2AP3 - Chapter 6 - Somatic/dissociative disorders

What are Somatic Symptom and Related Disorders?

These are a group of disorders characterized by excessive thoughts, feelings, and behaviors related to somatic symptoms. These individuals experience real physical symptoms, but the physical pain cannot be fully explained by a medical condition.

What is the prevalence of physical symptoms in the general population?

85% to 95% of people experience at least one physical symptom every 2–4 weeks, commonly including chest pain, abdominal pain, dizziness, headaches, and fatigue.

What is the role of physicians in managing these symptoms?

Physicians often reassure patients by saying “nothing is wrong” when no organic cause is found, but the symptoms persist.

What is Somatic Symptom Disorder (SSD)?

SSD involves the presence of real physical symptoms (e.g., chest pain, back pain, headaches), and excessive concern about these symptoms. Patients experience pain and distress despite no clear medical cause.

What are the common symptoms of SSD?

Pain (e.g., back pain, chest pain), gastrointestinal distress, psychogenic seizures, headaches, and fatigue.

What is the role of excessive thoughts, feelings, and behaviors in SSD?

Patients with SSD often exhibit disproportionate thoughts about the seriousness of their symptoms, leading to anxiety and preoccupation with their health.

What is Illness Anxiety Disorder (IAD)?

IAD is characterized by preoccupation with having or acquiring a serious illness, even in the absence of physical symptoms or with only mild symptoms.

What are the common symptoms of IAD?

Patients are extremely anxious about their health and often seek reassurance from physicians. They may repeatedly check for symptoms, but reassurance is not helpful.

What are the key diagnostic criteria for IAD?

A. Preoccupation with having or acquiring a serious illness. B. Somatic symptoms are absent or mild. C. There is high anxiety about health, with frequent checks for signs of illness.

What are the cognitive factors contributing to IAD?

Cognitive distortions such as somatic amplification (perceiving bodily sensations as dangerous) and catastrophizing (expecting the worst outcome) are common in IAD. These beliefs lead to health anxiety.

What is somatic amplification in IAD?

Somatic amplification refers to the exaggeration of normal bodily sensations, where individuals perceive these sensations as symptoms of a serious illness.

What is catastrophizing in IAD?

Catastrophizing involves jumping to the worst-case scenario, imagining that minor bodily symptoms are indicative of a severe illness.

What are inaccurate beliefs about illness in IAD?

1. How prevalent or contagious an illness is. 2. The meaning of bodily symptoms. 3. The course and treatment of illnesses (often expecting the worst possible outcome).

What are the psychological factors contributing to Somatic Symptom and Illness Anxiety Disorders?

Children and adults with these disorders often report more aches and pains, are less able to regulate their emotions, and have poor awareness of their emotional states.

What are the behavioral factors contributing to these disorders?

Modeling and reinforcement are important in the development of these disorders. For example, if someone receives attention or sympathy for being sick, they may continue the behavior to get those rewards.

What are the environmental stressors linked to these disorders?

Stress, childhood abuse, family separation, and family conflict are significant environmental factors that can contribute to the development of somatic symptom and illness anxiety disorders.

What is the treatment for Somatic Symptom and Illness Anxiety Disorder?

Cognitive Behavioral Therapy (CBT) helps individuals reduce stress, minimize help-seeking behaviors, and learn how to relate to others without excessive health-related worry.

How does CBT help patients with Somatic Symptom and Illness Anxiety Disorders?

CBT helps by identifying distorted cognitions, educating patients on how emotions affect physical sensations, and teaching techniques to reduce stress and avoid excessive medical reassurance.

What is Conversion Disorder (Functional Neurological Symptom Disorder - FNSD)?

Conversion Disorder, now called **Functional Neurological Symptom Disorder**, involves real physical symptoms (e.g., paralysis, blindness) that **cannot be explained by medical conditions**. The symptoms are related to **neurological dysfunction**.

What are the key symptoms of FNSD?

1. **Motor symptoms**: Impaired coordination, paralysis, tremors, or abnormal gait. 2. **Sensory symptoms**: Loss of touch or pain sensations, double vision, or blindness. 3. **Globus**: Sensation of a lump in the throat, difficulty swallowing, shortness of breath.

What is **La Belle Indifference**?

**La belle indifference** refers to the **emotional indifference** to dramatic physical symptoms. It is **not a required symptom** but is often seen in FNSD.

What is **glove anesthesia**?

**Glove anesthesia** refers to a **loss of sensation** only in the hand, but not in the arm, which is **impossible** in actual neurological disorders but common in FNSD.

What is the difference between **Conversion Disorder** and a **physical health disorder**?

1. **Motor or sensory symptoms** incompatible with neurological conditions. 2. **Symptoms not explained** by any other medical or mental disorder. 3. **Distress or impairment** in functioning.

What is the prevalence of Conversion Disorder (FNSD)?

FNSD is relatively **rare in mental health settings** but more common in **neurological settings**, with a prevalence rate of **30%**.

Who is most likely to develop FNSD?

FNSD typically develops in **adolescence**, and is more **common in women**. **Trauma** (especially childhood trauma) is often associated with its development.

What are the causes of Conversion Disorder?

1. **Repression of stress or anxiety**: Unconscious anxiety gets converted into physical symptoms. 2. **Interpersonal factors**: **Substantial stress**, such as **abuse or parental divorce**, may trigger FNSD symptoms. 3. **Social factors**: Those in **lower socioeconomic** groups or **less educated** populations are at greater risk.

