PSYCH 2AP3 WEEKS 8-12

this is like a good chunk of the final exam yeah

Somatic Symptom Disorder

involves expression of psychological issues through bodily symptoms without any known medical condition

Psychogenic Seizure

not an identifiable medical condition, created by abnormal electrical activity without a cause

True or false: a person with somatic symptom disorder must have preoccupation with experienced symptoms for a diagnosis and spend a lot of mental energy worrying about physical symptoms

true

Why is it difficult to diagnose somatic symptom disorders?

their concerns with health are seen in anxiety disorders like GAD and OCD

What do clinicians rely on when differentiating disorders from one another?

expert subjectivity (e.g., “is this person performing compulsive behaviours?” → OCD, not SSD)

What does somatic symptom disorder look like?

persistently high levels of anxiety about health or symptoms and excessive energy spent devoted to these concerns

How persistent is somatic symptom disorder?

6+ months

Illness Anxiety Disorder

can have physical symptoms which are mild or absent, has preoccupation about becoming sick, and repetitive behaviours

What do people with illness anxiety disorder worry about the most?

getting sick

What are repetitive behaviours seen in illness anxiety disorder?

reassurance seeking, self-monitoring (e.g., continuously checking blood pressure), avoiding feared situations

What are two issues people with illness anxiety disorder have with doctors?

1. Doctor reassures individual → individual feels they are not being listened to

2. Refuses to visit doctor in fear their concerns will be confirmed

What is illness anxiety disorder comorbid with?

depressive disorders

Are somatic symptoms present in illness anxiety disorder?

no, but if they are, they are only mild in intensity

Can the feared illness change over time?

yes, an individual can be concerned with influenza for 3 months and then switch to COVID-19

What is the difference between SSD and IAD?

• SSD = mild to severe present pain that an individual is preoccupied with

• IAD = abstract concern of becoming sick in the future, symptoms are mild

Is the onset of IAD late or early?

late

Which group is most susceptible to IAD and why?

unmarried women of low SES; due to concerns with health and not having a partner to reassure them

What are psychological factors to SSD and IAD?

• poor self-awareness of presence of physical symptoms → not good at regulating their emotions

• lack of understanding of emotional stress and its relation to physical function

How are behavioural principles like modelling and reinforcement factors to SSD and IAD?

child has sick sibling → models sick role → being sick garners attention → reinforced

Somatic Amplification

tendency to perceive any bodily sensation as more intense than somebody would experience or think, creates inaccurate beliefs about conditions

How does CBT help with individuals with SSD or IAD?

learning to socialize → make friends and have better social supports

FNSD

marked by sudden loss of functioning in a part of the body, usually following an extreme psychological stressor, cannot be explained by other phenomena

What kinds of symptoms are found in FNSD?

motor, globus (mouth), sensory abnormalities (most severe)

La Belle Indifference

substantial emotional indifference to the presence of these dramatic physical symptoms

Do symptoms of FNSD follow known neurological patterns of the human body?

no

How does FNSD override typical neurological patterns of the body?

in glove anesthesia, patients report loss of sensation in the hand. Nerves extend from the finger tips to the spinal cord, thus the numbness would follow this route and not localize at just the hand

Why don’t FNSD patients seek out psychological treatment?

doctors cannot find a reason for their condition and says it is psychological, creating a resistance to treatment

What was Freud’s hypothesis on FNSD?

people are unconsciously repressing anxiety or stress, may eventually boil over and creates physical sensations

What are the interpersonal factors behind FNSD?

substantial stress

What is the treatment for FNSD?

stress reduction, but it is not very effective as they seek out medical treatment

CBT Thought Record

helps client learn how thoughts are brought up and how it affects their thinking, feeling, and behaviour

How do thought records help with FNSD?

interprets symptoms in an adaptive manner, driving the individual to either go to the doctor or avoid the doctor depending on their circumstances

Factitious Disorder

physical or psychological symptoms intentionally produced in what appears to be a desire to assume a sick role, done to acquire special attention

Malingering

person intentionally produces physical symptoms to avoid something aversive

What is the distinction between factitious disorder and malingering?

whether or not there are tangible or external incentives

Factitious Disorder Imposed on Self

deceptive practices to produce signs of illness on self, invents false demographics and fakes symptoms

Factitious Disorder Imposed on Another

deceptive practices to produce signs of illness in someone else, form of child abuse, child is typically unaware

Typical Child Abuse

results from direct physical contact, conceals injuries, children receive punishment, children know they are being abused

Atypical Child Abuse (Factitious Disorder)

misrepresents child’s illness, brings child to the attention of healthcare staff, children serve as pawns in gaining attention, child has no idea what is going on

Doctor Shopping

not getting what they want from one doctor and moves on to another doctor, uses more than fair share of resources

What are cognitive aspects of SSD?

experiencing a symptom and assuming it is the worst

What are behavioural aspects of SSD?

constant checking behaviour

Dissociative Disorder

severe maladaptive disruptions or alterations of identity, memory, and consciousness that are experienced as being beyond one’s control

