somatic symptoms & dissociative disorders

somatic symptom disorders

inability to explain symptoms not sufficient for diagnosis of mental illness; psychological distress; frequent health care visits; remission and exacerbation

illness anxiety disorder

unrealistic/inaccurate interpretation of physical sx, feel things greatly; overly aware of body sx; associate with an illness; preoccupied with illness; anxiety even if diagnostics negative, doctor shopping/avoid medical assistance

functional neurological symptom disorder

INDIFFERENCE with a loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism; usually only a few weeks

factitious disorder

conscious, intentional feigning of physical or psychological symptoms, Munchausen Syndrome (gypsy rose)

primary gain

avoid stressful situations/emotional internal gain

secondary gain

become a focus of attention because of the sickness; getting external gain

tertiary gain

gains received by people close to the patient (ex: parents get days off work to take care of patient)

dissociative fugue

sudden, unexpected travel away from customary places or bewildered wandering; individual may not recall personal identity and sometimes assumes new identity

dissociative identity disorder

two or more personality states in single individual; alter identities/alters gradually or suddenly (mult personality disorder/split)

depersonalization-derealization disorder

temporary change in quality of self-awareness; changes in body image; feelings of unreality/detachment from environment

depersonalization

feeling of viewing own body from a distance

derealization

situation or objects are dream-like

psychodynamic theory of depersonalization-derealization disorder

repression of distressing mental contents from conscious awareness Freud saw unconscious as dynamic entity

we want to rule out ________ __________ and refer them to talk about them to a _________

physical complaints; physician

have a patient keep a diary of what three qualities of physical symptoms?

appearance, duration, and intensity

help patient identify ways to achieve ___________ without resorting to physical symptoms

recognition

patient goal for fear

verbalize fears are irrational

with patients with impaired memory, do not confront them about information they do not remember and obtain as much info as possible from…

family/others

with patients with impaired memory, expose them to stimuli from…

pleasant past experiences

localized dissociative amnesia

creates a gap in memory; can’t recall incidents

selective dissociative amnesia

only recalling certain incidents in the event; selective memory

generalized dissociative amnesia

lost ability to identify self and history

gradually withdraw attention to ________ ________

physical symptoms

disturbed sensory perception goal

want them to demonstrate recovery of loss

drugs for somatic and dissociative disorders

as according to their symptoms: TCAs for pain, benzos for anxiety, IV amobarbital for retrieving lost memories in dissociative amnesia

integration

trying to combine subpersonalities as a whole in dissociative identity disorder

abreaction

have client recall past trauma and mentally go through it again

reintegration

move away from traumatization and victimization

malingering

pretending to have something to get out of something else

assist case manager to develop a follow-up appointment with provider every _-_ _____

4-6 weeks