Somatic Symptom Disorders Overview

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Questions and Answers

Which psychological response pattern involves individuals expressing their feelings of fear, anger, and anxiety through visible signs like crying and sobbing?

Controlled Response Pattern

Silent Rape Reaction

Expressed Response Pattern (correct)

Compound Rape Reaction

What is a common characteristic of perpetrators of sexual violence?

Easily identifiable physical traits

Higher intelligence

Increased likelihood of having experienced childhood abuse (correct)

Lower rates of planning their assaults

What is one of the immediate physical symptoms that may appear following sexual violence?

Increased energy levels

Enhanced social interaction

Decreased appetite

Vaginal discharge or burning upon urination (correct)

Which of the following statements best describes a 'Silent Rape Reaction'?

Suppresses anxiety and tells no one about the assault Signup and view all the answers

Which of the following is a psychological outcome for victims of sexual violence?

Manifestation of PTSD symptoms Signup and view all the answers

Which of the following is recommended to communicate to a victim of sexual violence?

You are safe Signup and view all the answers

In terms of demographic risk factors, which group faces the highest risk of being a victim of sexual violence?

Those never married and below 34 years old Signup and view all the answers

What effect can childhood abuse have on future behavior concerning sexual violence?

Contributes to increased likelihood of perpetrating violence Signup and view all the answers

Which statement is true regarding the nature of rapes?

Rapes are often premeditated Signup and view all the answers

What factor may help decrease regressive behaviors in child abuse victims?

Immediate attention to physical injuries Signup and view all the answers

What is characterized by excessive motor activity that can be either purposeful or aimless?

Hyperactivity Signup and view all the answers

Which of the following is NOT a sign of impaired executive function?

Ability to follow strict directions Signup and view all the answers

Which disorder has the highest prevalence among common comorbidities with ADHD?

Oppositional defiant disorder Signup and view all the answers

What is a potential prenatal factor that can predispose an individual to ADHD?

Maternal smoking Signup and view all the answers

Which type of medication is primarily used in the psychopharmacological treatment of ADHD?

Central Nervous System Stimulants Signup and view all the answers

Which of the following is an example of a nonpharmacological intervention for ADHD?

Trigeminal nerve stimulation Signup and view all the answers

What is the essential feature of Tourette's Disorder?

Presence of multiple motor tics and one or more vocal tics Signup and view all the answers

What common side effect is associated with the use of Central Nervous System Stimulants for ADHD?

Decreased sleep Signup and view all the answers

What is the primary role of a Sexual Assault Nurse Examiner (SANE)?

Testify in court and collect evidence Signup and view all the answers

Which of the following is NOT a principle of Trauma-Informed Care (TIC)?

Assume all patients have the same coping strategies Signup and view all the answers

What does the 'Resist' principle of TIC emphasize?

Avoiding retraumatization of patients Signup and view all the answers

Which cultural pillar of the Sanctuary Model promotes development and improvement?

Growth & change Signup and view all the answers

At what age does the onset of Tourette's disorder most commonly occur?

6 or 7 years Signup and view all the answers

When utilizing crisis interventions, what is the primary focus?

Reintegration into previous lifestyle Signup and view all the answers

What is one of the most effective treatment strategies for Tourette's disorder?

Combination of pharmacological and behavioral therapy Signup and view all the answers

Which disorder is associated with persistent emotional problems in children and can be hard to diagnose?

Separation Anxiety Signup and view all the answers

Which of the following is a common characteristic of Oppositional Defiant Disorder (ODD)?

Recurrent pattern of defiance and blaming others Signup and view all the answers

What is a key goal of the Trauma-Informed Care framework?

Screening for trauma history and facilitating recovery Signup and view all the answers

What is a common predisposing factor associated with Conduct Disorder?

Power struggles with parents Signup and view all the answers

Which disorder listed is characterized by a pattern of angry/irritable mood and argumentative/defiant behavior?

Oppositional Defiant Disorder (ODD) Signup and view all the answers

What role do environmental factors play in the development of Tourette's disorder?

They include complications during pregnancy and head trauma Signup and view all the answers

Which behavior is critical in Trauma-Informed Care to ensure patient interaction?

Asking for permission before touching a patient Signup and view all the answers

What is the average age of onset for Oppositional Defiant Disorder?

6 years Signup and view all the answers

What is one of the seven cultural pillars of the Sanctuary Model focused on community engagement?

