Ch 8: Somatic Symptom and Dissociative Disorders

• Somatic: of or relating to the body, especially as distinct from the mind. Maladaptive physical symptoms with no medical cause
• Somatic Symptom Disorder: one or more somatic symptoms that are distressing or result in significant disruption of daily life
• Somatic Symptom Disorder is characterized by excessive thoughts, feelings, or behaviors related to somatic symptoms or associated with health concerns manifested by: persistent thoughts about seriousness of symptoms, persistently high level of anxiety about health concerns, and excessive time and energy devoted to symptoms/health concerns
• With somatic symptom disorder there is high functional impairment, high healthcare utilization and unnecessary medical procedures, and more commonly diagnosed in women than men
• Etiology of Somatic Symptom Disorder: behaviorism-learning history, misinterpreted bodily sensations
• Treatment of Somatic Symptom disorder: Harder to diagnose in older people, Cognitive-behavioral treatment (CBT), and medical management (limiting amount of healthcare appointments, they use the ER less often
• Illness anxiety disorder: excessive preoccupation with having or acquiring a serious illness very future oriented. Somatic symptoms not present or very mild. Active or avoidant of healthcare.
• Etiology and treatment of Illness anxiety disorder is similar to Somatic Symptom Disorder
• Conversion Disorder is characterized by symptoms of altered motor or sensory dysfunction not attributable to a medical condition or physical cause
• Conversion Disorder is NOT intentionally caused, sudden onset but sometimes aren't concerned, stressor immediately before, symptoms usually resolve if stressor is removed. Motor, sensory deficits, seizures, and convulsions, More common in women (except during WWI)
• Primary gain: they are able to escape stressor (EX: avoiding military)
• Secondary gain: unknown urge to get attention, praise, sympathy
• Treatment of Conversion disorder: beings in inpatient unit and may be behavioral
• Factitious Disorder: INTENTIONAL, goal is to be sick but unaware of why they are making themselves sick
• Factitious disorder imposed on another: Perpetrator (usually parent) intentionally falsifying or inducing injury or disease on another (usually child) in absence of external rewards. Normally seen in the hospital
• Treatment of Factitious disorder: involuntary treatment. Treatment of Factitious disorder imposed on another is get child away from parent
• Dissociation: experience characterized by disruption in normal processes of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.
• Most people experience some degree of unwanted intrusions/ inability to access information/ control mental functions normally
• Identity confusion: no consistency on how you perceive yourself
• Depersonalization disorder (body internal): feeling detached from your body, out of body experience. Feeling like you are standing next to yourself or watching yourself do something as if you were looking at another person
• Derealization Disorder (environment external): feeling like you or your environment is unreal/unfamiliar. Feeling that other people, objects, or the world around you isn't real. More common especially if people are tired
• Most people experience both depersonalization and derealization disorder but not required to.
• Dissociative Amnesia: inability to recall autobiographical information, inconsistent with normal forgetting. Normally associated with trauma or stressor. Can be localized or generalized amnesia
• Dissociative fugue (flight): purposeful or bewildered wandering associated with identity amnesia. Picking up life and moving away
• Dissociative Identity Disorder (DID): disruption of identity characterized by two or more distinct states and recurrent gaps in memory. Can include all 5 factors of dissociation
• Dissociative amnesia presents in DID in 3 way: gaps in remote memory of personal life events, lapses in dependable memory, discovery of evidence of their everyday actions/tasks they don't recall
• DID is a highly controversial diagnosis (25% believe in it) Diagnostic reliability is unknown and poor construct validity
• Iatrogenic: when treatment is causing the symptom (EX: planting seeds not needed)
• In DID, symptoms are not consistently present. Memory is also flexible and requires reconstruction. So when bringing memory from long term storage back to short term it can be changed
• Post traumatic theory of DID: correlation of childhood abuse and diagnosis, Splitting results from child's attempt to cope. Psychodynamic split from mind. Can't be empirically supported
• Sociocognitive theory of DID: patient is highly suggestible and adapts to reinforcement evidence of stimulators changing prevalence rates and cultural manifestations. Evidence to support this.
• Dissociative amnesia usually clears up on its own without treatment interventions
• There are no evidence-based treatments for dissociative disorders
• Traditional treatment of DID involves integration of alters of personality. NOT evidence based, not effective actually creates more alters
• Malingering is when physical symptoms are produced intentionally to avoid something or to obtain financial compensation. Could be faking sick or just exaggerating problems