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by: Sanya Jaffer

Tester ECON 1011

Sanya Jaffer

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This 11 page Class Notes was uploaded by Sanya Jaffer on Saturday August 13, 2016. The Class Notes belongs to ECON 1011 at Loyola University Chicago taught by in Fall 2016. Since its upload, it has received 5 views.


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Date Created: 08/13/16
2/18/15 Ch. 8 Somatic Symptom and Dissociative Disorders What are Somatic Symptom Disorders?  Somatic Disorder: A group of conditions that involve physical symptoms and complaints suggesting the presence of a medical condition  Physical symptoms combined with abnormal cognitions and behaviors in response to the symptoms  No evidence of physical pathology  Patients have no control over their symptoms  Not faking their disorder  4 disorders in DSM-5 1. Somatic Symptom disorder 2. Illness anxiety disorder 3. Conversion disorder 4. Factitious disorder  No medical cause  Change in DSM-5 -Hypochondriasis, somatization disorder, and pain disorder are no longer separate diagnoses -Now is just one disorder called symptom disorder -Medical diagnosis is no longer a requirement Somatic Symptom Disorder  Experience chronic somatic complaint symptoms that are distressing and showing dysfunctional thoughts, feelings, behaviors  3 features in DSM-5 1. Disproportionate and persistent thoughts about seriousness of symptoms 2. Persistently high anxiety about symptoms or health 3. Excessive time/energy devoted to symptoms or health  Must show at least one of these symptoms  Can show more than one symptom  Will continue to pursue the diagnosis for their symptoms  Unnecessary tests or surgeries Hypochondriasis  Preoccupation with the fear that one has or will contract a serious disease  75% of people who would have received a diagnoses for hypochondriasis will now be diagnosed with somatic symptoms disorder  Misinterpretation of bodily signs or symptoms -Ex: faintinghead stroke  Intrusive thoughts about their symptoms  Not reassured by medical evaluations  Must persist for 6 months  Will constantly shop around for more doctors or second opinions  Prevalence rate=2-7% in general medical practice  No gender differences  Onset: early adulthood most common  If left untreated it can be chronic  Course: chronic  Comorbidity with mood disorders, panic disorders, and other somatic disorders What Causes Hypochondriasis?  Cognitive theories -Misinterpretations of bodily sensations -Past experiences lead to dysfunctional assumptions -Went to the doctor too late as a childlead to it being too late -Attentional bias for illness-related information -Judge certain diseases to be more likely than it is -Look for symptoms that match a disease they are convinced they have  Secondary reinforcements maintain behaviors -Gets more attention when sick -Like this special attention -Likes being excused from certain responsibilities -May have been around people who have been sick  Hypochondriasis reduced by onset of serious medical conditions  Folks who were diagnosed with other major medical problems (not the disorder they believe they have)reduces their hypochondriasis for other disorders How is Hypochondriasis Treated?  Cognitive-behavioral treatments are effective -6-16 sessions -Group Format -Cognitive component -Assess patient’s beliefs about illness -Modify misinterpretations of bodily sensations -Behavioral component -Inducing innocuous symptoms by having patients intentionally focus on their body -Response prevention -Not checking their bodies and not seeking reassurance from others Somatization Disorder  Somatization Disorder: History of many physical complaints beginning before age 30 that occur over a period of several years  No longer recognized in DSM-5  Cannot be explained by medical condition  Significant impairment in functioning/medical treatment  Cost health care system a lot of money  Unnecessary medical tests and treatments  DSM-IV criteria required 8 out of 33 symptoms  4 types of symptoms -Four pain symptoms -Two gastrointestinal symptoms -One sexual symptom -One pseudoneruological symptom  Great deal of overlap between somatization and hypochondriasis  No need to distinguish between somatization and hypochondriasis because they are now a common category  People are not faking; actually experience the symptoms  Prevalence: -0.2 to 2% in women -0.2% in men  Onset: adolescence  3 to 10 times more common in women  More common in lower educated and lower socioeconomic status  Course: chronic  Prognosis: poor  Comorbidity -Depression -Panic disorder -Phobic disorder -GAD What Causes Somatization Disorder?  Uncertain about developmental course and specific etiology  Genetic component? -Familial linkage between antisocial personality disorder in men and somatization disorder in women  Common link may be impulsivity?  Perceive bodily sensations as somatic symptoms -My heart is racingI’m going to have a heart attack How is Somatization Disorder Treated?  Historically, very difficult to treat!  