What is the role of **positive reinforcement** in Conversion Disorder?

People with FNSD often receive **attention and sympathy** when they exhibit physical symptoms, reinforcing the behavior and making the symptoms more likely to persist.

What is Factitious Disorder?

Factitious Disorder (also known as **Munchausen Syndrome**) involves **intentionally producing symptoms** to **appear sick** and gain **attention** or **sympathy**.

What is the difference between **Factitious Disorder** and **Malingering**?

Factitious Disorder is driven by the **desire for attention** and **sympathy**, while **Malingering** involves **faking symptoms for external rewards** like financial compensation or avoiding responsibilities.

What are common reasons for **faking a disorder**?

**Financial incentives**, **drug-seeking behavior**, **avoiding responsibilities**, or **getting out of criminal charges**.

What is generalized dissociative amnesia?

Inability to remember anything, including identity. Triggered by major trauma. Typically involves complete memory loss of personal information.

What is localized dissociative amnesia?

Inability to remember specific events, usually traumatic ones. Triggered by major trauma. A person may forget certain events, such as a car accident, but not their personal identity.

What is the A criterion for Dissociative Identity Disorder (DID)?

Disruption of identity characterized by two or more distinct personality states. This may be described in some cultures as an experience of possession. Symptoms include alterations in affect, behavior, memory, perception, cognition, and/or sensory-motor functioning.

What is the B criterion for Dissociative Identity Disorder (DID)?

Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

What is the C criterion for Dissociative Identity Disorder (DID)?

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

What is the D criterion for Dissociative Identity Disorder (DID)?

The disturbance is not a normal part of a broadly accepted cultural or religious practice. Symptoms are not attributable to imaginary playmates or fantasy play.

What is the E criterion for Dissociative Identity Disorder (DID)?

Symptoms are not attributable to the physiological effects of a substance (e.g., alcohol intoxication) or another medical condition (e.g., complex partial seizures).

What is the posttraumatic model in the etiology of Dissociative Identity Disorder?

DID may result from severe traumatic experiences. The person may take on different identities as a way of escaping from the trauma. These identities emerge to protect the original identity from physical and emotional pain caused by trauma.

What is the criticism of the posttraumatic model for Dissociative Identity Disorder?

Childhood sexual abuse increases the risk of adult psychopathology in general, but not the development of DID. This raises questions about why some people develop DID and others develop PTSD or other disorders.

What is the suggestibility hypothesis in the etiology of Dissociative Identity Disorder?

Suggestible individuals may use dissociation as a defense against trauma. Less suggestible people may develop PTSD instead. Studies on this are inconclusive.

How does therapy relate to the development of Dissociative Identity Disorder?

DID prevalence has increased since the 1970s, possibly due to media coverage (books, movies). 80–100% of patients are unaware of alters prior to therapy. As therapy progresses, the number of alters tends to increase. The more a therapist believes in the diagnosis, the more likely they are to diagnose DID. Some therapists have used leading questions in therapy, potentially suggesting false memories or identities.

Can therapy cause DID?

There is evidence that therapists asking leading questions may create false memories of traumatic events, leading individuals to believe they have DID when they may not. False memories of abuse or molestation have been reported in some patients after therapy.

What is dissociation?

Dissociation is the lack of normal integration of thoughts, feelings, and experiences in consciousness and memory. It is a state of detachment or alteration from one's reality, experienced as being beyond one’s control.

What are some normal dissociative experiences?

Autopilot driving; Getting immersed in a very good book, movie, or video game; Jobs with repetitive tasks; Puzzles.

How is dissociation different for those with disorders compared to typical dissociative experiences?

People with dissociative disorders cannot "snap out" of dissociation and it causes distress or dysfunction. For those without disorders, dissociation doesn't cause distress, and they can usually snap out of it.

What are the general symptoms of depersonalization and derealization?

Depersonalization: Loss of sense of one's reality, feeling as though you are an outside observer of your own body or mind. Derealization: Loss of sense of reality regarding the external world, such as perceiving objects or people as unreal or dreamlike.

What are the impacts of dissociative disorders on the individual?

Severe feelings of detachment; Reality testing remains intact, meaning the person knows what is real but feels detached from it. Can cause panic attacks and deficits in emotion regulation.

What are the treatment options for dissociative amnesia?

For those whose amnesia does not resolve by itself, treatment typically does not resolve the memory loss, but therapy can address the emotional impacts.

What treatments are available for derealization disorder?

No controlled trials have been conducted for derealization, though some case studies suggest antidepressants may be helpful.

What is the treatment for depersonalization?

CBT has been shown to be effective for some people, as it helps manage stress and panic symptoms associated with depersonalization, though it does not resolve the depersonalization itself.

What is the average number of personalities in Dissociative Identity Disorder?

15 on average.

What is the host identity in Dissociative Identity Disorder?

The original identity, typically the most dominant personality. The host usually asks for treatment.

What is an alter in Dissociative Identity Disorder?

An alternate personality state. Alters can sometimes become the dominant personality.

What is a "switch" in Dissociative Identity Disorder?

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

What cultural difference exists in the diagnosis of Dissociative Identity Disorder?

In Western cultures, DID is pathologized. In Eastern cultures, it may be seen as possession or shamanic experience and not considered a disorder.