Comprehensive Guide to Somatic, Dissociative, and Eating Disorders in Psychiatry

What are somatic symptom disorders characterized by?

Physical symptoms without a medical cause, abnormal thoughts, feelings, behaviors, and resulting distress and dysfunction.

What genetic factor is associated with somatic symptom disorders?

Presents in 20% of first-degree female relatives of female patients, higher in monozygotic twins.

What environmental factors contribute to somatic symptom disorders?

Environmental learning, early trauma, societal devaluation of psychological distress, and school stressors.

What psychological theory relates to somatic symptom disorders?

Maladaptive/anxious attachment, perceived rejection, and difficulty expressing distress verbally.

What is the clinical picture of Somatic Symptom Disorder?

Multiple physical symptoms, significant distress, impaired functioning, obsession with health concerns, and persistent symptoms.

What is Illness Anxiety Disorder also known as?

Hypochondriasis.

What characterizes Conversion Disorder?

Impaired motor or sensory function complaints inconsistent with known neurologic conditions.

What is the difference between somatic symptom disorders and factitious disorders?

Somatic disorders are affected by stress or psychological factors, while factitious disorders involve fabrication of symptoms for attention.

What is Factitious Disorder Imposed on Self?

Deliberate symptom fabrication or self-injury without obvious secondary gain.

What is malingering?

Faking injury for obvious secondary gain, such as money or avoiding responsibilities.

What are primary gains in the context of somatic disorders?

Internal benefits such as gaining sympathy or feeling less guilt.

What are secondary gains?

External benefits obtained by faking illness, like avoiding work or legal obligations.

What is the nursing assessment focus for somatic symptom disorders?

History of past symptoms, current physical and mental status, and assessing for primary and secondary gains.

What are common nursing diagnoses for somatic symptom disorders?

Ineffective coping, distorted perceptions of symptoms, chronic pain of psychological origin, and dependence on medications.

What are the hallmark characteristics of dissociative disorders?

Disturbances in consciousness, memory, identity, and perception, often as a defense against overwhelming anxiety.

What is Depersonalization?

Feeling like you are watching yourself from outside your body.

What is Derealization?

Feeling unreal, detached, or with a distorted sense of time or perception.

What is Dissociative Amnesia?

Psychologically induced memory loss after a severe stressor, with inability to recall important personal information.

What is the difference between somatic symptom disorders and dissociative disorders?

Somatic disorders involve physical symptoms without medical evidence, while dissociative disorders involve mental detachment from consciousness.

What is the nursing intervention for patients with somatic symptom disorders?

Offer support during diagnostic tests, avoid reinforcing complaints, and teach stress reduction techniques.

What is the role of cognitive style in somatic symptom disorders?

Patients may misinterpret physical stimuli and have a reality distortion regarding their symptoms.

What is the significance of Paul Briquet's study in 1859?

He studied hysteria, which is now related to somatic symptom disorders.

What is the clinical picture of Illness Anxiety Disorder?

Persistent high anxiety over health, alarmed by body sensations, with or without mild symptoms.

What are the co-morbidities associated with Conversion Disorder?

Childhood abuse, depression, anxiety, and personality disorders.

What is the nursing diagnosis 'Powerlessness' related to?

It relates to the patient's feeling of lack of control over their symptoms or situation.

What is the primary motivation for Factitious Disorder Imposed on Another?

Attention or nurturing for the perpetrator at the expense of a dependent victim.

What is the outcome criteria for patients with somatic symptom disorders?

Patients will articulate feelings, resume work roles, identify ineffective coping patterns, and allow family involvement.

What is dissociative amnesia with fugue?

A condition characterized by sudden, unexpected travel from a customary locale and inability to recall one's identity after a traumatic event.

Provide an example scenario of dissociative amnesia with fugue.

Lin, a 19-year-old, was found wandering in a parking lot and could not recall her identity after her fiancé canceled their wedding.

What is dissociative identity disorder (DID)?

Formerly known as multiple personality disorder, DID involves the presence of two or more distinct personality states that control behavior.

