Chapter 6 Notes and Vocab
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Date Created: 10/18/16
Chapter 6 Notes Somatic symptom and dissociative disorders Introduction to the somatic symptom disorders This common feature of these disorders is physical symptoms without physical cause The symptoms are linked to psychological factors, but they are not intentional; not under voluntary control Malingering - intentional production of psychological or physical symptoms with an external incentive List of disorders Somatic symptoms disorder Illness anxiety disorder Conversion disorder Psychological factors affecting other medical conditions Factitious disorder Somatic symptom disorder Multiple persistent (more than 6 months) physical complains for which no medical cause can be found Persistent thoughts about the seriousness of one's symptoms Excessive time and energy devoted to the symptoms Symptoms can include pain, fatigue, nausea, weakness, etc. More common in women; prevalence about 7% Seems to be more common in children and older people Person may seek care from multiple doctors but seem unresponsive to treatment Somatic symptoms Gastrointestinal o Vomiting o Abdominal pain o Nausea o Bloating and excessive gas Pseudoneurological o Amnesia o Difficulty swallowing o Loss of voice o Difficulty walking o Seizures Pain o Diffuse pain o Pain in extremities o Joint pain o Headaches Reproductive organ o Burning sensation in sex organs o Pain during intercourse o Irregular menstrual cycles o Excessive menstrual bleeding Cardiopulmonary o Shortness of breath at rest o Palpitations o Chest pain o Dizziness Other o Vague food allergies o Hypoglycemia o Chronic fatigue o Chemical sensitivity Illness anxiety disorder Preoccupation with having or acquiring a serious illness; physical (somatic) symptoms are not present or only mild High level of anxiety about health; person performs excessive health-related behaviors Duration of symptoms is at least 6 months Illness becomes a central feature of the person's identity Incessant worrying becomes stressful for others Prevalence is about 5%; equally common in men and women The former diagnosis of hypochondriasis is not split between somatic symptom and illness anxiety disorders Conversion disorder Characterized by one or more symptoms of altered voluntary motor or sensory function No physical cause can be found Symptoms can include weakness or paralysis, tremors, numbness, blindness, loss of hearing, non-epileptic seizures, loss of speech, etc. Individuals are not consciously faking symptoms; they believe the problem is genuine Formerly known as hysteria; called "mass psychogenic illness" when it occurs in groups More common in women, in rural populations, and in lower SES groups Prevalence is about 2% Onset - across the life-span Factitious disorder Falsification of physical or psychological symptoms, or deliberately causing injury or disease for the sole purpose of assuming the sick role Not malingering; no personal gain (such as an insurance settlement) Two types: 1. imposed on self or 2. another - Munchausen syndrome/by proxy Prevalence: about 1% in hospital settings, unknown in the general population Features of factitious disorder Dramatic or atypical presentation; vague details Long medical record with multiple hospital admissions Knowledge of textbook descriptions of illness and unusual grasp of medical terms Presentation in the ER during times when obtaining old medical records is hampered (like holidays, late Friday afternoons) No desire to recover; do not cooperate with treatment Symptoms do not result from illness or injury Factitious disorder types Imposed on self o Presentation of oneself to others as ill or impaired; recurrent lying or inducing physical symptoms o May sabotage or interfere with medical care Imposed on another o Pattern of falsification or physical or psychological symptoms in another individual o Often a mother who appears loving and attentive while simultaneously sabotaging child's health o Relatively new diagnostic category o Diagnosis of this condition is difficult Factitious disorder Underlying issue appears to be a need to be the center of attention or to feel superior to authority figure Supportive psychotherapy and family therapy may help families understand patients and their need for attention "A mother's betrayal" Etiology of somatic symptom disorders Causes are poorly understood; symptoms are seen as a way to manifest psychological stress as a physical disability Primary and secondary gain need to be evaluated Rejection or abuse from family members, or family members with chronic physical illness are often contributing factors Risk factors: lower educational levels, ethnicity (like the link between stress and physical complains, especially strong from Asian Americans) and immigrant status Treatment of somatic symptom disorders Biological o Antidepressant medications such as SSRI's reduce anxiety and depression; rarely successfully by itself Psychological treatments o Empathy, accepting symptoms as genuine o Providing information about stress o Mindfulness strategies help patients accept physiological sensations Dissociation Psychological state in which some part of identity, memory or consciousness is altered Results in severe disruption of personality functioning Used to escape anxiety and conflict Usually related to trauma Dissociation "trait" Some people appear to easily fantasize, divide their attention, engage in daydreaming, and have a good imagination If this "trait" is present, and a trauma occurs, the dissociation can become pathological Several measures exist for dissociation Dissociative disorders Involve some sort of dissociation (separation) of a part of a person's consciousness, memory, or identity Types of dissociative disorders: o Dissociative amnesia o Depersonalization/derealization disorder o Dissociative identity disorder (multiple personality) o Relatively rare Dissociative identity disorder (DID) Formerly known as multiple personality disorder Chronic disorder usually beginning in childhood as a result of physical or sexual abuse Two or more distinct