Combination of medical management and CBT promising -Identification of one physician who integrates patient care and reduces medications and unnecessary testing  CBT should focus on: -Promoting better coping and personal adjustment -Discouraging illness behavior and preoccupation with physical symptoms  Reducing secondary gain is critical Pain Disorder  Pain Disorder: Persistent and severe pain in one or more areas of the body that is not intentionally produced or feigned  No longer in DSM-5  Person reports experiencing pain in one or more parts of the body  Acute if less than 6 months  Chronic if more than 6 months  Can be related to a medical condition  Prevalence: unknown  More common in women  Comorbidity -Anxiety disorders -Mood disorders  Great deal of social and occupational impairment -Cannot go out because of pain  Intensity and frequency of pain can be influenced by secondary gain/secondary reinforcement How is Pain Disorder Treated?  Cognitive-behavioral treatment is successful -Relaxation training -Support and validation that pain is real -Scheduling of daily activities -Cognitive restructuring -Reinforcement of “no-pain” behaviors -“Mind over matter”  Tricyclic antidepressants and SSRIs reduce pain intensity Illness Anxiety Disorder  Illness Anxiety Disorder: high anxiety about having or developing a serious illness -Somatic symptoms are NOT present  New to the DSM-5  Anxiety is distressing and/or disrupting to their lives  Excessive health-related behaviors  Worry about developing disorder; not misinterpreting the bodily sensations  Ex: obsessed with the fact that you might develop cancer  Present for 6 months  25% of those diagnosed with hypochondriasis in DSM-IV will be diagnosed with illness anxiety disorder in DSM-5 Conversion Disorder (Functional Neurological Symptom Disorder)  Conversion Disorder: Symptoms or deficits affecting sensory or voluntary motor functions that suggest a medical or neurological condition  Psychological factors play a role  Ex: paralysis or blindness due to psychological reasons  Originally termed as hysteria  Some of Freud’s ideas are still used: -Primary gain: Continued escape or avoidance of a stressor -Secondary gain: Any external circumstance that reinforces/maintains the disabilityex: attention from loved ones  We don’t know the causes  Common during WWI and WWII -Paralysis of the leg, blindness -Soldiers during stressful conditions/environments  Current prevalence: 1-3% of all disorders referred for treatment -Prevalence in patients at neurology clinics=50% -Prevalence in general population=0.005%?  2-3 times more common among women  More common among rural populations from lower socioeconomic status  Onset: generally rapid onset after significant stressor -Often resolves within 2 weeks if stressor is removed Range of Conversion Disorder Symptoms  Sensory symptoms or deficits -Visual systemblindness -Auditory systemdeafness -Sensitivity to feelingGlove anesthesia -Person may report not being able to see anything, but they can navigate around a room without bumping into anything -Are they deceiving sensory information or not receiving it? -Sensory input likely received, but screened out from consciousness  Motor symptoms or deficits -Paralysisusually confined to a single limb and selective for certain functions. Ex: cannot write but can use that same hand for scratching -Aphoriaunable to speak above a whisper -Globus Hystericusdifficulty swallowing  Seizures -Pseudoseizures -No EEG abnormalities -No confusion or memory loss Treatment of Conversion Disorder  Neurological testing has reduced rates of misdiagnosis  No well-controlled treatment studies have been conducted  Motor conversion symptoms have been successfully treated with behavioral therapy and reinforcements -Remove secondary gain  CBT has shown some effectiveness for psychogenic seizures  Some effectiveness in hypnosis What About Faking?  Malingering: when a person intentionally produces physical symptoms and is motivated by external incentives -Ex: to avoid work, prison, military service, to get money from others  Factitious disorder: a person intentionally produces symptoms and has no external incentives  People who are faking do NOT want to talk about it -Don’t want to be caught in a loophole  How to tell someone is faking: -Defensive, evasive and suspicious -Reluctant to be examined -Less likely to talk about their symptoms What Are Dissociative Disorders?  Dissociative Disorders: group of conditions involving disruptions in consciousness, memory, identity, and perception  Cannot remember where they came from or who they are  May have more than one personality that can dictate their behavior  Dissociation: mental activity that splits off from, or is independent of conscious awareness -We all do this to a certain degree”zoning out” or “daydreaming” -50-70% of us do this on a daily basis -May occur after a stressful event -People who have dissociative disorders dissociate at a higher degree  Two types of symptoms 1. Depersonalization: lose a sense of your own reality 2. Derealization: lose a sense of reality of the external world Depersonalization/Derealization Disorder  Depersonalization/Derealization Disorder: Persistent feelings of unreality and feelings of being detached from oneself  Feels like you’re living in a dream  Patients report feeling fear  Reality testing remains