PSYC 2161: Chapter 7: Somatic Symptom Disorders and Dissociative Disorders SLIDES

Somatoform Disorders DSM4

If you had physical bodily symptoms that doctors couldn’t find a medical explanation

—> Reinforced mind-body dualism (mental and physical health are completely separate; OUTDATED)

1) Somatic Symptom and Related Disorders DSM5 definition

2) What was one reason why DSM5 changes were made

3) Diagnostic criteria (2)

4) How many symptoms are required for diagnosis

1. Regardless of cause, is this person experiencing significant distress, worry, or behaviour changes in response to their symptoms

2. Prevalence was low in primary care (<1%)

3. Must experience distress about physical symptom + have health anxiety/disproporionate and repetitive thoughts

4. Just one symptom is enough

Pain disorder

1) Recognized in DSM 5? If so, different name?

2) What is it

1) No. (most likely diagnosed w/ somatic symptom disorder w predominant pain)

2) Psychological factors are viewed as playing an important role in the onset, maintenance, and severity of the pain

Body Dysmorphic Disorder (BDD)

1) Recognized in DSM-5? If so, different name?

2) If so, what is it

1) Yes —> Under OCD

2) Preoccupation with imagined or exaggerated defects in physical appearance

Hypochondriasis

1) Recognized in DSM-5? Different name?

2) If so, what is it

3) When does it begin; acute vs chronic course?

4) DSM5 —> Whats it called if bodily concerns are present

5) DSM5 —> Whats it called if bodily concerns are NOT present

1) No

2) Preoccupation with fears of having a serious illness

3) Early adulthood ; chronic course

4) Somatic symptom disorder

5) Illness anxiety disorder

1) What’s it called wen someone has a strong belief that unexplained bodily changes are ALWAYS a sign of serious illness

2) —> Who found that this ^ maintained health anxiety for men and women

1) Castrophizing (catastrophic misinterpretations)

2) Gautreau and colleagues (2015)

4 contributing factors of cognitive model of health anxiety

1) Critical precipitating incident

2) Previous experience of illness and related medical factors

3) Presence of inflexible or negative cognitive assumptions

4) Severity of anxiety

Conversion disorder

1) Recognized in DSM-5? Different name?

2) What is it

3) Examples (4)

1) No —> Functional Neurological Symptom Disorder

2) Sensory or motor symptoms without any physiological cause

3)

• Paralysis of arms/legs

• Seizures and coordination disturbances

• Sensation of prickling, tingling, or creeping on the skin

• Insensitivity to pain

Anaesthesias

—> Part of which disorder in DSM4/5

Sudden loss or impairment of sensations (vision, voice, smell, etc)

—> Part of conversion Disorder / Functional neurological Symptom Disorder

Hysteria

Term originally used to describe conversion disorders / functional neurological symptom disorder

Malingering

Faking an incapacity in order to avoid a responsibility

La belle indifference

1) What does it do

2) What is it characterized by

3) Diagnostic of what

1. Helps differentiate conversion disorder from malingering

2. Characterized by a relative lack of concern of blase attitude towards the symptoms

3. Diagnostic of conversion disorder

Factitious Disorder

1) What is it

2) Compared to malingering, are symptoms more or less obviously linked to some benefit or secondary gain

1. Intentionally produce symptoms (usually physical such as pain) or cause self-injury

2. LESS obviously linked to some benefit/gain

Theories of Conversion Disorders

PSYCHOANALYTIC THEORY

1) What is it

2) Freud

3) Modern psychodynamic evidence

Specific symptoms related to traumatic events

Freud: Unresolved Electra Complex (sexual attachment to father)

People SAY they can’t see but still respond to visual info (hysterical blindness study)

Theories of Conversion Disorders:

BEHAVIOURAL THEORY + COGNITIVE FACTORS

1) What is it similar to

2) What does research show conversion symptoms were linked with

3) Ullmann + Krasner: Conversion symptoms are ______ learned and reinforced

4) Cognitive factors: people with conversion disorders often(4)