Shared governance Signup and view all the answers

Which medication is commonly used for Tourette's disorder?

Haloperidol Signup and view all the answers

Conduct Disorder is more prevalent in which gender, especially in child-onset cases?

Males Signup and view all the answers

What role do decreased levels of serotonin and endorphins play in somatic symptom disorder?

They may contribute to the condition's development. Signup and view all the answers

How does psychodynamic theory explain physical complaints in anxiety disorders?

They serve as an expression of low self-esteem. Signup and view all the answers

What is tertiary gain in the context of family dynamics related to somatic symptoms?

The stability brought to the family by redirecting conflict. Signup and view all the answers

Which symptom is characteristic of depersonalization-derealization disorder?

Feelings of unreality. Signup and view all the answers

Which type of amnesia is characterized by the inability to recall specific events surrounding a traumatic experience?

Localized amnesia. Signup and view all the answers

In dissociative identity disorder, how does one personality usually transition to another?

Suddenly and often triggered by stress. Signup and view all the answers

What is a common psychological trauma associated with dissociative identity disorder?

Severe physical or sexual abuse. Signup and view all the answers

What does learning theory suggest about somatic complaints?

They can be reinforced by avoiding stressful tasks. Signup and view all the answers

What type of psychotherapy may be beneficial for treating somatic symptom disorders?

Individual psychotherapy. Signup and view all the answers

What is a key characteristic of the derealization aspect of depersonalization-derealization disorder?

Belief that one's environment is unreal. Signup and view all the answers

Which of the following is NOT a treatment strategy for somatic symptom disorders?

Avoidance therapy. Signup and view all the answers

What does current research suggest about genetic contributions to dissociative disorders?

There is no significant genetic evidence found. Signup and view all the answers

How are dissociative symptoms generally perceived according to psychodynamic theory?

As a coping mechanism for unresolved issues. Signup and view all the answers

What does generalized amnesia involve?

Inability to remember one's entire life history. Signup and view all the answers

Study Notes

Somatic Symptom Disorders

Somatic symptom disorders occur when physical symptoms are present, but no underlying medical explanation can be found.
Biochemical: Decreased serotonin and endorphin levels may be associated with somatic symptom disorders, particularly those involving pain.
Neuroanatomical: Brain dysfunction, including impaired information processing, is implicated in factitious disorder.
Psychodynamic Theory: Somatic symptoms may be an ego defense mechanism to express feelings of low self-esteem and worthlessness. In conversion disorder, traumatic emotions might be converted into physical symptoms.
Family Dynamics: In dysfunctional families, a child's illness can shift focus from conflict, providing stability and positive reinforcement (tertiary gain).
Learning Theory: Somatic complaints can be reinforced by avoiding obligations (primary gain), gaining attention (secondary gain), and shifting family focus away from issues (tertiary gain).
Illness Anxiety Disorder: A history of personal or family experience with serious illness can increase the risk of developing illness anxiety disorder.

Dissociative Disorders

Depersonalization-Derealization Disorder: Individuals experience a temporary change in self-awareness, including feelings of unreality, altered body image, detachment from the environment, and observing oneself from an outside perspective.
- Depersonalization: Disconnection from oneself and reality.
- Derealization: A sense that the external environment is not real.
Dissociative Amnesia: Involves a loss of memory for specific events or periods of time.
- Dissociative Fugue: Sudden travel away from home with amnesia for the past.
Dissociative Identity Disorder (DID): Two or more distinct personalities within a single individual, often triggered by stress. The primary personality is unaware of the alter personalities.
Predisposing Factors to Dissociative Disorders:
- Genetics: Limited evidence for a significant genetic contribution.
- Neurobiological: Dissociative amnesia may be linked to neurophysiological dysfunction, with EEG abnormalities observed in some DID cases.
- Psychodynamic Theory (Freud): Dissociation is a defense mechanism against painful memories.

Somatic Symptom Disorder Treatment Strategies

Individual Psychotherapy: Addressing underlying emotional issues and developing coping mechanisms.
Group Psychotherapy: Providing support and sharing experiences with others.
Cognitive Behavioral Therapy (CBT) and Psychoeducation: Challenging negative thoughts and behaviors related to illness.
Psychopharmacology: Treating underlying depression or anxiety.

