attributable to the effects of a substance, neurological or any other medical condition

47
Q

What are some criticisms to the diagnosis of dissociative amnesia?

A

Intentional forgetting vs. amnesia

We have gaps in memory normally

Little empirical support - cases better attributed to organic brain damage, suppression of thoughts etc

48
Q

Treatment for dissociative amnesia?

A

The disorder usually spontaneously remits

49
Q

What is depersonalisation disorder (DD)?

A

Recurrent experience of derealisation and or depersonalisation

50
Q

What is derealisation?

A

The feeling your surrounding are not real or that familiar places are new/unknown

51
Q

What is depersonalisation?

A

The feeling you are not real, living in a dream or movie, or are watching yourself from the outside

52
Q

What does the DSM say about depersonalisation disorder?

A

The presence of persistent or recurrent experiences of depersonalisation, derealisation or both

During these experiences, reality testing remains intact (awake and alert)

Significant distress and impairment

Not attributable to a substance or other medical condition

Not better explained by another mental disorder

53
Q

How prevalent is DD?

A

Derealisation and depersonalisation are relatively common experiences (more than 50% of the general population, mainly adolescents)

BUT the disorder itself is not common (2%)

54
Q

When is the typical onset of DD?

A

In adolescence

55
Q

Are there any gender differences in DD?

A

No

56
Q

Are there any memory deficit differences in the dissociative disorder?

A

Deficits in explicit (conscious recall of experience) but not implicit (hard to explain memories such as procedural, things that cannot be consciously recalled) memories

Clinical Psychology (15 decks)

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