Chapter 6 - Summary Abnormal Psychology: an Integrative Approach PDF

Preview

Summary

CHAPTER 6: SOMATIC SYMPTOM AND RELATED DISORDER, ANDDISSOCIATIVE DISORDERSSOMATIC SYMPTOM DISORDERSoma means body, and the problems pre occupying these seem initially to be physical disorders.It is characterized by a focus or one or more physical symptoms accompanied by marked anxiety and distress f...

Description

CHAPTER 6: SOMA SOMATIC TIC SYMPT SYMPTOM OM AND REL RELA ATED DISORDER, AND DISSOCIA DISSOCIATIVE TIVE DISORDERS

SOMA SOMATIC TIC SYMPT SYMPTOM OM DISORDER Soma means body, and the problems pre occupying these seem initially to be physical disorders. It is characterized by a focus or one or more physical symptoms accompanied by marked anxiety and distress focused on the symptom that is disproportionate to the nature or severity of physical symptoms. It is also characterized by an extreme focus on physical symptoms such as pain or fatigue that causes major emotional distress and problems functioning. In 1859 Pierre Briquet a French Physician describes patient who came to see him seemingly endless lists of somatic complaints for which he could find no medical basis (American Psychiatric Association 1980). The disorder used to be referred as Briquet Syndrome. Important factor of SSD is not just physical symptom but also Psychological or behavioral factors particularly Anxiety and distress.

SYMPT SYMPTOMS OMS • Pain. - this is the most commonly reported symptom. Areas of reported pain can include chest, arms, legs, joints, back, abdomen, and other areas. • Neurological symptoms - such as headaches, movement disorders, weakness, dizziness, fainting • Digestive symptoms -such as abdominal pain or bowel problems, diarrhea, incontinence, and constipation • Sexual symptoms -such as pain during sexual activity or painful periods.

DSM-5 DIAGNOSTIC CRITERIA A. One or more somatic symptoms that are distressing and/or result in significant disruption of daily life. B. Excessive thoughts, feelings, and behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. High level of health-related anxiety. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

TREA TREATMENT TMENT 

Cognitive behavi behavioral oral ther therapy apy (CB (CBT) T)

Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people's difficulties, and so change the way they feel. To provide reassurance, reduce stress and minimize help, seeking behavior 

Pharmacother Pharmacotherapy apy

Medications used to treat somatic symptom disorder include antidepressants, antiepileptics, antipsychotics, and natural products. The effectiveness of many of these treatments has limited support. 

Psychodynamic ther therapy apy

Used to reveal the unconscious conflict that a patient has. Using this therapy has seldom reports on effectiveness ILLNES ILLNESS S ANXIET ANXIETY Y DISORDER Formerly known as hypochondriasis, is a severe anxiety that focuses on the possibility of developing a more serious disease. Individuals are preoccupied with bodily symptoms that they misinterpret them as indicative of a more serious illness.

IAD share symptoms with anxiety, mood disorders, and panic disorder. They’re quite similar in age of onset, personality characteristics, and familial aggregation. Patients with illness anxiety disorder have beliefs that are difficult to shake. This is referred as disease conviction which is the core feature of both disorder. Patients with this disorder continues to seek assurance and they demand unnecessary medical treatment. However, despite all assurance that the doctor will give, they will remain unconvinced.

SYMPT SYMPTOMS OMS 

Being preoccupied with having or getting a serious disease or health condition



Worrying that minor symptoms or body sensations mean you have a serious illness



Being easily alarmed about your health status



Finding little or no reassurance from doctor visits or negative test results



Worrying excessively about a specific medical condition or your risk of developing a medical condition because it runs in your family



Having so much distress about possible illnesses that it's hard for you to function



Repeatedly checking your body for signs of illness or disease



Frequently making medical appointments for reassurance — or avoiding medical care for fear of being diagnosed with a serious illness



Avoiding people, places or activities for fear of health risks



Constantly talking about your health and possible illnesses



Frequently searching the internet for causes of symptoms or possible illnesses

DSM-5 DIAGNOSTIC CRITERIA A. Preoccupation with fears of having or acquiring a serious illness. B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition

(e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate. C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status. D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctors’ appointments and hospitals). E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, generalized anxiety disorder, or obsessivecompulsive disorder.