intact Person is aware that this is only a feeling  Clinically significant distress or impaired functioning  Prevalence: unknown, but estimated at 1-2% of the population  Comorbidity -Anxiety -Mood Disorders -Personality Disorders  Onset: early 20s  Course: chronic  “Feels like you have no self, no ego, no remnant of inner strength that allows you to deal with the world around you and the world inside you” Dissociative Amnesia  Dissociative Amnesia: Failure to recall previously stored personal information  Amnesia affects: -Episodic Memory -Autobiographical memory  Usually occurs under severe stress  Episodes last from a few days to a few years  Can have one episode or multiple episodes  Classic Example: individual who was driving and hit and killed a pedestrian. This experience caused him to feel dissociative amnesia  People will forget who they are, how old they are, where they came from Dissociative Fugue  Amnesic state  Inability to recall their past, but also depart from home  Confusion about identity or assumption of a new identity  “Fugue” means “Flight”  People will be confused about who they are and assume a new identity which will remain until the state is over with  Behavior or identity during fugue state is often very different than their previous or usual life  Caused by an extremely traumatic stressor  Fugue state could last days, weeks, or years  No longer a separate diagnosis in DSM-5  Very little systematic research  Now a sub-type of dissociative amnesia -Now can have dissociative amnesia with flight or without flight Dissociative Amnesia/Fugue  Very little systematic researchonly case studies  Semantic knowledge seems intact  Deficits in episodic or autobiographical memory -Some evidence suggests that implicit memory may be intact  Ex: Patient forget he had a family, but when asked what he would name his children he said the real names of his kids  We don’t have enough research  Its hard to study this in a systematic way Dissociative Identity Disorder  Dissociative Identity Disorder: patient manifests two or more distinct identities  Host identity: most frequently encountered when interacting with the individual. -Carries the person’s real name, but not always the original or most adjusted identity. -Tries to keep fragments of the other identities together  Alters identities: personalities other than host personality -Not fully developed personalities -Reflect failure to integrate various aspects of person’s identity, consciousness, and memory  Personalities may differ completely from each other -Glasses/not, accents, knowledge, handedness  Switch: transition to another personality  Personalities do not fight for control  Switch is not a dramatic processhappens very gradually  Sometimes the host personality is not aware of the other ones Dissociative identity Disorder: Clinical Description  Average # of personalities: -50% shows at least 10 personalities  Prevalence rates: 3-6%  Sex ratio: 3-9:1 (f: m)  Women have more alters than men  Age of onset: childhood  Course: chronic  Comorbidity -Average # of comorbid conditions is 5 -Depression -PTSDmost common -Substance abuse disorders -Borderline Personality Disorder  Under extreme stressors certain personalities emerge Why Has DID Been Increasing?  Increased public awareness  Increased professional acceptance of disorder  Decreased misdiagnosis of cases as schizophrenia  Some of the increase are artifactual cases -As public awareness increased, therapists reinforced/encouraged patients to produce more alters  What about faking? -Factitious and malingering cases of DID are rare -Kevin Bianchi? What Causes DID?  Posttraumatic theory -95% of patients report severe child abuse -Majority of children who experience abuse do not develop DID  DID is an attempt to cope with hopelessness and powerlessness  Escape (dissociation) through a process like self-hypnosis  Diathesis-stress model may be likely -A person has some sort of predisposition to develop DID then they experience extreme stress  Sociocognitive theory -DID develops when a highly suggestible person learns to adopt and enact the roles of multiple identities -Evidence: most DID patients do not show unambiguous signs of the disorder before therapy -What happens with the therapist is unintentional Treatment of Dissociative Disorders  Depersonalization/Derealization Disorder -No systematic, controlled treatment studies -Generally thought to be resistant to treatment -Treatments showing minimal effectiveness -Self-hypnosis -Hypnosis by a trained professional -Antidepressant, antianxiety, and antipsychotic medications -Administering rTMS to the temporo-parietal junction Treatment for DID  Very little treatment effectiveness research  Reintegrating personalities -Goal is for person to develop a unified personality -Clients often very resistant  Treatment is psychodynamic and insight-oriented  Working through trauma and conflict -Identifying cues and triggers of trauma and neutralize them -Relive the trauma to increase sense of control  Hypnosis  For successful treatment -It must last for many years -The more severe the case, the longer the treatment needed -Publication bias


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