personality states; alterations in behaviors, attitudes, and emotions Personality change in complete and not tied to context Diagnosed about age 30, but symptoms are usually present before that DID experiences Changes in behavior reported by an observer Use of "we" Being told of things they have done but do not remember Discovering objects, productions, or handwriting that they cannot account for or recognize Amnesia for events that occurred between their mid-childhood and early adolescence Legal debate over responsibility for actions Symptoms of DID Depression, anxiety, phobias, panic attacks; often co-occurs with other disorders Physical symptoms (severe headaches or other bodily pain) Fluctuating levels of function, from highly effective to disabled Time distortions, substance abuse, suicidal preoccupation and attempts Prevalence reports vary - may be very rare or underdiagnosed Famous DID cases Sybil - Shirley Ardell Mason; suffered from extreme abuse at the hands of her mother, under psychiatric care, 16 different personalities were uncovered Truddi Chase - experienced violent abuse from her stepfather, reported to have 92 personalities Diagnostic controversy of DID Characteristics have changed over time Some believe clinician bias, faulty assessment, or diagnostic techniques may influence diagnosis Questions regarding reports of memories retrieved from very early ages Post-traumatic model of DID Depersonalization/derealization of disorder Most common dissociative disorder; characterized by feelings of unreality of being detached from oneself and the environment Consciousness is never split Feel like separate observers of themselves; own reality feels temporarily lost Common phenomenon - needs to be persistent, recurrent, and distressing to be diagnosed Onset between ages 15 and 30 Dissociative amnesia Not due to organic cause Sudden inability to remember important personal information Usually pertains to a trauma Prevalence is difficult to establish Types of amnesia: o Localized - inability to recall a specific event or events o Systematized - loss of memory for certain categories of information o Selective amnesia - inability to remember certain details of an incident Repressed memory Amnesia may come to light only after recalling details of a traumatic event Not all researchers believe in the validity of repressed memories Parents or therapists may unintentionally plant memories Etiology of dissociative disorders Memory is disrupted due to acute stress Permanent structural changes in amygdala due to trauma may play a role Repression protects the individual from painful memories or conflicts o Severe internal conflict, guilt, unresolvable interpersonal difficulties, criminal behaviors Dissociative symptoms develop because of the traumatic experience and inability to cope Treatment of dissociative disorders Dissociative amnesia and depersonalization seem to resolve on their own, so treatment is aimed at alleviating depression and stress (medication, CBT, stress management) DID is treated with trauma-focused therapy to help the individual develop healthier ways of dealing with stressors, major goal is integration of personalities Chapter 6 Vocabulary Somatic symptoms and related disorders - a broad grouping of psychological disorders that involve physical symptoms or anxiety over illness, including somatic symptom disorder, illness anxiety disorder, conversion disorder (functional neurological symptom disorder) Somatic symptom - physical or bodily symptoms Somatic symptom disorder - a condition involving a pattern or reporting distressing thoughts regarding the seriousness of one's physical symptoms combined with excessive time and concern devoted to worrying about these symptoms Somatic symptom disorder with predominant pain - a condition involving excessive anxiety of persistent concerns over pain that appears to have no physical basis Illness anxiety disorder - persistent health anxiety and/or concern that one has an undetected physical illness; the person has only mild or no physical symptoms Conversion disorder (functional neurological symptom disorder) a condition involving sensory or motor impairment suggestive of a neurological disorder but with no underlying medical cause Psychogenic - originating from psychological causes Malingering - feigning illness for an external purpose Factitious disorder - a condition in which a person deliberately induces or stimulates symptoms of physical or mental illness with no apparent incentive other than attention from medical personnel or others Factitious disorder imposed on self - symptoms of illness are deliberately induced, simulated, or exaggerated, with no apparent external incentive Factitious disorder imposed on another - a pattern of falsification or production of physical or psychological symptoms in another individual Dissociative disorders - a group of disorders, including dissociative amnesia, dissociative identity disorder, and depersonalization/de-realization disorder, all of which involve some sort of dissociation, or separation, of a part of the person's consciousness, memory, or identity Dissociative amnesia - sudden partial or total loss of important personal information or recall of events due to psychological factors Localized amnesia - lack of memory for a specific event or events Systematized amnesia - loss of memory for certain categories of information Selective amnesia - an inability to remember certain details of an event Dissociation fugue - an episode involving complete loss of memory of one's life and identity, unexpected travel to a new location, or assumption of a new identity Depersonalization disorder - a dissociative condition characterized by feelings of unreality concerning the self and the environment Dissociative identity disorder - a condition in which two or more relatively independent personality states appear to exist in one person, including experiences of possession; also known as multiple personality disorder Possession - the replacement of a person's sense of personal identity with a supernatural spirit or power
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