TREA TREATMENT TMENT 

Cognitive behavi behavioral oral treatmen treatmentt

Focuses on identifying and challenging illness-related misinterpretations. It also explains how disorder was created by focusing attention on symptoms in certain body areas. CBT can help you: o Identify your fears and beliefs about having a serious medical disease o Learn alternate ways to view your body sensations by working to change unhelpful thoughts o Become more aware of how your worries affect you and your behavior o Change the way you respond to your body sensations and symptoms o Learn skills to cope with and tolerate anxiety and stress o Reduce avoidance of situations and activities due to physical sensations

o Reduce behaviors of frequently checking your body for signs of illness and repeatedly seeking reassurance o Improve daily functioning at home, at work, in relationships and in social situations o Address other mental health disorders, such as depression 

Antidepressants

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), may help treat illness anxiety disorder. Medications to treat mood or anxiety disorders, if present, also may help. 

Psychodynamic ther therapy apy

Aims to reveal the unconscious of the patient where the conflict came from. This may include past experiences and situations that they are repressing on their consciousness. Only few reports of success in using psychotherapy.

PSYCHOLOGICA PSYCHOLOGICAL LF FACT ACT ACTORS ORS AFFECTING MEDICAL CONDITION A related SSD is called Psychological factors affecting medical condition. Essential feature of this disorder is the presence of diagnosed medical condition such as Asthma, diabetes, severe pain (cancer). This can be affected by one or more psychological or behavioral factor which has an impact on the course and treatment of the medical condition. This is more probably to be diagnosed as adjustment disorder.

CONVERSION DISORDER (Functional Neurol Neurological ogical Symptom Disord Disorder) er)

Conversion disorder is a physical malfunctioning, such as paralysis, blindness or difficulty speaking (aphonia), without any physical or organic pathology to account for the malfunction. They can affect motor functions and your senses. The symptoms must cause distress or impairment in a person’s work, relationships, or other areas of life

SYMPT SYMPTOMS: OMS: 

Difficulty walking



Loss of balance



Body tremors



Weakness or paralysis



Hearing difficulty



Vision problems or blindness



Loss of sensation



Trouble swallowing



Seizures or shaking episodes



Unresponsiveness

Symptoms th that at might be included (in mental health cond condition): ition): 

mood disorder



panic disorder



generalized anxiety disorder



post-traumatic stress disorder



dissociative disorders



obsessive-compulsive disorder



somatic disorders



personality disorders



Depression (non-epileptic seizures)

DSM-5 lists these criteria for con conversion version disorder (f (functional unctional neurological symptom disorder): A. One or more symptoms of altered voluntary motor or sensory function. B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. C. The symptom or deficit is not better explained by another medical or mental disorder. D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

TREA TREATMENT TMENT 

Neurologist

a multispecialty team approach 

Speech thera therapy py

may benefit the individual if their symptoms include trouble with speaking or swallowing. 

Physical or occupational ther therapy apy

may be required if a person has trouble with mobility, paralysis, or weakness 

Behavior ther therapy apy

that focuses on stress reduction and relaxation techniques can also help reduce symptoms. 

Stress reduction or di distraction straction techniques.

Stress reduction techniques can include methods such as progressive muscle relaxation, breathing exercises, physical activity and exercise 

Psychother Psychotherapy apy (mental health option) a) Cognitive behavior behavioral al ther therapy apy (CB (CBT) T) can help people identify negative or irrational thought patterns and respond to challenges more effectively

b) Hypnosis and self self-hypnosis -hypnosis have also proven beneficial for symptom reduction in conversion disorder. c) Pharmacother Pharmacotherapy apy for conversion disorder usually involves medication that treats the symptoms of co-occurring conditions d) Neurologists, psychiatrists, and other professionals. Treating other mental health conditions. Anxiety, depression or other mental health disorders can worsen symptoms of functional neurologic disorders. Treating mental health conditions along with functional neurologic disorders can help recovery.

FACTITIOUS DISORDER People intentionally produce physical symptoms (or sometimes psychological ones) to assume the role of the patient. It is a mental disorder in which a person acts as if he or she has a physical or mental illness when, in fact, he or she has consciously created the symptoms. Types of F Factitious actitious Disorder A. Factit actitious ious disorder imposed on self includes the falsifying of psychological or physical signs or symptoms, as described above. An example of a psychological factitious disorder is mimicking behavior that is typical of a mental illness, such as schizophrenia. (the experience of sensing things that are not there; for example, hearing voices). B. Factitious disorder imposed on another: People with this disorder produce or fabricate symptoms of illness in others under their care: children, elderly adults, disabled persons, or pets. It most often occurs in mothers (although it can occur in fathers) who intentionally harm their children in order to receive attention. The diagnosis is not given to the victim, but rather to the perpetrator. SYMPT SYMPTOMS OMS   

