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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