Chapter 6 – Somatic Symptom, Related, and Dissociative Disorders

Flashcards cover definitions, diagnostic criteria, epidemiology, etiology, cultural factors, and treatments for Somatic Symptom, Related, and Dissociative Disorders presented in Chapter 6.

What is the core feature shared by all Somatic Symptom and Related Disorders?

An excessive or maladaptive response to physical symptoms or health concerns.

Name the five primary Somatic Symptom and Related Disorders listed in DSM-5.

Somatic Symptom Disorder, Illness Anxiety Disorder, Psychological Factors Affecting Medical Condition, Conversion Disorder, and Factitious Disorder (plus the non-diagnostic category of malingering).

What are the diagnostic criteria for Somatic Symptom Disorder?

One or more distressing somatic symptoms, excessive thoughts/feelings/behaviors about those symptoms, clinically significant impairment, and persistence for 6+ months.

Which older label did Somatic Symptom Disorder replace?

Briquet’s syndrome.

Typical onset, sex ratio, and course of Somatic Symptom Disorder?

Often begins in adolescence, occurs more in women (≈2:1), and tends to run a chronic course.

List two commonly cited causes of Somatic Symptom Disorder.

Possible genetic contribution (family aggregation) and learned attention/reinforcement for health concerns.

What are two key treatment components for Somatic Symptom Disorder?

Cognitive-behavior therapy and use of a single ‘gate-keeper’ physician to limit medical visits.

Illness Anxiety Disorder is most similar to which DSM-IV diagnosis?

Hypochondriasis.

Describe the hallmark cognitive feature of Illness Anxiety Disorder.

Severe anxiety about having or acquiring a serious illness despite mild or absent physical symptoms.

Does medical reassurance usually reduce Illness Anxiety Disorder symptoms?

No, reassurance rarely alleviates the anxiety.

Prevalence and sex ratio for Illness Anxiety Disorder?

Approximately 1–5% of the population with an equal male-to-female ratio (1:1).

List three etiological contributors to Illness Anxiety Disorder highlighted in lecture.

Stressful life events, high family disease incidence, and perceived ‘benefits’ of being ill.

Two empirically supported treatments for Illness Anxiety Disorder?

Psychoeducation/CBT that challenges misinterpretations and stress-management strategies; antidepressants offer limited benefit.

Define the culture-specific syndrome ‘Koro.’

An anxiety condition in some Asian cultures involving fear that the genitals are retracting into the abdomen.

What is ‘Dhat’ in Indian cultures?

A condition where dizziness and fatigue are attributed to semen loss.

Give two additional culture-bound somatic complaints mentioned.

Hot sensations or crawling in the head (African patients) and burning in hands/feet (Pakistani/Indian patients).

When does DSM-5 use the diagnosis ‘Psychological Factors Affecting Medical Condition’?

When psychological variables (e.g., denial, impulsivity) adversely influence a verified medical illness (e.g., poor medication adherence).

Core diagnostic feature of Conversion Disorder (Functional Neurological Symptom Disorder).

Altered voluntary motor or sensory function inconsistent with known neurological or medical conditions.

What is ‘la belle indifference’ in Conversion Disorder?

A seemingly indifferent attitude toward significant neurological symptoms.

How is Conversion Disorder distinguished from malingering?

Symptoms are not intentionally produced for external gain in Conversion Disorder, whereas malingering involves deliberate faking for concrete benefits.

Typical epidemiology of Conversion Disorder.

Rare, onset in adolescence, more common in females, often intermittent/chronic, and frequently comorbid with anxiety or mood disorders.

Freud’s notion of primary and secondary gain in Conversion Disorder refers to what?

Primary gain: reduction of internal anxiety through symbolic symptom formation; Secondary gain: external advantages such as attention or avoidance of duties.

Treatment focus for Conversion Disorder following trauma.

Processing the trauma, treating any PTSD symptoms, and removing sources of secondary gain.

What is the defining motive in Factitious Disorder (Munchausen syndrome)?

Deliberate production or feigning of symptoms for the purpose of assuming the sick role without obvious external rewards.

Differentiate Factitious Disorder from malingering.

Factitious Disorder: motivation is internal (sick role); Malingering: motivation is external (tangible gains such as money or avoiding work).

What is Factitious Disorder Imposed on Another?

A caregiver intentionally produces or falsifies illness in a dependent person to receive attention or sympathy.

Name the primary symptoms in depersonalization and derealization.

Depersonalization: feeling detached from one’s self or body; Derealization: experiencing the external world as unreal or dream-like.

Diagnostic requirement for Depersonalization/Derealization Disorder.

Persistent or recurrent depersonalization/derealization that causes distress/impairment and is not explained by another disorder or substance.

Prevalence, onset, and comorbidity pattern of Depersonalization/Derealization Disorder.

1–3% prevalence, onset around age 16, equal sex ratio, high comorbidity with anxiety and mood disorders, often linked to trauma history.

Is there strong evidence that SSRIs help Depersonalization/Derealization Disorder?

No, SSRIs have not shown consistent benefit.

Differentiate generalized versus localized (selective) Dissociative Amnesia.

Generalized: inability to recall anything, including identity; Localized/selective: loss of memory for a specific period or event.

What is a dissociative fugue?

A subtype of amnesia where the individual travels or wanders, assumes a new identity, and cannot recall the past or how they arrived at the new location.

Define Dissociative Trance and when it becomes a disorder.

Culturally shaped possession-like state with personality change; only a disorder when it causes distress or impairment.

Key defining features of Dissociative Identity Disorder (DID).

Presence of two or more distinct personality states (alters) with discontinuity in sense of self and agency, accompanied by gaps in memory.

In DID terminology, what are ‘alters,’ the ‘host,’ and the ‘switch’?

Alters: alternate identities; Host: the main identity that manages the others; Switch: the rapid transition from one identity to another.

Most common etiological factor linked to DID.

Severe, chronic childhood trauma, particularly abuse, often without social support.

Briefly describe the autohypnotic model of DID.

Suggests highly hypnotizable children use dissociation as a self-hypnotic defense to escape unbearable trauma.

Why must therapists be cautious about ‘false memories’ in DID treatment?

Suggestion can create inaccurate memories of abuse, which may harm patients and their families.

Primary therapeutic goals in treating DID.

Reintegration of identities, processing traumatic memories, identifying and neutralizing triggers, and fostering control over dissociative episodes (sometimes aided by hypnosis).

what is the sensation of a lump in the throat that makes it difficult to swallow, eat, or sometimes talk?

globus hystericus