PSY110P-Chapter-6-Somatic-Symptom-and-Related-Disorders.pptx

SOMATIC SYMPTOM AND RELATED DISORDERS AND DISSOCIATIVE DISORDERS  Soma = Body Preoccupation with health or appearance Physical complaints No identifiable medical condition  Somatic symptom disorder formally Briquet’s syndrome Continually feel weak and ill Severe pain ○ Physical symptoms...

SOMATIC SYMPTOM AND RELATED DISORDERS AND DISSOCIATIVE DISORDERS  Soma = Body Preoccupation with health or appearance Physical complaints No identifiable medical condition  Somatic symptom disorder formally Briquet’s syndrome Continually feel weak and ill Severe pain ○ Physical symptoms Illness anxiety disorder  A preoccupation with fears of having a serious disease despite having no significant somatic symptoms.  Illness anxiety disorder was formerly known as “hypochondriasis” Less concerned with any specific physical symptom and more worried about the idea that she was either ill developing an illness ○ Reassurances from numerous doctors has little affect   The diagnostic criteria also stipulate that the belief cannot have the intensity of a delusion (more appropriately diagnosed as delusional disorder) and cannot be restricted to distress about appearance (more appropriately diagnosed as body dysmorphic disorder). Brief hypochondriacal states can occur after major stresses, most commonly the death or serious illness of someone important to the patient, or a serious (perhaps life-threatening) illness that has been resolved but that leaves the patient temporarily hypochondriacal in its wake.  Statistics 1% to 5% 6.7% median rate of medical patients Female : Male = 1:1 Onset at any age ○ Peaks: adolescence, middle age, elderly Chronic course  Causes Disorder of cognition or perception ○ Physical signs and sensations Cause is unlikely to be found in isolated biological or psychological factors Familial history of illness and learning Three factors that may contribute to etiology ○ Stressful life events ○ High family disease incidence ○ “Benefits” of illness Conversion Disorder  Conversion disorders generally have to do with physical malfunctioning, such as paralysis, blindness, or difficulty speaking (aphonia), without any physical or organic pathology  Functional Neurological Symptom Disorder Common Symptoms of Conversion Disorder   Astasia-abasia  Paralysis  Weakness  Aphonia (inability to Motor Symptoms  Involuntary movements  Tics  Blepharospasm - any abnormal contraction or twitch of the eyelid.  Torticollis - a symptom defined by an abnormal, asymmetrical head or neck position  Opisthotonos - a condition in which the body is held in an abnormal position.  Seizures  Abnormal gait  Falling produce voice)  Sensory Deficits  Anesthesia, especially of extremities Midline anesthesia  Blindness  Tunnel vision  Deafness  Visceral Symptoms  Psychogenic vomiting  Pseudocyesis - false pregnancy  Globus hystericus - the sensation of a lump in the throat causing difficulty with swallowing when there is no physical cause.  Swooning or syncope - medical term for fainting or passing out, is precisely defined as a transient loss of consciousness and postural tone.  Urinary retention  Diarrhea Conversion Disorder (Functional Neurological Symptom Disorder)  Statistics Rare Prevalence depends on setting Female > male Onset = adolescence Chronic, intermittent course Associated Features of Conversion Disorder Primary Gain  Patients achieve primary gain by keeping internal conflicts outside their awareness. Symptoms have symbolic value; they represent an unconscious psychological conflict. Secondary Gain  Patients accrue tangible advantages and benefits as a result of being sick; for example, being excused from obligations and difficult life situations, receiving support and assistance that might not otherwise be forthcoming, and controlling other persons' behavior. La Belle Indifference  La belle indifference is a patient's inappropriately careless attitude toward serious symptoms; that is, the patient seems to be unconcerned about what appears to be a major impairment. Identification  Patients with conversion disorder may unconsciously model their symptoms on those of someone important to them. For example, a parent or a person who has recently died may serve as a model for conversion disorder. Somatic Symptom Disorder Complex Somatic Symptom Disorder: Three core criteria for complex somatic symptom disorder: (1) one or more somatic symptoms that are distressing or result in significant disruption in daily life (2) excessive anxiety, concern, or time and energy devoted to the somatic concern, and (3) duration of at least 6 months. DSM IV TR’s Somatization Disorder  4 Pain  2 Gastrointestinal symptom  1 sexual Symptom  1 pseudoneurological symptom Etiology of Somatic Symptom Disorder Hyperactive  Anterior insula and the anterior cingulate - Pain and uncomfortable physical sensations, such as heat, increase activity in these regions of the brain.  Somatosensory cortex – Heightened activity in these regions is related to greater propensity for somatic symptoms Psychological Factors Affecting Medical Condition  The essential feature of this disorder is the presence of a diagnosed medical condition such as asthma, diabetes or severe pain  Behavioral or psychological factors would have a direct influence on the course or perhaps the treatment of the medical condition  Tendency to be overly concerned about one’s health may have evolved from early experiences of medical symptoms or from family attitudes to physical illness.  