1) Malingering

2) Deficits in attention, executive functioning, and working memory

3) Role enactments

4)

• Downplay psychological causes

• Hold strong illness beliefs

• Avoid acknowledging stress

• Suppress emotional distress

Theories of Conversion Disorders:

SOCIAL AND CULTURAL FACTORS

1) Increase or decrease of conversion disorder in last century

2) Increase incidence among which group of people

• Decrease incidence of conversion disorder in the last century

• Increase among people with lower socio-economic status and from rural areas

Theories of Conversion Disorders:

BIOLOGICAL FACTORS IN CONVERSION DISORDER

1) Level of evidence

2) Conversion symptoms more likely to occur on left or right side of body

3) When processing stressful events, people with conversion disorder have a failure to activate the ____ when processing stress and the connectivity between the ____ and ___ areas of the brain are ____ in these people

1) low

2) left

3)

• Right inferior frontal cortex

• Amygdala

• Motor

• Enhances

Theories of Conversion Disorders:

BIOPSYCHOSOCIAL MODEL

1. Triggering life events (abuse)

2. Perpetuating factors (life stress)

3. Risk factors (social class)

Dissociative Amnesia

1) What is it? Is it permanent

2) What is total amnesia

3) How long does it last? Is recovery gradual or sudden

1. Memory loss following a stressful experience

—> Information not permanently list, but cannot be retrieved during episode of amnesia

2. Patient does not recognize friends/relatives but retains ability to talk/read/reason/talents/knowledge

3. Several hours —> Several years; disappears as suddenly as onset

Dissociative Fugue

1) What is it

Memory loss more EXTENSIVE than in dissociative amnesia

• Person becomes totally amnesic and suddenly leaves home and work and assumes a new identity

**Usually triggered by stress

Depersonalization / Derealization Disorder

1) What is it

2) What causes it

3) When does it start; acute or chronic course

4) Comorbid with what (3)

5) People with this disorder may feel WHAT two things

1. Person’s perception or experience of the self is disconcertingly and disruptively altered

2. Stress

3. Adolescence —> Chronic course

4. Anxiety, depression, personality disorders

5. That their extremities have changed in size OR that they’re watching themselves from a distance

Dissociative Identity Disorder (DID)

1) Diagnosis requirement

2) Who is the treatment sought out by

3) Existence of alters MUST

4) Often accompanied by:

5) Begins when, diagnosed when

6) More common in women or men

1. Person has at least two separate ego states (called alters) that exist independently of each other ; alters emerge and are in control at different times

2. Primary alter

3. Be long lasting and cause considerable disruption in one’s life

4. Often accompanied by:

   • Headaches

   • Substance abuse

   • Phobias

   • Hallucinations

   • Suicide attempts

   • Sexual dysfunction

   • Self abuse behaviour

   • Other dissociative symptoms like amnesia and depersonalization

5. Begins in childhood but rarely diagnosed until adulthood

6. More common in WOMEN

ETIOLOGY OF DID

Psychoanalytic + Behavioural Perspectives

Dissociation as an avoidance response that protects the person from memories of traumatic experiences

ETIOLOGY OF DID

Trauma model of dissociation

DID is a result of severe physical or sexual abuse

ETIOLOGY OF DID

Fantasy model of dissociation

Individuals with DID are prone to engage in fantasy

—> Research suggests empirical support for TRAUMA model NOT fantasy

Treatment of dissociative disorders

_____________________________

Treatment of DID

1. Psychoanalytic Treatment

   1. Goal = Lift repression of traumatic events

2. Treatments for PTSD trauma applied to dissociative disorders

DID = Hypnosis used for age regression in hopes of integration of the several personalities

Witthoft’s 4 main clusters of somatic symptom distress

1. Gastrointestinal symptoms (nausea, diarrhea)

2. Fatigue

3. Cardiopulmonary symptoms (chest pain, SOB)

4. Pain symptoms (generalized or localized)