Somatic and Dissociative Disorders PDF

SOMATIC AND DISSOCIATIVE DISORDERS PSYC 3340 HISTORY Somatic and dissociative symptoms used to be under general term “hysteria” Hysteria meant “wandering uterus” Freud proposed “conversion hysteria” which is when unconscious emotions and conflicts present as physical symptoms.  SOMATIC SY...

SOMATIC AND DISSOCIATIVE DISORDERS PSYC 3340 HISTORY Somatic and dissociative symptoms used to be under general term “hysteria” Hysteria meant “wandering uterus” Freud proposed “conversion hysteria” which is when unconscious emotions and conflicts present as physical symptoms.  SOMATIC SYMPTOM DISORDER One or more somatic symptoms that are distressing or impairing Excessive thoughts, feelings, or behaviors related to somatic symptoms including at least one of the following: Persistent thoughts about seriousness of symptoms Persistent high levels of anxiety about symptoms Excessive time and energy devotes to symptoms Do not have to be present continuously but have to be persistent (usually more than 6 months) Specifiers: predominant pain, persistent (severe symptoms, marked impairment, and long duration) Severity: mild, moderate severe SOMATIC SYMPTOM DISORDER More prevalent in: Females Older age Less education Lower SES History of Abuse Comorbid anxiety or depression Additional physical or psychiatric disorders Social stress Reinforcing factors ILLNESS ANXIETY DISORDER Preoccupation with having or developing a serious illness Somatic symptoms are mild or not present Significant anxiety about health Has either: Excessive health-related behaviors (checking for signs of illness) Maladaptive avoidance (avoiding doctor appointments, medical care) Preoccupation lasts at least 6 months Similar rates in males and females  SOMATIC SYMPTOM AND ILLNESS ANXIETY Risk Factors Treatment Stressful life events Cognitive behavioral High rates of medical therapy issues in family members ”Explanatory Therapy” Social and interpersonal Exposure therapy without influence (such as explicit cognitive attention) interventions. PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITIONS Diagnosed medical condition (asthma, diabetes, etc.) is present Psychological or behavioral factors adversely impact this condition Example: in denial about patient with diabetes’ need to check blood sugar levels Has to not be better explained by adjustment disorder CONVERSION DISORDER Also known as Functional Neurological Symptom Disorder One of more symptoms or deficits affecting voluntary motor or sensory function NOT intentionally produced Symptoms are incompatible with recognized neurological or medical conditions Specifiers: with weakness or paralysis, with abnormal movement (gait, tremor), with swallowing symptoms, with speech symptoms, with attacks of seizures, with anesthesia or sensory loss, with special sensory symptoms, or with mixed symptoms  Specify if: CONVERSION Acute episode (symptoms present less than 6 months) Persistent symptoms (more than 6 months) DISORDER With psychological stressor (stressor must be specified) Without psychological stressor Occurs 2-3x more frequently in women Cause (modified from Freud’s original theory) Traumatic event that present a threat Desire to avoid threat , which manifests as becoming sick but there is a detachment from conscious Conversion symptom is an escape-maintained behavior which continues until the underlying issues is resolved. Secondary gain? Attention, sympathy?  CONVERSION DISORDER Risk Factors Treatment Prior medical Identification of trauma complications or stressor Lower education level Reduce reinforcement and/or SES Family medical problems Stress FACTITIOUS DISORDER Intentional feigning or physical or psychological symptoms or creation of injury or disease Types: Imposed on self Imposed on another (by proxy) ABSENCE of external incentives Specifiers: single or recurrent episodes MALINGERING Intentional production of false or exaggerated physical or psychological symptoms Motivated by external incentives https://www.psychdb.com/somatic/dsm-5/factitious DISSOCIATIVE DISORDERS Involve a disturbance or alteration in the integration of identity, memory, perception, consciousness, emotion, behavior, body representation, and motor control. Often occur after a traumatic experience Often more common in women  DISSOCIATIVE DISORDERS Types Dissociative Identity Disorder Dissociative Amnesia Depersonalization/ Derealization Disorder Symptoms: “Positive” symptoms: fragmentation of identity, depersonalization, derealization. “unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience “Negative” symptoms: such as amnesia “inability to access information or to control mental functions that normally are readily amenable to access or control” DISSOCIATIVE AMNESIA Inability to recall autobiographical information that is inconsistent with normal forgetting Amnesia may be: Localized (event or period of time) Selective (specific aspect of events) Generalized (identity or personal history) May include travel or wandering (called “fugue state”), “lost time,” though often initially unaware of amnesia (“amnesia for amnesia” ) DISSOCIATIVE AMNESIA Usually onset is in adulthood but before age 50 Chronic course Fugue states: end abruptly and person usually remembers what happened during this state Most common of dissociative disorders “Amok” Syndrome Males Not found in Western Culture Violent acts Lack of memory “running amok” is when the person runs in a trance- like state DEPERSONALIZATION/ DEREALIZATION DISORDER Intact reality but persistent or recurrent symptoms of depersonalization and/or realization Depersonalization: detachment from one’s self (body, mind, self, etc) Derealization: detachment from surroundings or environment  DEPERSONALIZATION/ REALIZATION Often symptoms better accounted for by acute stress or other disorders Mean age of onset is 16 years Course tends to be chronic High rates of comorbid anxiety, mood, personality disorders Differences in perception, emotion regulation, and dysregulation of HPA axis  DISSOCIATIVE IDENTITY DISORDER Presence of two or more distinct personality states In children, not better explained by imaginary friends or play Recurrent episodes of amnesia, which may manifest as: Gaps in remote episodic memory (personal life event) Gaps in procedural memory (how to do things) Finding out about actions and tasks that they don’t remember doing When distinct personalities are not directly observed, symptoms may include: Recurrent, inexplicable intrusions into conscious functioning and sense of self (e.g., voices, dissociated actions and speech, intrusive thoughts, emotions, impulses) Alterations in sense of self (attitudes, preferences, feeling like body or actions are not one’s own Odd changes in perception (depersonalization or derealization, detachment from one’s body while self-harming) Intermittent functional neurological symptoms  DISSOCIATIVE IDENTITY DISORDER Stress can exacerbate symptoms Possession-form identity: as if an spirit, supernatural being, or outside person has taken control (e.g., person speaks or acts in distinctly different manner) Can’t be better explained by cultural or spiritual practice, and need to be recurrent, involuntary and causing distress Number of identities average around 15 Onset almost always in childhood Almost always trauma related People with DID tend to be suggestible DID IN MEDIA  DISSOCIATIVE IDENTITY DISORDER (DID) https:// www.youtube. com/watch? v=uxktavpRdz U