Cognitive - two cognitive variables appear important: Attention to body sensations Interpretation of those sensations Treatment Cognitive Behavioral Therapy  (1) identify and change the emotions that trigger their somatic concerns  (2) change their cognitions regarding their somatic symptoms  (3) change their behaviors so they stop playing the role of a sick person and gain more reinforcement for engaging in other types of social interactions Malingering and Factitious Disorder     Malingering A person intentionally fakes a symptom to avoid a responsibility, such as work or military duty, or to achieve some goal, such as being awarded an insurance settlement. Often, malingering has a clear potential for reward. Factitious Disorder People intentionally produce physical symptoms (or sometimes psychological ones) to assume the role of a patient. They may make up symptoms—for example, reporting acute pain. Some will take extraordinary measures to make themselves ill. They may injure themselves, take damaging medications, or inject themselves with toxins. Factitious disorder imposed on another/ Munchausen syndrome by proxy   Diagnosed in a parent who creates physical illnesses in a child. In one extreme case, a 7-year-old girl was hospitalized over 300 times and experienced 40 surgeries at a cost of over $2 million. Her mother had caused her illnesses by administering drugs and even contaminating her feeding tube with fecal material. The motivation in a case such as this appears to be a need to be regarded as an excellent parent who is tireless in seeing to the child’s needs. DISSOCIATIVE DISORDER Dissociative Disorders   The essential feature of the dissociative disorders is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. Types of disorders Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder Depersonalization-Derealization Disorder Depersonalization-Derealization Disorder  Severe alterations or detachments Normal perceptual experiences  Significant impairments Identity Memory Consciousness   Depersonalization—Distortion in perception of reality Derealization —Losing a sense of the external world Depersonalization-Derealization Disorder  Statistics 0.8% to 2.8% Female : Male = ~1:1 High comorbidities ○ Anxiety and mood disorders Onset = age 16 Lifelong, chronic course Depersonalization-Derealization Disorder  Cognitive deficits Attention Short-term memory Spatial reasoning Easily distracted  Decreased emotional response Dissociative Amnesia  Dissociative amnesia  Generalized type— Inability to recall anything, including their identity  Localized or selective type— Failure to recall specific (usually traumatic) events Dissociative Fugue  Dissociative fugue: Flight or travel Assumption of new identity Amok as in “running amok” Dissociative Fugue  Statistics Tends to occur in adulthood Rapid onset Rapid dissipation Females > males Dissociative Fugue  Causes Little is known Trauma and life stress  Treatment Resolution without treatment Memory returns Dissociative Identity Disorder (DID)  Clinical description  Amnesia  Dissociation of personality  Adopt several new identities or “alters” ○ 2 to 100 ○ Average = 15 ○ Unique characteristics  Characteristics  Alters—The different identities  Host—The identity that keeps other identities together  Switch—Quick transition from one personality to another Dissociative Identity Disorder Dissociative Identity Disorder (DID)  Statistics 1.5% (year) Female : Male = 9:1 Onset = childhood Lifelong, chronic course Etiology of DID     Posttraumatic Model The posttraumatic model proposes that some people are particularly likely to use dissociation to cope with trauma, and this is seen as a key factor in causing people to develop alters after trauma Sociocognitive Model the sociocognitive model, considers DID to be the result of learning to enact social roles. According to this model, alters appear in response to suggestions by therapists, exposure to media reports of DID, or other cultural influences  Role playing  A leading advocate of the idea that DID is basically a role-play suggests that people with histories of trauma may be particularly likely to have a rich fantasy life, to have had considerable practice at imagining they are other people, and to have a deep desire to please others.   DID Symptoms Can Be Role-Played it has been established that people are capable of role playing the symptoms of DID. One relevant study was conducted in the 1980s after the trial of a serial murderer in California known as the Hillside strangler. The accused murderer, Ken Bianchi, unsuccessfully pled not guilty by reason of insanity, claiming that the murders had been committed by an alter, Steve. Treatment of DID  These include an empathic and gentle stance, with the goal of helping the client function as one wholly integrated person. The goal of treatment should be to convince the person that splitting into different personalities is no longer necessary to deal with traumas.  Similar to PTSD treatment Reintegration of identities Identify and neutralize cues/triggers Visualization Coping Hypnosis