Hehi Test #2 - Somatoform And Dissociative Disorders

Front 1

Psychosomatic Disorder

Back 1

General medical conditions affected or exacerbated by psychobiological factors

*Physical symptoms brought about by psychological illness - medical manifestations

Front 2

Somatoform Disorder

Back 2

Symptoms SUGGEST a medical disorder, however, physical changes are not found

*Complaints not proven through physical examination - no physiological signs

Front 3

Fictitious Disorder

Back 3

Symptoms are controlled by the patient (Munchausen)

Front 4

Millingering

Back 4

Person fakes or makes up symptoms consciously

Front 5

Biological ties to Somatoform disorders

Back 5

1. Increased risk with first affected first degree relative
2. Neuronal and perceptual pathways/ signals
3. CNS arousal or disturbance - conversion disorders

Front 6

Biological Theories related to pain disorder

Back 6

1.Possible limbic structure changes
2. Possible decrease in serotonin and endorphins

Front 7

Psychosocial Theories of Somatoform Disorders

Back 7

1. Behavioral - learned helplessness
2. Cognitive - misinterpretation or sensations; low self-esteem - focus on physical rather than emotional
3. Psychoanalytical - defense mechanisms fail to alleviate anxiety and somatic symptoms manifest

Front 8

pseudoneurological

Back 8

voluntary motor or sensory functioning (ex. suddenly not able to move right arm)

Front 9

Somatization Disorder

Back 9

1. History of multiple physical complaints < 30 yo
2. Result in seeking treatment, r significant impairment
3. Allmust be present at some time:
- 4 pain symptoms
- 2 GI symptoms
- 1 sexual symptom
- 1 pseudoneurological symptom
4. Either: Unexplained by medical condition or substance abuse or medical condition is present but impairment is excessive
5. SYMPTOMS ARE NOT CONSCIOUSLY FEIGNED

Front 10

Symptoms of Somatization Disorder

Back 10

1. Colorfu, exaggerated, lacking facts - vague complaints
2. Inconsistent historians
3. Several concurrent physicians
4. Commonly undergo multiple: exams, tests, hospitalizations and even surgeries - multiple M.D. (do not know about each other)
5. Common: prominent anxiety and depressive symptoms
*Males at risk for antisocial personality disorder
6. May be impulsive and antisocial

Front 11

Hypochondriasis

Back 11

1. Lasts for at least 6 months
2. Persistent preoccupation with fear of having disease
3. Significant impairment/ distress
4. Usually focus on one body function or vague
5. Commonly fear of aging and death
6. "doctor shopping"
7. Real medical conditions may be missed once individual has been diagnosed
8. Resistant against psychological diagnosis
9. Symptoms do not follow normal progression of illness

Front 12

Pain disorder

Back 12

1. Psychological factors have role in onset, severity
2. Severe disruption in daily life
3. Increase in risk substance abuse/ dependence
4. No physiological findings or pain rated much more intense than others with similar problems
5. Subtypes: with or without medical problems
PATIENT IS NOT MAKING UP PAIN

Front 13

Body dysmorphic Disorder

Back 13

1. Preoccupation with imagined defect, or excessive concern
2. Significant distress and' or impairment
3. Frequent checking or the "defect"
4. May alternate with avoidance
5. Some: excessive exercise, dieting, changing clothes
6. Seeking sugical and dental interventions
7. Onset = adolescence or adulthood

Front 14

Conversion Disorder

Back 14

1. Symptoms or deficit that suggest a neurological or medical disorder
2. Psychological factors are associated with onset
3. Present in dramatic or histrionic fashion or show la belle indefference
4. Symptoms may change with suggestions
5. Most often occurs after extreme stress
6. Sudden onset - voluntary motor or sensory deficits
PATIENT IS NOT AWARE THEY ARE NOT REALLY ILL.

Front 15

Diagnostic Criteria for Hypochondriasis

Back 15

For at least 6 months:
1. Preoccupation with fears of having idea that one has, a serious disease
2. Preoccupation persists despite appropriate medical tests and reassurances
3. Other disorders are ruled out
4. Preoccupation causes significant impairment in social or occupational functioning or causes marked distress

Front 16

Diagnostic Criteria for Pain Disorder

Back 16

1. Pain in one or more anatomical sites is a major part of the clinical picture
2. Causes significant impairment in occupational or social functioning or causes marked distress
3. Psychological factors thought to cause onset, severity, or exacerbation, Pain associated with psychological factors
4. Symptoms not intentionally produced or feigned. If medical condition present, it plays minor role in accounting for pain.
5. Pain may be associated with a psychological and/or medical condition. Both factors are judged to be important in onset, severity, exacerbation, and maintenance of pain

Front 17

Diagnostic Criteria for Body Dysmorphic Disorder

Back 17

1. Preoccupation with some imagined defect in appearance. If the defect is present, concern is excessive
2. Preoccupation causes significant impairment in social or occupational functioning or causes marked distress.
3. Preoccupation not better accounted for by another mental disorder.

Front 18

Therapeutic Management Symptom Assessment

Back 18

IMPORTANT TO RULE OUT MEDICAL CONDITIONS BEFORE DIAGNOSING A SOMATOFORM DISORDER.
1. Safety
2. Rest
3. Nutrition
4. Pain
5. Interest

Front 19

Symptom Assessment - Is there voluntary control over symptoms?