What predisposes an individual to develop dissociative identity disorder?

Severe sexual, physical, and/or psychological trauma in childhood.

Describe a scenario that illustrates dissociative identity disorder.

Taylor, a 23-year-old, presents with different behaviors and memory lapses during visits to a health center.

What are key components to assess in dissociative disorders?

Patient history, mood, substance use, and the effect on the patient and family.

What are some expected outcomes for patients with dissociative disorders?

Patients will verbalize a clear sense of identity, report decreased stress, plan coping strategies, and refrain from self-injury.

What communication guidelines should be followed for patients with dissociative disorders?

Use gentle, supportive communication to build rapport.

What is the importance of early treatment for childhood mental health disorders?

Early treatment is crucial to prevent complications, such as suicide, which is a leading cause of death in young people.

What are common barriers to treatment for children with mental health disorders?

Stigma, scarcity of providers, cost of care, and parental factors.

What are the causes of intellectual developmental disorder (IDD)?

Causes may include heredity, alterations in embryonic development, pregnancy complications, and trauma.

How is the severity of IDD determined?

Severity is assessed through conceptual, social, and practical domains, rather than IQ alone.

What are some key components of an Individualized Educational Plan (IEP)?

IEPs provide appropriate schooling and support for students with disabilities until 12th grade.

What defines Autism Spectrum Disorders (ASDs)?

ASDs are characterized by deficits in social and communication interactions, along with repetitive patterns of behavior.

What are the severity levels of Autism Spectrum Disorders based on?

Severity levels are based on functional ability, social deficits, and communication skills.

What are some common deficits seen in individuals with ASD?

Deficits include social and emotional reciprocity, and verbal/nonverbal communicative behaviors.

What environmental factors are suspected to contribute to the rise in autism rates?

Suspected factors include viruses, heavy metals, pesticides, and certain chemicals in household products.

What is the significance of resilience in children facing adversity?

Resilience helps children adapt and thrive despite hardships, often supported by good parenting or mentoring.

What role does brain plasticity play in childhood development?

Brain plasticity allows the brain to adapt and change in response to experiences, especially critical in the first five years of life.

What is the prevalence of mental disorders in children and adolescents?

Approximately 21% of those under age 21 have a serious mental disorder, but only a fifth receive treatment.

What is the relationship between comorbidity and childhood mental health disorders?

Children with mental illness often meet criteria for multiple diagnostic categories, complicating treatment.

What are the DSM-5 domains used to determine the severity of IDD?

Conceptual, social, and practical domains are used to assess severity.

What is the impact of adverse childhood experiences (ACEs) on development?

ACEs are associated with problems in school and can affect emotional and physical health.

What is the significance of therapeutic alliances in treating dissociative disorders?

Therapeutic alliances foster trust and improve treatment outcomes for patients.

What are some effective treatment strategies for dissociative disorders?

Psychotherapy is the most effective treatment, along with coping skills and stress management techniques.

What is a common social deficit observed in children with Autism Spectrum Disorder (ASD)?

Poor eye contact

At what age are children usually diagnosed with Autism Spectrum Disorder?

Around toddler-hood

What percentage of children with ASD have a co-morbid mental condition?

Two thirds

What is one type of therapy used in the implementation of ASD treatment?

Cognitive therapies

What are the three presentations of Attention Deficit Disorders (ADD/ADHD)?

Combined Presentation, Predominantly Inattentive Presentation, Predominantly Hyperactive or Impulsive Presentation

What assessment tool is commonly used for diagnosing ADHD?

Vanderbilt Assessment Scale

What are two stimulant medications used to treat ADHD?

Methylphenidate (Ritalin) and Dextroamphetamine (Adderall)

What is Developmental Coordination Disorder characterized by?

Delayed coordinated motor skills, clumsiness, and difficulty with handwriting

What is a common treatment for Tourette's disorder?

Comprehensive Behavioural Intervention for Tics (CBIT)

What is Separation Anxiety Disorder?

