Psychopathology Chapter 8: Somatic Symptom and Dissociative Disorders

Flashcards based on the powerpoints for Module 8 as well as the chapter.

A somatic symptom disorder may be diagnosed when…

concern about somatic symptoms is severe and leads to significant distress.

A dissociative disorder may be diagnosed when…

feelings of ‘being out of it’ become so persistent and recurrent that the person has profound and unusual memory deficits.

In the past, SSDs and DDs were considered to be:

forms of neurosis.

Soma means…

body.

People with somatic symptom disorders experience bodily symptoms that can cause…

them significant psychological distress and impairment.

Old disorders of hypochondriasis, somatization disorder and pain disorder would now be…

diagnosed with Somatic Symptom Disorder.

For a diagnosis of SSD to be made, an individual must be experiencing chronic somatic symptoms that are distressing to them as well as…

dysfunctional thoughts, feelings and/or behaviors.

What did people USED to think the cause of SSD was?

Symptoms developed as a defense mechanism against unresolved or unacceptable unconscious conflicts.

Simplified Model of Somatic Symptom Disorder

people with SSD tend to have a cognitive style that leads them to be hypersensitive to their bodily sensations. They also experience these sensations as intense, disturbing, and highly aversive. Another characteristic of such patients is that they tend to think catastrophically about their symptoms, often overestimating the medical severity of their condition.

Patients of Somatic Symptom Disorder are more likely to be…

female and to have high levels of comorbid depression and anxiety.

Malingering

consciously faking symptoms to achieve a specific goal such as winning a personal injury lawsuit.

What is the approach of CBT to SSD.

Treatment focuses on assessing the patient’s beliefs about illness and modifying misinterpretations of bodily sensations.

Sometimes patients are directed to engage in response prevention that includes:

1. not checking their bodies as they usually do.

2. stopping their constant seeking of reassurance.

CBT are also used in the treatment of somatic symptom disorder that involves pain. This includes:

1. relaxation training

2. support and validation that the pain is real

3. scheduling of daily activities

4. cognitive restructuring

5. reinforcement of “no-pain” behaviors.

Illness Anxiety Disorder

People with this disorder have high anxiety about having or developing a serious illness.

The main difference between SSD and Illness Anxiety Disorder is:

the severity: people with SSD have more comorbid conditions and visit doctors more frequently.

Conversion Disorder

This disorder is characterized by the presence of neurological symptoms in the absence of a neurological diagnosis. Patients have symptoms or deficits affecting either the senses or motor behavior.

What are some examples of symptoms of conversion disorder?

Partial paralysis, blindness, deafness and episodes of limb shaking accompanied by impairment or loss of consciousness that resembles seizures.

Anesthesia

person loses feeling in a part of the body.

Conversion Blindness

Person reports being unable to see, yet navigates spaces without problems.

Conversion Deafness

Person reports not being able to hear and yet orients appropriately upon “hearing” his or her own name.

What are some motor symptoms of Conversion Disorder?

conversion paralysis, usually confined to a single limb.

Aphonia: a speech related conversion disturbance

Globus: the sensation of a lump in the throat

Seizures from conversion disorder resemble:

epileptic seizures, but are not true seizures. Patients show no EEG abnormalities and no confusion or memory loss afterwards.

What is true about the diagnosis of a conversion disorder?

An accurate diagnosis is difficult; symptoms can mimic a variety of medical conditions.

What are some criteria used to diagnosis conversion disorders and true neurological disturbances?

1. Frequent failure of the dysfunction to conform clearly to the symptoms of the particular disease or disorder simulated.

2. Nature of the dysfunction is highly selective.

3. Under hypnosis or narcosis, the symptoms can usually be removed, shifted, or reinduced at the suggestions of the therapist.

What is true about the relationship between a stressor and conversion disorder?

Rapid onset after a significant stressor; often resolves within two weeks if stressor is removed.