Back 19

No = somatoform (deceives self)
Yes = fictitious or malingering (deceives other); manipulation is a symptom of an illness.

Front 20

Secondary Gain - "What can't you do now that you could do before you had this symptom?"

Back 20

Personal benefit derived from having he symptoms
* Attention
* Caring
* Get out of responsibilities

Front 21

Communication Strategies

Back 21

1. Once a symptom has been assessed, avoid further reinforcement
2. Don't imply symptoms are not real - respect and support
3. Shift focus from physical complaints to feelings
4. Be matter-of-fact
5. Positive reinforcement of strengths

Front 22

Therapies used in Somatoform Disorders

Back 22

1. Insight-oriented - individual/ group counseling designed to foster development of insight
2. Cognitive - explore thoughts/ feelings
3. Behavioral - family, support client
4. Exposing client to people actually affected by disorder can be controversal but helpful

Front 23

Coping Skills in Somatoform Disorders

Back 23

1. Self-care
2. Body knowledge
3. Relaxation techniques
4. Assertiveness
5. Exercise - release endorphins, decrease anxiety
6. Gain control over symptoms

Front 24

Dissociative Disorder

Back 24

Involves a disturbance in the integrated organization of memory, identity, perception, or consciousness ALL DISSOCIATIVE DISORDERS ARE LINKED TO TRAUMATIC LIFE EVENTS

Front 25

Biologial Theories of Dissociative Disorders

Back 25

1. Limbic system - memories stored in hippocampus of limbic system; lack of attachment has been shown to negatively affect limbic development
2. Lack of attachment have also been demonstrated to have effects on serotonin levels
3. Result of some neurological diseases (epilepsy, brain tumors, schizophrenia)
4. Drugs - ETOH, barbiturates, benzos, beta adrenergic antagonists

Front 26

Psychosocial Theories of Dissociative Disorders

Back 26

1. Learned Helplessness - learned methods of avoiding stress and anxiety
2. Conscious avoidance = may become "autonomic" the more it is used
3. Unconscious defense mechanism

Front 27

Depersonalization Disorder

Back 27

Feeling detached from body,parts of body, or mental process

- Alert and oriented x 4, described as "living in a dream"
- 50% experience a single brief episode, 1/3 of people who experience a life-threatening danger, 40% hospitalized mentally ill

Front 28

Dissociative Amnesia

Back 28

Inability to recall important personal information (usually of traumatic nature)
- Often more than one episode
- Several types of memory disturbances
- Associated memory loss is reversible
- Is not induced by drugs, injury, or medical diagnosis

Front 29

Localized Amnesia

Back 29

Can't remember specific, isolated periods of time

Front 30

Selective Amnesia

Back 30

Don't remember details, but remember major events i.g. the person beside them died

Front 31

Dissociative Fugue

Back 31

- Sudden, unexpected travel without remembering past
- Establishes new identity (rare) or is confused about their identity
- usually single episode
- Usually rapid recovery
- May have amnesia of past traumas
- .2%, but increases during stressful events and natural disasters

Front 32

Depersonalization Disorder criteria

Back 32

1. One of more episode of inability to recal important information - usually of a traumatic or stressful nature
2. Causes significant distress or impairment in social occupational, or other important areas of functioning.

Front 33

Dissociative Fugue criteria

Back 33

1. Sudden, unexpected travel away from home or one's place of work with inability to remember past
2. Confusion about personal identity or assumption of new identity
3. Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning

Front 34

Dissociative Identity Disorder Criteria

Back 34

1. Existence of two or more distinct subpersonalities each with its own patters of relating, perceiving, and thinking
2. At least two or these subpersonalities take control of the person't behavior
3. Inability to recall important information too extensive to be explained by ordinary forgetfulness

Front 35

Depersonalization Disorder Criteria

Back 35

1. Persistent or recurrent experience of feeling detached from and outside of one's mental processes or body
2. Reality testing remains intact
3. The experience causes significant impairment in social or occupational functioning or causes marked distress.

Front 36

Dissociative Identity disorder

Back 36

Formerly: Multiple personality disorder
1. Presence of 2 or more distinct personalities
2. At least 2 of these distinct identities control the persons behavior
3. Cannot recall extensive important information
4. Is considered identity fragmentation rather than separate personalities
5. usually victim of emotional/ sexual/ physical abuse
6. Method of coping - effective, usually not diagnosed for 5-7 years after the disorder presents

Front 37

Associated features of DID

Back 37

1. History of severe physical and sexual abuse
2. Post-traumatic symptoms
3. Self-mutilation and suicidal behaviors
4. Each personality state is experienced as if having a distinct personal history
5. DID reflects a failure to integrate: memory, consciousness, and identity
6. Primary identity is usually more passive than alternate identities; the alternate identities protect the primary identity

Front 38

Therapeutic Management: Psychosocail Interventions

Back 38

1. Use name to confirm identity
2. Safety and support
3. Simple structure and routine
4. Encourage independence
5. Positive reinforcement of non-dissociative coping
6. Stress reduction techniques - CONTROL over symptoms

Front 39

DID therapies

Back 39

1. Therapeutic alliance/ relationship
2. Identification of triggers
3. Prevention of further episodes
4. DISTRACTION- used for the person who is dissociating; at all other times, face reality

Front 40

Expected Client Outcomes

Back 40

1. Safety
2. Decrease anxiety
3. positive coping
4. Stress is handled without dissociating