Sexual Violence

Sexual violence encompasses acts of sexual coercion, unwanted sexual experiences, and rape.
Profile of Perpetrator: Not distinguishable by physical traits or intelligence but more likely to be individuals who have experienced childhood abuse, often premeditate the act, and disregard the rights of others.
Profile of Victims: Individuals under 34 years old, with lower income, and unmarried are at higher risk.

Sexual Violence: Psychological Responses - Rape Trauma Syndrome

Immediate Presentations:
- Expressed Response Pattern: Showing overt emotions like fear, anger, and anxiety through crying, restlessness, and tension.
- Controlled Response Pattern: Suppressing emotions, appearing calm, composed, or subdued.
In Following Days to Weeks:
- Physical symptoms like contusions, headaches, sleep disturbances, stomach pain, vaginal discharge, rage, humiliation, fear, self-blame, and potential development of PTSD symptoms.

Sexual Violence: Other Psychological Responses

Compound Rape Reaction: Rape trauma syndrome symptoms combined with depression, suicidal ideation, substance use, and psychotic behaviors.
Silent Rape Reaction: The victim does not disclose the assault and suppresses anxiety, potentially leading to overwhelming emotional burden.

Sexual Violence: Outcomes

Sexual Assault:
- No longer experiencing panic anxiety.
- Demonstrates a degree of trust in the primary nurse.
- Received immediate attention for physical injuries.
- Initiates behaviors consistent with grief response.
Physically Battered:
- Received immediate attention for physical injuries.
- Verbalizes assurance of immediate safety.
- Discusses life situation with the primary nurse.
- Verbalizes choices for receiving assistance.
Child Abuse:
- Received immediate attention for physical injuries.
- Trusts the primary nurse, potentially disclosing abuse through play therapy.
- Decrease in regressive behaviors.

Sexual Violence: Interventions

Communicate:
- "You are safe."
- "I'm sorry that it happened."
- "I'm glad you survived."
- "It's not your fault."

Sexual Violence: Forensic Nursing

Sexual Assault Nurse Examiners (SANE) Nurses:
- Provide specialized care, evaluation, and advocacy for victims of sexual assault.
- Investigate wounds and reports.
- Collect and preserve evidence.
- Testify in court.

Trauma-Informed Care (TIC)

Framework: Developing interventions that consider the impact of trauma on individuals and how it affects their response to healthcare.
Understanding Trauma Response: Recognizing that everyone reacts differently to trauma, often driven by the "fight or flight" response of the autonomic nervous system.
Goals:
- Accommodate the vulnerability of trauma survivors.
- Avoid inadvertent re-traumatization.
- Facilitate consumer empowerment in healthcare.

Four R's of TIC

Realize: The widespread impact of trauma, screening for trauma history, and understanding potential paths for recovery.
Recognize: Signs and symptoms of trauma in patients, families, staff, and others involved.
Respond: Integrating knowledge about trauma into policies, procedures, and practices.
Resist: Re-traumatization, exhibiting behaviors like trustworthiness, transparency, patient safety, collaboration, and empowerment.

TIC: Sanctuary Model

Institutional Model: Designed for children exposed to violence, abuse, and trauma.
Applications: Residential settings, schools, shelters, group homes, community-based programs, acute care, and juvenile justice.
Seven Cultural Pillars:
- Nonviolence: Promoting a safe and respectful environment.
- Emotional Intelligence: Building awareness and understanding of emotions.
- Inquiry & Social Learning: Encouraging open communication and learning from each other.
- Shared Governance: Promoting a sense of ownership and responsibility.
- Open Communication: Creating an environment where individuals feel comfortable sharing thoughts and feelings.
- Social Responsibility: Encouraging individuals to contribute to the community and care for others.
- Growth & Change: Supporting personal development and transformation.

Crisis Interventions

Goal: Help survivors return to their previous lifestyle as quickly as possible.
Patient Involvement: Individuals should be involved in planning interventions and aftercare.
Time Limit: Usually 6-8 weeks.
Focus: Developing coping strategies.
Safe House or Shelter: Providing a secure and supportive environment.
Family Therapy: Addressing dysfunctional patterns and interactions.

Chapter 23: Children and Adolescents

Disorders:
- Separation Anxiety Disorder
- Intellectual Developmental Disorder (IDD)
- Autism Spectrum Disorder (ASD)
- Attention-Deficit Hyperactivity Disorder (ADHD)
- Tourette's Disorder
- Oppositional Defiant Disorder (ODD)
- Conduct Disorder
Introduction:
- Some disorders in childhood may not be recognized until later in life.
- Distinguishing typical childhood behaviors from emotional problems can be difficult.

