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Health Psychology and Somatic Anxiety (Lectures (Syndromes and Disorders…

- - - - Cancer: Response of immune system, survival rates, and adherence to treatment
      - Chronic pain: Pain behaviours, emotional suffering
        
        Gate Control Theory: Dorsal horns in the spine act as gates
      - Heart disease: Type A personality traits: competitive drive, angry outbursts, high rate of speech
  - - - CBT
      - Biofeedback
      - Relaxation
      - Mindfulness
      - Stress-reduction
      - Health-oriented behaviour
      - Medication to support sleep and decrease anxiety
  - - - Clinically evaluated medically unexplained fatigue, lasting > 6 months (it's new, not from exhaustion, not improved by rest, reduction in activities)
      - Presence of 4+ physical symptoms
        
        Perceived memory deficit, sore throat, tender lymph nodes, muscle pain, joint pain, headaches, sleep is replenishing, post-exertional fatigue
      - Associated with beliefs of inadequacy, orientation to high achievement, high self-expected coping
    - - Distressing symptom that can result in disruption of activities
      - Excessive thoughts, feelings, etc related to the symptoms: persistent worry, significant time spent to try to medicate it
      - Present for over 6 months, symptoms can be pain, persistent impairment, etc.
      - Briquet's syndrome
        
        Preoccupation with physical symptoms, long list of medical complaints with no apparent etiology, unexplained physical symptoms lead to health anxiety.
        
        Can be overwhelming for family physicians and emergency services
    - - Patient thinks they have a serious illness but they are completely fine. Treat with education, CBT, exposure therapy
    - - Unconscious avoidance of conflict, often indicate presence of other disorders
      - Symptoms cause distress/impairment in social and or occupational situations
    - - Intentionally faking a disorder, obvious deception
    - - Derealisation: Sense of reality to external world lost
      - Depersonalisation: Feeling detached from self
      - 50% of patients with this disorder have mood/anxiety disorders as well
      - Dissociative Fugue: memory loss around specific event, often a trip
      - Dissociative Amnesia: A: inability to recall specific autobiographic events
      - DP+DR Disorder: Combined, not attributable to effects of substance
      - Dissociative Identity Disorder (DID)
        
        B. Recurrent gaps in recall of events, personal information, traumatic events
        
        C. Symptoms cause significant distress
        
        D. Not part of culturally accepted practice
        
        E. Symptoms are not attributable to the effects of substance
        
        A. Disruption of Identity characterized by 2 or more personality states. Culturally could be described as possession
- - - - DP/DR disorder
        
        Person feels like they aren't in their own body, etc. but they also know that isn't the case, aware it's happening in their head
        
        Cases
        
        40 year old lady: Feels like she's in a different dimension from others. Feels others can hear what she's saying but are puzzled about what it actually is/what it means
        
        Bonnie, dance instructor: She can be teaching dance, then suddenly feel like she's not the one controlling her legs, gets tunnel vision (physically), which causes her to panic. Linked to marijuana usage
        
        One study found people with DP/DR disorder were easily distracted and had some trouble perceiving three-dimensional objects because they tended to flatten these objects into two dimensions
        
        Brain scan done, patients with DP/DR showed greatly reduced emotional responding compared with other groups, tendency to selectively inhibit emotional expression. Other study done showed dysregulation in HPA axis
        
        No noted treatments yet
        
        Dissociative amnesia
        
        Usually very selective, associated with trauma
        
        Cases
        
        Murder trial, one guy forgot that he burned someone due to this
        
        fugue
        
        Happens sometimes on trips, people leave towards somewhere and later find themselves in a new place, not knowing why they're there or how they even got there
        
        Cases
        
        Agatha Christie disappeared for 11 days forgetting what happened, due to trauma of her mother passing away and infidelity of her husband
        
        amok state
        
        Trance like state, someone assaults or kills people/animals. A type of "dissociative trance disorder"
        
        Dissociative Identity Disorder
        
        Different identities or alters in person, can have a lot in common or can be very distinct, switches between them
        
        Case of Jonah, had 4 identities with different personalities, all appearing from various traumatic events except original one
        
        Host identity is the identity asking for treatment, usually isn't the original/normal identity, usually develops later
        
        Case of Bianchi, murderer who feigned ignorance saying he had DID, but was concluded to be faking it
        
        Can't fake GSR or EEG measurements
        
        Usually linked to abuse as child, some studies found > 95% of patients were abused as a child. Child creates separate identity to escape the abuse and get through life.
        
        Higher suggestibility, those with DID were found to have an "imaginary friend" as a child more often than those without DID
        
        Possibility of false memories, therapist can even create false memories through misuse of suggestions
        
        ~22-25% of patients integrate their identities in a healthy way from various types of therapy
      - During an intense panic attack, ~50% of patients experience "unreality" or DP/DR
      - Temporary dissociation can occur for anyone from extremely stressful events, at least temporarily
- - - - Play a major role in developing/maintaining many physical disorders
      - Behavioural medicine
        
        Application of behavioural science techniques to prevent, diagnose, and treat medical problems
      - Health psychology
        
        Focus on psychological factors involved in the promotion of health and well-being
      - May contribute directly to illness and disease, psychological effects of stress can affect the immune system, etc.
        
        Autoimmune disease: Immune system attacks body's normal tissues when really weak
        
        Some of these diseases include AIDS, rheumatoid arthritis, and cancer
      - Psychoneuroimmunology
        
        Field that studies connections between nervous system and immune system
      - Long-standing lifestyle patterns can put people at risk of diseases, like poor diet/exercise, unhealthy sexual practices, etc.
        
        ~50% leading causes of death in Canada are due to these poor lifestyle choices
      - These factors also contribute to chronic pain
      - Chronic fatigue syndrome
        
        New disorder, attributed part to stress, may also have an undiscovered viral or immune system dysfunction component