Lie about or mimic symptoms Hurt themselves to bring on symptoms Alter diagnostic tests (such as contaminating a urine sample or tampering with a wound to prevent healing)



Be willing to undergo painful or risky tests and operations in order to obtain the sympathy and special attention given to people who are truly medically ill

DSM-5 DIAGNOSTIC CRITERIA A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents himself or herself to others as ill, impaired or injured. C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better accounted for by another mental disorder such as delusional belief system or acute psychosis.

 la belle indiff indifference erence (uncountable) (psychiatry) A condition in which the person is unconcerned with symptoms caused by a conversion disorder. A naive, inappropriate lack of emotion or concern for the perceptions by others of one's disability, usually seen in persons with conversion disorder.

 Malingering A person intentionally fakes a symptom to avoid responsibility Factit actitious ious disorde disorderr differs from a pattern of falsified or exaggerated behavior called malingering. While malingerers make their claims out of a motivation for personal gain, people with factitious disorder have no such motivation.

DISSOCIA DISSOCIATIVE TIVE DISORDERS Characterized by individuals feeling of being detached from themselves or the surroundings. The experiences are divided into two parts – depersonalization and derealization. Depersonalization

Experience of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions. ( e.g., perceptual alterations, distorted sense of time, unreal absent self, emotional and/or physical numbing). Derealization Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, visually distorted).

DEPERSONALIZA DEPERSONALIZATION-DEREALIZA TION-DEREALIZA TION-DEREALIZATION TION DISORDER When feelings of unreality are so severe and frightening that they dominate an individual’s life and prevent normal functioning. Person’s perception of the self or surroundings is disconcertingly and disruptively altered. It is often comorbid with anxiety, depression and personality disorder.

SYMPT SYMPTOMS OMS Depersonalization      

Feeling detached from one’s body,mind,feeling, and/or sensations Feeling that you’re an outside observer of your thoughts,feelings,your body or parts of your body Feeling like a robot or that you’re not incontrol of your speech or movements The sense that your body,legs or arms appear distorted, enlarged or shrunken, or that your head is wrapped in cotton Emotional or physical numbness of your senses or responses to the world around you A sense that your memories lack emotion, and that they may or may not be your own memories

Derealization  

Feeling detached from their surroundings ( eg, people,objects,everything), which seem unreal Feelings of being alienated from or unfamiliar with your surroundings

   

Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall Surroundings that appear distorted, blurry,colorless, two-dimensional or artificial, or a heightened awareness and clarity of your surroundings Distortion is perception of time, such as recent events feeling like a distant past Distortions of distance and the size and shape of objects

DSM-5 DIAGNOSTIC CRITERIA A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing). Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted). B. During the depersonalization or derealization experience, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia or panic disorder.

TREA TREATMENT TMENT   

Cognitive techniqu techniques es can help block obsessive thinking about the unreal state of being. Behavior Behavioral al techniques can help patients engage in tasks that distract them from the depersonalization and derealization Grounding techniq techniques ues use the 5 senses (eg, by playing loud music or placing a piece of ice in the hand) to help patients feel more connected to themselves and the world and feel more real in the moment.





Psychodynamic ther therapy apy helps patients deal with negative feelings, underlying conflicts, or experiences that make certain affects intolerable to the self and thus dissociated Moment-t Moment-to-moment o-moment tracking and labelling of affect and dis dissociation sociation in therapy sessions works well for some patients DISSOCIA DISSOCIATIVE TIVE AMNESIA

Is a type of dissociative disorder that involves inability to recall important personal information that would not typically be lost with ordinary forgetting. It is usually caused by trauma or stress. A potentially reversible memory impairment that primarily affects autobiographical information.

SYMPT SYMPTOMS OMS 

The main symptom of dissociative amnesia is memory loss that is inconsistent with normal forgetfulness. The amnesia may be Localized, Selective, Gener Generalized, alized, Systematize Systematized d amnesia, Continuous amnesia

   

Most patients are partly unaware that they have gaps in their memory. Patients Seen shortly after they become amnestic may appear confused. Difficulty forming and maintaining relationship Depressive and functional neurologic symptom are common.

DISSOCIA DISSOCIATIVE TIVE FUGUE is an uncommon phenomenon that sometimes occurs in dissociative amnesia. Characterized by sudden, unexpected, purposeful travel away from home and bewildered wandering.

DSM-5 DIAGNOSTIC CRITERIA A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The disturbance is not attributable to the physiologi...