Freud used the term _____ for these disorders; believed that the symptoms were an expression of repressed sexual energy.

Conversion Hysteria

Primary Gain:

reduction in anxiety and intrapsychic conflict.

Secondary Gain:

receiving sympathy and attention from loves ones.

Individuals with depression and individuals with conversion disorder show reduced brain levels in…

brain-derived neurotrophic factor relative to nondisordered controls.

What is the behavioral approach to the treatment of conversion disorder?

Specific exercises prescribed to increase movement or walking; reinforcements provided when patients show improvements.

Hypnosis combined with other problem-solving therapies can also be useful in the treatment of what disorder?

Treatment of Conversion Disorder

In factitious disorder,

the person intentionally products psychological or physical symptoms (or both).

What is the goal of the behavior with factitious disorder?

To obtain and maintain the benefits that playing the ‘sick role’ may provide, including the attention and concern of family and medical personnel.

What is true about factitious disorder and the categorization of this disorder in the DSM-5?

The factitious disorder has been moved into the category of somatic symptom disorders - which is viewed as unfortunate by some because these disorders have a history of being stigmatized; many doctors do not take them very seriously.

What is one of the biggest identifiers in factitious disorder?

The person receives no tangible external rewards.

How is factitious disorder different from malingering?

1. intentionally producing or grossly exaggerating physical symptoms.

2. Motivated by external incentives (avoiding work or military service)

It can be difficult to distinguish the difference between the disorders and make a correct diagnosis.

True

Individuals with conversion disorders (and other SSDs) are not…

consciously producing their symptoms.

People who are malingering and those who have factitious disorders are…

consciously perpetrating fraud - faking symptoms of diseases or disabilities.

Dissociative Disorders

are a group of conditions involving disruptions in a person’s normally integrated functions of consciousness, memory, identity, or perception.

Dissociation only becomes pathological when the dissociative symptoms are perceived as…

disruptive or as “recurrent, jarring involuntary intrusions into executive functioning and sense of self.”

Much of our mental life involves:

automatic nonconscious processes that occur below the radar of deliberate self-awareness and monitoring.

Implicit Memory

Remembering things an individual cannot consciously recall.

Implicit Perception

Responding to sights and sounds as if they had been perceived, even though the individual cannot report that they have seen or heard them.

DSM-5 recognizes several types of pathological dissociation including:

• Depersonalization/derealization disorder

• Dissociative amnesia

• Dissociative identity disorder

Symptoms of dissociation are transdiagnostic:

associated with many different forms of psychopathology.

Derealization

One’s sense of of the reality of the outside world is temporarily lost.

Depersonalization:

one’s sense of one’s self and one’s own reality is temporarily lost.

Depersonalization/derealization disorder may be diagnosed when…

episodes become consistent and recurrent and interfere with normal functioning.

In the DSM-5, depersonalization disorder and derealization disorder are combined.

True or False

Retrograde Amnesia

is the partial or total inability to recall or identify previously acquired information or past experiences.

Anterograde Amnesia

is the partial or total inability to retain new information.

Dissociative Amnesia

is failure to recall previously stored personal information when that failure cannot be accounted for by ordinary forgetting.

The only types of memory that are affected with Dissociative Amnesia are…

1. Episodic (events experienced)

2. Autobiographical (personal events experienced)

Dissociative Fugue

Is a defense by actual flight; the person is not only amnesic for some or all aspects of their past, but also they depart from home surroundings.

What are some symptoms of Dissociative Amnesia?

• confusion about personal identity or even assumption of a new identity.

• Individuals unaware of memory loss for prior stages of their life.

• Memory of what happens during the fugue stage is intact.

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With Dissociative Amnesia, individuals semantic knowledge..

seems to be intact. Their primary deficit is their compromised episodic or autobiographical memory.

Dissociative Identity Disorder

formerly known as Multiple Personality Disorder, is a disruption of identity characterized by two or more distinct personality states as well as recurrent episodes of amnesia.

a trance occurs when…

someone experiences a temporary marked alteration in state of consciousness or activity.