Developmentally inappropriate fear of separation from the person to whom the child is most attached

What is Selective Mutism?

Consistent failure to speak in situations where speaking is expected, despite being able to speak at other times

What are two common types of phobias in childhood?

Fear of the dark and fear of monsters

What is Trichotillomania?

Recurrent twisting or pulling out one's hair resulting in hair loss

What is Reactive Attachment Disorder?

A consistent pattern of inhibited, emotionally withdrawn behavior in children

What is Pica?

Persistent eating of non-food substances not part of a culturally accepted ritual

What is Enuresis?

Repeated voiding of urine into bed or clothes, considered normal until age 5

What is Oppositional Defiant Disorder (ODD)?

A disorder characterized by angry mood and defiant behaviors

What distinguishes Conduct Disorder from ODD?

Conduct Disorder is more severe, involving physical aggression and lack of guilt

What is a common cognitive distortion seen in eating disorders?

All or Nothing thinking

What is the treatment approach for feeding and eating disorders?

Therapy to retrain behaviors and monitor weight and nutrition

What is the role of SSRIs in treating anxiety disorders?

They can be used as antidepressants to help manage anxiety symptoms

What is the significance of the DSM-5 criteria in diagnosing childhood disorders?

It provides standardized criteria for assessment and diagnosis

What is Cognitive-Behavioral Therapy (CBT) used for in childhood disorders?

To address anxiety, OCD, and other behavioral issues

What is the importance of early intervention in ASD?

It can significantly improve outcomes for children with ASD

What are the two types of Elimination Disorders?

Enuresis and Encopresis

What is the goal of parent management training in treating disruptive disorders?

To help parents manage their child's behavior effectively

What underlying emotions are connected to eating disorders (EDs)?

Anxiety, dysphoria, low self-esteem, feelings of lack of control.

What is the estimated lifetime prevalence rate for developing anorexia nervosa in women?

1%

What is the estimated lifetime prevalence rate for developing bulimia nervosa in men?

0.5%

What factors influence the prevalence of eating disorders?

Cultural influences and social norms.

At what age does anorexia nervosa typically appear?

Early to middle adolescence.

At what age does bulimia nervosa typically appear?

Late adolescence.

What percentage of people with anorexia have another psychiatric disorder?

More than 50%.

What are common co-morbid psychiatric disorders with eating disorders?

Mood disorders, anxiety disorders, substance abuse, body dysmorphic disorders.

What personality traits are commonly associated with anorexia nervosa?

Perfectionism, rigidity, risk and harm avoidance.

What personality traits are commonly associated with bulimia nervosa?

Impulsivity and emotional dysregulation.

What is the core psychopathologic characteristic of eating disorders?

Low self-esteem and self-doubts about personal worth.

What are some clinical signs of anorexia nervosa?

Bradycardia, hypotension, electrolyte imbalances, amenorrhea.

What is the acute treatment phase for anorexia nervosa?

Establishment of trust, monitoring weight and eating, milieu therapy.

What medication has shown some efficacy in treating anorexia nervosa?

Olanzapine (Zyprexa).

What are common clinical signs of bulimia nervosa?

Cardiomyopathy, electrolyte imbalances, erosion of teeth.

What is a key therapeutic approach for bulimia nervosa?

Cognitive-behavioral therapy (CBT).

What distinguishes binge-eating disorder from other eating disorders?

Recurrent episodes of eating large amounts of food with feelings of disgust and guilt.

What is the relationship between dieting and binge eating in bulimia nervosa?

Dieting is almost always an antecedent of binge eating.

What is the DSM-5's recognition of binge-eating disorder?

It is now recognized as a specific disorder.

What is the prevalence of mood disorders among binge eaters?

High rates of mood disorders and personality disorders are found among binge eaters.

What is a common treatment approach for obese binge eaters?

Integration of mood modification and weight management.

What is the significance of the Academy for Eating Disorders (AED) in relation to eating disorders?

They advise assessing for psychiatric risk, including suicidal thoughts.