Somatoform and dissociative disorders
somatoform
dissociative
mental disorders that take the form of physical disorders
disruption in the integration of higher order brain systems eg consciousness, memory etc
sensory and motor components split off
disorders
Somatic symptom disorder
illness anxiety disorder
conversion disorder
factitious disorder
DSM criteria
differentiating physical and somatoform disorder
how many sx listed
degree of bodily preoccupation
how intensely does individual worry about health
how forcefully do they seek health care
hx of disgruntlement with healthcare system?
can be hard to differentiate from other psych conditions eg anxiety-heart palpitations
eastern and western societies view somatic sx differently
biology
trauma
individuals more likely to have experienced trauma
HPA-axis involvement
gateway control theory
family factors
learned illness behaviours
environmental factors
rewards for sx, reinforcing illness behaviour
General cognitive factors
more sensitive the physical sensations
attentional bias towards physical sensations
attributional bias (concluding causes is physical not psych)
abnormal illness behaviour (excessive test seeking etc)
vicious cycle: tmt seeking heightens anxiety--> heightens physical sx etc
1 or more somatic sx that are distressing and interfere with everyday life
excessive thoughts, feelings a behaviours related to sx
disproportionate and persistent thoughts about seriousness
persistently high level of anxiety about sx
excessive time and energy devoted to sx
state of being symptomatic is persistent (6 months or more) although a single sx may not last that long
specify if pain is predominant feature
associated features
high level of health care utilisation
high comorbidity with depression
cognitive features
behavioural
attributional bias
attentional bias
worry about illness
fear that sx will damage body
repeated bodily checking
repeated seeking of medical help
avoidance of physical activity
risk factors
female gender
older age
fewer years of education
lower SES
being unemployed
abuse
concurrent osych or phsyical illness
social stress
re-enforcing social factors
description
cognitive and psychological aspects
preoccupation with having or acquiring illness
easily alarmed by hearing about illness
do not respond to appropriate medical reassurance
illness concerns assume a prominent place in person's life
hypersensitivity to bodily sensations
heightened anxiety regarding illness
biased thinking about threat or reality of serious illness
excessive reassurance seeking
more distrust of medical opinion by seek help more often
childhood learning experience of illness behaviour
catastrophic interpretations of benign signs
optimistic bias towards making judgements about own health
DSM criteria
associated features
1 or more sx of altered voluntary sensory or motor fcns
sx doesn't match clinical findings
not better explained by another medicine or medical disorder
causes distress
specify sx type
recent stressful event
family hx
lower education or SES
location of residence (rural or urban)
age between late childhood and under 35
maintenance factor-reduction in anxiety, elicited caregiving
DSM criteria
falsification of physical sx or induction of
individual presents themselves as ill or injured
behaviour present in absence of obvious external rewards
not better explained by another medical disorder
different to malingering where there is an obvious external reward eg money or legal benefits
sx experienced as
unbidden intrusions into awareness and behaviour with accompanying loss of continuity of subjective experience
inability to access information or to control mental fcns
disorders
dissociative identity disorder
DSM criteria
disruption in identity characterised by2 or more distinct personality states
involves marked discontinuity of sense of self and agency
alterations in affect, behaviour, consciousness, memory, perception etc
recurrent gaps in recall of everyday events, important personal info and/or traumatic events
cause clinically significant distress or impairment
not a normal part of cultural or religious practices
not attributable to physiological effects of a substance
features
two or more distinct personalities that switch
usually a host personality +alters
host/alters may or may not be aware of each other
alters differ in many ways
trauma theory
dissociation as an autohypnotic defence in which consciousness is split during a traumatic event
internal avoidance
compartmentalisation
people become skilled in this and construct identities to help deal with complexities
dissociative amnesia
DSM criteria
inability to recall autobiographic info usually related to traumatic event
sx cause clinically significant distress
not attributable to substance
not better explained by other medical conditions
subtypes
localised
failure to recall events associated with particular time
selective
can recall some but not all events
systemised
loses memories associated with a particular subject
continuous
forgets each new event as it occurs
generalised
complete loss of memory for one's life in general
depersonalisation/derealisation disorder
DSM criteria
presence of persistent or recurrent
depersonalisation
derealisation
experiences of unreality, outsider or detachment to one's own body, thoughts, feelings, sensations etc
surroundings appear unreal
during experience, reality checking remains in tact
sx cause distress
not due to substance
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