Dissociation

lack of normal integration of thoughts, feelings, and experiences in consciousness and memory

What does typical dissociation look like?

getting lost into a book, feeling like you are in story

Generalized Dissociative Amnesia

inability to remember anything, including their identity

Localized Dissociative Amnesia

inability to remember specific events (usually traumatic), seen in adulthood and rarely in childhood

Dissociative Fugue

subtype of dissociative amnesia, loss of memory of past and personally identity, also travels someplace suddenly

Dissociative Amnesia

involves an inability to recall important autobiographical information typically of a traumatic or stressful information

Depersonalization-Derealization Disorder

detachment from sense of self or reality, outside observer of own body or mind

Depersonalization

internal, lose sense of own reality

Derealization

external, lose sense of reality of external world

What are some causes of depersonalization-derealization disorder?

a traumatic event or consuming psychedelics

What is a biological factor of depersonalization-derealization disorder?

dysregulation in HPA axis → deficits in emotional regulation

Is reality testing intact for people with depersonalization-derealization disorder?

yes, differentiates from psychotic disorders

What is depersonalization-derealization disorder comorbid with?

depression, PTSD, and anxiety disorders

Is the treatment for dissociative amnesia?

no, it resolves without treatment

Is CBT helpful for depersonalization-derealization disorder?

only helpful for depersonalization

Dissociative Identity Disorder

several identities co-exist simultaneously, average amount of alters is 15, childhood onset

What disorders are comorbid with DID?

PTSD, depression, anxiety disorders

Alters

the different identities or personalities

Switch

instantaneous transition from one personality to another, 37% report changes in handedness to another

Which identity in DID typically asks for treatment?

host identity (original personality)

Are imaginary friends and other fantasy play signs of DID in childhood?

no, this is typical in childhood

Posttraumatic Model

somebody who has developed DID has lived through horrific child abuse, mind tries a way to protect them by creating a protector alter

What is a criticism of the posttraumatic model?

childhood abuse predisposes anybody to any type of disorder in general, but not the development of a particular disorder

Suggestibility Hypothesis

dissociation is used as a coping mechanism, detaching because they are undergoing something horrific

Autohypnotic Model

one’s ability to hypnotize themself, suggestible people may use dissociation as a defence against trauma, less suggestible

What was an issue with the diagnosis of DID during the 1990s?

therapists were not great at asking open ended questions, rather, asked leading questions which created false memories

True or false: therapy might have created a higher prevalence of DID.

true

Is DID inherited?

no, parents who have DID do not seem to pass it on to their children

What kinds of seizures are associated with DID symptoms?

temporal lobe epileptic seizures

When do dissociative symptoms tend to worsen?

when the person is tired

What is the treatment for DID?

long-term psychotherapy

What is the goal of psychotherapy in DID?

to reintegrate all personalities together and uncover their trauma

Mood Disorder

involves gross deviations in mood

Anhedonia

unique feature of depression and bipolar disorders, inability to feel pleasure even if an activity was pleasurable in the past

Mania

opposite of anhedonia, extreme pleasure in every activity where everything feels good, excessive euphoria

Hypomanic Episode

not as much dysfunction and does not get in the way of one’s life, less severe version of a manic episode (e.g., foolish investment choice)

Unipolar Mood Disorder

either depression or mania, not both (typically goes towards the depression / anhedonia side)

Bipolar

alternate between depression and mania

Mixed Features

describes experience of both (can be in a manic episode but still feels depressed in that same moment)

Major Depressive Disorder

depressed for most of the day, for most days up to 2 weeks, has physical and cognitive symptoms

Average duration of first episode if untreated is __ months.

9

Is it possible to have only one major depressive disorder in MDD?

yes, but most have more than one

Recurrent Depression

2 or more episodes separated by at least 2 months

What is the median number of depressive episodes?

4-7

What is the median duration of recurrent episodes?

4-5 months because they recognize it

True or false: having a diagnosis for MDD does not require recurrent episodes.

false, episodes are recurrent and if they are not they are usually a comorbid condition

How does depression differ between the sexes?

• men = irritable and angry

• women = sad and guilty

Persistent Depressive Disorder

chronic state of depression, does not tend to return to mood baseline, symptoms present for at least 2 years but individual is never without symptoms for more than 2 months

Is PDD less severe?

no, chronicity of PDD creates more dysfunction which leads to more severe outcomes

Are people with PDD less responsive to treatment?

yes

Double Depression

individuals who suffer with both major depression episodes and PDD, even more severe psychopathology and problematic course

Specifier

helps inform clinicians about prognosis and treatment of disorder, categorized as either mild, moderate, or severe

What indicates how severe a disorder is?

number of symptoms

MDD with Peripartum Onset

lower levels of depression or anhedonia shortly after the baby is born (affects both birthing and non-birthing parent)

True or false: depression ranks 4th in terms of global burden of disease.

true

What is the mean age of onset for MDD?

25 years old but it may be decreasing, trend toward developing depression at increasingly earlier ages

True or false: earlier PDD onset has poorer outcomes than adult onset, will persist longer

true