In a possession trance…

alteration of consciousness or identity is replaced by a new identity that is attributed to the influence of a spirit, deity or other power.

In DID, different personalities…

emerge and are apparent to an outside observer.

Host Identity:

the one identity most frequently encountered and who carries the person’s real name.

Alter identities:

fragments of a single person. Some alters may have more knowledge than others.

Additional symptoms of DID include…

depression, self-injurious behaviors, frequent suicidal ideation and attempts, erratic behavior, headaches, hallucinations.

DID usually starts in…

childhood: most patients are in their teens, 20s and 30s at time of diagnosis.

Approximately ____ more females than males are diagnosed with DID.

3 - 9 times more

Gender differences in DID is believed to be due to…

greater proportion of childhood sexual abuse among females.

Is DID a real disorder or are people faking it?

Controversial diagnostic issue, as disorder could be used by defendants and their attorneys to try to escape punishment for crimes.

According to Trauma Theory, DID starts from…

early childhood trauma and reflects an attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse.

According to the Sociocognitive Theory, DID develops when…

a highly suggestible person learns to adopt and enact the roles of multiple identities.

Are recovered memories of abuse in DID are real or false?

Repressed memories may be false, a product of highly leading questions and suggestion techniques. It is difficult to determine which memories of abuse are real and which are false.

In terms of DID, the sociocognitive model has evolved into…

diathesis-stress model

Little is known about how to treat Dissociative Disorders successfully.

True

Hypnosis may be useful in treating which disorders?

Dissociative Disorders

Treatment for Dissociative Disorders include…

psychodynamic and insight-oriented focused on uncovering and working through the trauma and other conflicts that are thought to have led to the disorder.

What is the ultimate goal for treating dissociative disorders?

Integration of the previously separate alters and their merging into the host personality is seen as the ultimate goal of treatment. Treatment must be prolonged to be successful - often years-long.

What was Richard from the textbook experiencing?

Richard is a 46-year-old software engineer who reports a long history of many somatic complaints. His problems began in high school when he started to have headaches and pain in his chest. As time has progressed he has developed a broad range of symptoms all over his body including back pain, abdominal pain and discomfort, joint pain, feelings of dizziness, and a general sense of weakness and fatigue. During the past 20 years, Richard has seen many doctors and received numerous medical examinations. Although he has received several descriptive diagnoses that do little more than describe his symptoms, no medical explanation for his problems has been found. Richard worries constantly that something is being missed and that, on the days the tests were done, the underlying problem was somehow unable to be detected. Richard subscribes to several health newsletters and frequently uses the Internet to learn more about the possible causes of his symptoms. He realizes his current doctor is getting annoyed with his frequent visits, but he continues to worry constantly about his health.

What was Anna from the textbook experiencing?

Anna G., a 38-year-old married woman, the mother of five children, reports to a mental health clinic with the chief complaint of depression, meeting diagnostic criteria for major depressive disorder. Her marriage has been a chronically unhappy one. Anna describes her husband as an alcoholic with an unstable work history, and there have been frequent arguments revolving around finances, her sexual indifference, and her complaints of pain during intercourse. Anna describes herself as having been nervous since childhood and also as having been continuously sick from an early age. She experiences chest pain and says she has been told by doctors that she has a “nervous heart.” Anna sees physicians frequently for abdominal pain, having been diagnosed on one occasion as having a “spastic colon.” In addition to physicians, Anna has consulted chiropractors and osteopaths for backaches, pains in her extremities, and a feeling of anesthesia in her fingertips. She was recently admitted to a hospital following complaints of abdominal and chest pain and of vomiting. During this admission she received a hysterectomy. Since the surgery she has been troubled by spells of anxiety, fainting, vomiting, food intolerance, weakness, and fatigue. So far, physical examinations have failed to reveal any explanations for her symptoms.