Somatoform and Dissociative Disorders

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Somatoform and Dissociative Disorders
2011-10-29 23:49:22

Somatoform and dissociatve Disorders Abnormal psych
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  1. Hypochodriasis
    • Severe anxiety over possibility of having serious illness
    • Not alleviated by medical reasurrance
    • Causes significant distress or interference with functioning, make changes to behavour and life choiced based on erronous hypothesis about health.
    • For at least 6 months
  2. Overlap and differential for hypochondriasis
    Overlap with panic disorder but more concern with implications and longterm outcome of perceived illenss.

    Differentiated from phobia by disease conviction

    Differentiated from delusion as they can entertain the possibility of ot having the perceived illess
  3. Hypochodriasis cognitions and perception
    Cgntive and erceptual distrbances amplify sysmomes and emtionalality/mood.

    They misinterpret ambiguous stimuli as threatening-anxiety - preccuation with body -back to physical symtoms.

    Past reinforcement of poor health makes it worse
  4. Treatment of Hypochondriasis
    • Rule out physical illness
    • Regular appointments for GP that are planned and have clear conditions/boundaries to change pattern
    • CBT
  5. Prevelence of Hypochondriasis
    • Peaks in Adolescence, and between 40-60yrs
    • Culturally specific: Kovo in China (genitals retract into abdoment), Dart in India (loosing semen)
  6. Somatisation Disorder
    • History of many physical complaints
    • Focus o sysmptoms rather than feared underlying illness
    • Meet 4 criteria
    • 1.Pain (in 4 sites or functioning)
    • 2.Gastrointestinal
    • 3.Sexual (irregular periods)
    • 4.Psuedoneurological (sensory loss, double vision etc
  7. Onset and treatment for somatoform disorder
    • Before the age of 30
    • Seeking treatment over several yrs

    Help them adapt to symptoms and shift focus to life stressors
  8. Conversion Disorder
    • 1.Symptoms or deficits affecting voluntary motor or sensory function without identifyable organic cause
    • 2. Assciated psychological factores (identifable life stressor at time of onset & maint)
    • 3. Not intensionally feigned
    • 4.Can be diffcult to distinguish from genuine or faked illness (difference is a focus on symptoms but indifferent/not stressed by it)

    eg. Blindness, psuedo seizures
  9. Malingering & fictitious disorder
    • 1.Malingerig: Faking for material or legal gain (often get details and pattern of proposed illness wrong)
    • 2. Fictitious: Faking for benifts of sick role (culturally sanctioned)
    • 3.Muncheusen syndrome is factitious disorder by proxy (often underlying personality disorder common & should be focus of treatment)
  10. Pain Disorder
    • 1. Pain has clear organic orgins but maintenance is psychological (pain is real)
    • 2. Can be difficult to distiinguish because all pain is psychological expereince
    • 3. Pain response best to psychological treatment

    eg dsyprenea
  11. Treatment for Pain Disorder
    • CBT (cogntive restructuring)
    • Relaxation
    • Behavioural activation
    • Anti depressents
  12. Body Dysmorphic Disorder
    • 1. Preoccupation with imagiined defect in normal appearance
    • 2. Causes significant distress or impairment
    • 3. Not delusional
    • 4. Often seek plastic/cosmetic surgery (often not satisfied with outcome)

    Underdiagnosed as people often too ashamed to disclose or bring attention to it
  13. Treatment for Body Dysmorphic Disorder
    • CBT
    • Anti-depressents (SSRI's) if phobic/obsessive
    • Anxiety managment
  14. Epidemiology of Somotaform disorders (prevelence)
    • Relatively rare conditions
    • -Conversion: 50/100 000
    • -BDD: 0.7%
    • -Somatoform: 0.13% (lifetime prev)
    • -Symptoms not warranting full diagnosis: 11.6%
  15. Epidemiology of Somotaform disorders (gender and social factors)
    • 1.All more common in women except hyochondriasis
    • 2.Feminist view- suppression/abuse of women
    • 3.All more common in low SES less educated grous
    • 4.Co-occurrence with depression and anxiety high
    • 5.Less tolerence or knowledge of phyical/psychologcal health issues.
  16. Aetiological considerations with somatoform disorders
    • Biological factors: Diagnosis by exclusion
    • Psychological factors:
    • 1. Early traumatic experiences
    • 2. Early theory vs contemporary evidece
    • 3. Secondary gain/reinforement
    • 4. Cognitve factors -negative memory bias
    • 5. Alexathymia: difficulty recognising, verbalising and expressing emotions = amplifies symatic complaints, or misattributes emotions as somatic
  17. Treatment for somatoform disorders
    CBT for reducing physical symptoms in Somatoform, Hypochondriasis, and Body Dysmorphic disorder.

    Anti-depressents (prozac) SSRI's

    Hypochondriasis: regular medical appointments
  18. Dissociation
    • 1. Losing touch wth reality
    • 2. Depersonalisation; losing sense of your own reality
    • 3. Derealisation; losing sense of reality of external world
    • 4. Often occurs under stressful conditions
  19. Depersonalisation disorder
    • 1. Feeling detached from yourself
    • 2. Causing serious distress or impairment
  20. Dissociative amnesia
    • Psychogenic
    • Generalised
    • Localised or selective (before, during and/or after trauma)
    • Memories aren't yet intergrated
  21. Dissociative fugue
    • 1. Escape from unbearable stress
    • 2. Usually amnestic for what has happened during fugue
    • 3. Start or establish new identity, often retur to normal functioning after fugue state
  22. Dissociative trance disorder
    • 1. Trance without alternate identity OR
    • 2. Possession trance with alternate identity (culturally santioned trance distinguised by distress)
    • 3. Causes significant distress or impairment
  23. Dissociate Identity Disorder
    • 1. Person has 2 or more distinct personality states
    • 2. At least 2 of which recurrently controlling persons behaviour
    • 3 Extensive gaps in personal memory
  24. Trauma and Dissociation
    • 1.Fugue and psychogenic amnesia usualy preciitated by trauma
    • 2. DID linked to early past trauma (very controversial)
  25. Epidemioloy of Dissociative Disorders
    • DID: very rare 200 cases in history to 1980
    • -by 1986 6000 cases in America
    • -Higher in psychiatric hospitals (40%)
    • Issues of misdiagnosis
    • Issues of existence of DID
  26. Aetiological Considerations
    Psychological Factors: Trauma past (DID?) present (fugue)

    • Biological Factors:
    • -Orbital-frontal cortex: speculation
    • -Twin studies: no genetic contribution
    • -Can stem from substance use and cognitive disorders of aging

    Social Factors: iatrogenesis (made up by therapist)
  27. Treatment for Dissociative Disorders
    • DID: goal is reintergration of personalities
    • Antianxiety. antidepressents, antipsychotic meds
    • Await a more accurate decriptions of the disorders.