Somatic Disorders and Dissociative Disorders

What is somatoform?

excessive thoughts, feelings, and behaviors about a bodily senesation, disproportionate & persistent thoughts about the seriousness of symptoms(s), excessive time & energy devoted to symptom(s).

Examples of somatoform symptoms

There seems to be a fullness in my head

I have numbness in my skin

I have a lump in my throat often

I do not notice my ears ringing (reversed)

Desire to pass water

Mouth becoming dry

Butterflies in stomach

Muscles twitching or jumping

Where does somatoform lay on the HiTOP spectrum?

debate on if somatoform is an independent category or apart of the internalizing section

Why is there debate about where somatoform lies on the HiTOP spectrum?

while somatoform and internalizing possess distinct features that distinguish the two dimensions, they share common genetic and environmental correlates and these factors may give rise to the underlying superspectrum of emotional dysfunction.

What is the reason for debate on where somatoform should lie on the HiTOP spectrum?

Somatoform is not really measured so it doesn’t pop. – it’s a measurement issue.

What is the difference between pain and somatoform?

Pain is psychical suffering. Somatoform is experience of physical sensations that are disproportionate or unexplained by a physical cause.

What does SSD stand for?

somatic symptom disorder

What is the prevalence of SSD?

6.7% - 17.4%

Explain somatoform w/ pain.

Patient w/ fibromyalgia whose symptoms aren’t responding to/managed by typical intervention

Disproportionate & persistent thoughts about the seriousness of pain symptoms

Disproportionately excessive time & energy devoted to pain symptoms

What is the DSM-5 criteria for somatic symptom disorder?

1. 1(+) somatic symptoms that are distressing or result in significant disruption of daily life

2. excessive thoughts, feelings, or behaviors related to the somatic symptoms or assoicated health concerns as manifested by at elast one of the following

   1. disproportionate and persistent thoughts about the seriousness of one’s symptoms

   2. persistently high-level of anxiety about health or symptoms

   3. excessive time and energy devoted to these symotoms or health concerns

3. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent

What is the DSM-5 criteria for Somatic Symptom Disorder with Predominant Pain?

somatic cymptoms predominantly involve pain

What is the DSM-5 criteria for Somatic Symptom Disorder with Persistent?

this course is characterized by severe symptoms, marked by impairment and long duration (longer than 6 months)

What is the DSM-5 criteria for Somatic Symptom Disorder for mild severity?

only one of the symotoms specified in criterion B is fulfilled

What is the DSM-5 criteria for Somatic Symptom Disorder for moderate severity?

2(+) symptoms in criterion B is fulfilled

What is the DSM-5 criteria for Somatic Symptom Disorder for severe severity?

2(+) of the symptoms specified in criterion B are fulfilled, plus there are multiple somatic complaints. (or one very sever somatic symptom)

What is the DSM-5 criteria for Illness Anxiety Disorder?

A. Preoccupation with having or acquiring a serious illness

B. Somatic symptoms are not present, or if present, are only mid in intensity. If another medical conition is present of there is a high risk fir developing a medical condition, the preoccupation is clearly excessive or disproportionate.

C. There is a high level of anxiety about health and the person is easily alarmed about personal health status

D. The person performs excessive health-related behaviors or exhibits malaadaptive avoidance.

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obessive-compulsive disorder, or delusional disorder, somatic type.

What are the subtypes of Illness Anxiety Disorder?

care-seeking type (medical care, including physician cisits or undergoing tests and prodcedures, is frequently used)

care-avoidant type (medical care is rarely used)

What is functional neurological symptom disorder (conversion disorder)?

a somatic disorder in which a pt presents with neuological symptoms (numbness, blindness, paralysis, or fits, that are not consistent with an organix cause, causes significant distress, and can be traced back to a psychological trigger.

What are symptoms of functional neurological symptom disorder?

• blindness

• partial or total paralysis

• inability to speak

• deafness

• numbness

• difficulty swallowing

• incontinence

• balance problems

• seizures

• tremors

• difficulty walking.

What is factitious disorder?

a person acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms to attain a pts role.

What is factitous disorder imposed on another?

also called Muchausen syndrome by proxy, a condition where a person deliberately produces, feigns, or exaggerates the symptoms of someone in their care.

What are the Six Types of DSM-5 Dissociative Disorders?

1. Dissociative Identity Disorder

2. Dissociative Amnesia without dissociative fugue

3. Dissociative Amnesia with dissociative fugue

4. Depersonalization/Derealization Disorder

5. Other Specified Dissociative Disorder

6. Unspecified Dissociative Disorder

What are dissociative disorders characterized by?

an individual becoming split off or dissociated from their core sense of self. Memory and identity become distrubed; these distubances have a psychological rather than physical cause.