Attention-Deficit Hyperactivity Disorder (ADHD)

Subtypes: Predominantly inattentive, predominantly hyperactive/impulsive, and combined type.
Hyperactivity: Excessive psychomotor activity that can be purposeful or aimless.
Inattention/Distractibility: Common with hyperactive behavior.
Impulsivity: Acting without considering consequences; difficulty controlling urges.

Signs of Impaired Executive Function

Interrupting others frequently.
Difficulty stopping or changing ongoing behavior.
Difficulty returning to an activity after interruption.
Impatience.
Excessive touching or moving objects.
Difficulty with delayed gratification.
Disinhibition that decreases with age.
Difficulties with motor coordination and sequencing.
Impaired working memory and recall.
Impaired planning ability.
Difficulty following directions.
Impaired emotional regulation.

ADHD: Common Comorbidities

Oppositional defiant disorder (50%):
Conduct disorder
Anxiety (20%)
Depression (30%)
Bipolar disorder (20%)
Substance use disorders
Frontal lobe epilepsy (89.4%)
Disruptive Mood Dysregulation Disorder (DMDD)

ADHD: Predisposing Factors

Genetic:
- Biochemical Theories: Still under investigation.
- Anatomical: Decreased volume and activity in the prefrontal cortex and other brain areas.
Prenatal, Perinatal, and Postnatal Factors:
- Maternal smoking, exposure to toxins, maternal infections.
- Low birth weight, trauma, early infancy infections, and brain injuries.
Environmental Influences: Disorganized or chaotic environments, early life trauma.
Psychosocial Influences: Single-parent households, young maternal age, parental antisocial behavior, maternal depression, and low socioeconomic status.

ADHD: Psychopharmacological Interventions

Central Nervous System Stimulants:
- Examples: Dextroamphetamine, methamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate, dextroamphetamine/amphetamine mixture.
- Side Effects: Insomnia, anorexia, weight loss, tachycardia, and decreased growth.

ADHD: Nonpharmacological Interventions

Trigeminal nerve stimulation
Neurofeedback cognitive training
Cognitive behavioral therapy
Child or parent training
Dietary omega fatty acid supplementation

Tourette's Disorder

Key Features: Presence of multiple motor tics and at least one vocal tic.
Occurence: Can appear simultaneously or at different periods.
Impact: Can cause distress or interfere with social, occupational, or other areas of functioning.
Peak Severity: Pre-teen and teenage years.
Onset: As early as 2 years old, but most commonly around 6 or 7 years old.

Tourette's: Predisposing Factors

Biological: Genetic, biochemical, and structural factors.
Environmental: Complications in pregnancy, low birth weight, infections, and head trauma.

Tourette's: Pharmacological and Nonpharmacological Interventions

Most Effective: Combination with other therapies, such as behavioral therapy, individual or family counseling, and psychotherapy.
Common Medications:
- Antipsychotics: Haloperidol and Risperdal.
- Alpha Agonists:

Oppositional Defiant Disorder (ODD)

Leading Cause of Referral for Mental Health and Special Education Services:
Key Characteristics: Recurrent pattern of defiance, hostility, antagonizing, and blaming others for mistakes.
Age of Onset: Average age of onset is 6 years old, but symptoms may begin earlier and rarely start after early adolescence.
Predominantly Due to: Parenting or early childhood environmental factors, such as hostile or overly controlling parenting styles.

ODD: Predisposing Factors

Biological: Role not fully established.
Family Influences: Power struggles between parents and children, where authority is used for parental needs rather than guidance.

ODD: Treatment Strategies

Family-Based Interventions:
Social Training Interventions:
Pharmacological Interventions:

Conduct Disorder

Key Characteristics: Persistent pattern of behavior violating the basic rights of others, age-appropriate social norms, and rules.
Common Features: Physical aggression and disturbed peer relationships.
Prevalence: Ranges from 2% to 10%, increasing from childhood to adolescence.
Gender: More common in males, especially in child-onset cases.
Comorbidities: ADHD, mood disorders, learning disorders, and substance use disorders.

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Description

This quiz covers the nature and theories behind somatic symptom disorders, including biochemical, neuroanatomical, psychodynamic, family dynamics, and learning theories. Understand how these factors contribute to the manifestation of physical symptoms without a medical basis. Test your knowledge of the psychological and contextual influences at play.