What is the defintion of depersonalization?

a feeling of detachment or estrangement from one’s self; feeling as if you are an onlooker of your own body

What are the core themes of depersonalization?

1. Detachment from the world and one’s self

2. Embodiment, denoting unusual or changing experiences of the body

3. Identity changes, a lack of congruence between one’s felt self and words/actions

What is the definition of derelization?

An alteration in the perception of one’s surroundings so that a sense of reality of the external world is lost. The world you are experiencing doesn’t seem real.

What is teh definiton of Dissociative Amnesia?

when dissociation causes memory loss

Explain how memory works.

• Encoding: the receival and interpretation of information

  • the act of getting info into our memory from either automatic and effortful processing

• Storage: Maintaining information over time

  • the retention of encoded information

• Retrieval: the ability to access information when you need it

  • act of getting information out of storage and into awareness through recall and recognition

What are the 2 types of dissociative amnesia?

1. Retrograde: affects finding old memories. 

2. Anterograde: blocks the formation or storage of new memories

What is Identity Confusion?

thoughts and feelings of uncertainty and conflict a person has related to their identity. “At times it seems as if someone else inside of me decides what I do.”

What is Identity Alteration?

Manifestations of alters (or alternative identities) containing and expressing differing opinions, perceptions, and senses of self.

What is the DSM-5 criteria for Dissociative Identity Disorder?

A. Disruption of identity characterized by two or more distinct personality states which may be described in some sultures as an experience of possession. The disruption in identiy involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs ans symtoms may be observed by others or reported by the individual.

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

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

D. The distrubance is not a normal part os a broadly assepted cultural or religious practice.

E. The symptoms are not attributable to the physiological effects of a substance or another medical condition.

What is the prevalence of dissoicative identity disorder?

1.5% for 12-month prevalence

What does DID stand for?

dissoicative identity disorder

What is the DSM-5 criteria for Dissociative Amnesia +/- dissociative fugue?

A. An inability to recall important autobiographical inforation, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

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

C. The disturbance is not attributable to the physiological effects of a substance, neurological of other medical condition.

D. The distrubance is not better explained by DID, PTSD, acute stress disorder, somatic symptom disorder, of major/mild neurocognitive disorder.

F. WITH FUGUE: apparently purposeful travel or bewildered wandering that is associated with amnesia for identity of for other important autobiographical information.

What is a dissociative fugure?

A temporary state where a person has memory loss (amnesia) and ends up in an unexpected place. People with this symptom can't remember who they are or details about their past. Other names for this include a "fugue” or a “fugue state.

What is the DSM-5 criteria for depersonalization/derealization disorder?

A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both.

1. Depersonalization: experiences of unreality, detachment, orbeing an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions

2. Derealization: experiences of unreality or detachment with respect to surroundings

B. During the depersonalization or derealization experiences, reality testing remains intact,

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

D. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

E. The distrubance is not better explained by another mental disorder, such as schizophreniz, panic diorder, MDD, acute stress disorder, PTSD, or another dissociative disorder.

What is the 12-month prevalence of depersonalization/derealization disorder?

it was thought to be markedly less than for transient symptoms. 1-2%.

DSM-5 Criteria : Dissociative Identity Disorder (DID)

1. disruption of identity by 2+ distinct personality states involving a discontinuity in sense of self and sense of agency.

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

3. symptoms cause distress or impairment in day-to-day life

4. disturbance is not apart of a culture/religious practice

5. symptoms not attributable to a substance

• treatment

  • psychodynamic + insight oriented

  • goal of integration

• memory impairment: gaps in recall between different identity states or around traumatic events

• identity impairment: fragmentation, distinct alternate identities. 

• fugue states: not typically characterized.

detachment symptoms: may occur

amnesia w/ OR w/out dissociative fugue

definition 

• dissociative fugue: temporary state where a person has memory loss (amnesia) and ends up in an unexpected place, can't remember who they are, or details about their past. “fugue state".

DSM-5 Criteria

1. An inability to recall important autobiographical information inconsistent with ordinary forgetting

2. synotins cause significant distress/impairment

3. not attributed to a substance or other medical condition

4. not better explained by another dissociative disorder

   12-month prevalence

amnesia w/ dissociative fugue

• memory impairment: severe autobiographical memory loss

• identity impairment: some present during fugue states

• fugue states: present.

detachment symptoms: not main feature

amnesia w/out dissociative fugue

• memory impairment: severe gaps in autobiographical memory loss

• identity impairment: none.

• fugue states:none.

• detachment symptoms: not main feature