PSYC 4430 Lecture Notes - Lecture 5: Comorbidity, Doctor Shopping, Derealization

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8 Feb 2018
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Chapter 5: Somatic Symptom Disorders and Dissociative Disorders
1. SOMATIC SYMPTOM DISORDERS
a. Soma—eaig od
i. Preoccupation with health/body appearance and functioning
ii. No identifiable medical condition causing the physical complaints
b. Clinical description
i. Presence of one or more medically unexplained symptoms
ii. Substantial impairment in social or occupational functioning
iii. Concern about the symptoms (overly-concerned)
iv. I seere ases, sptos eoe the perso’s idetit
c. Statistics
i. Relatively rare
ii. Onset usually in adolescence
iii. More likely to affect unmarried, low SES women
iv. Runs a chronic course
d. Research to date is limited due to recent redefinition of the disorder in DSM
e. Somatic symptom disorder with predominant pain
i. Type of somatic symptom disorder, previously lassified as pai
disorder
ii. Clear physical pain that is medically unexplained
1. Little is known about origin
iii. 5-8% of the population may have this disorder
f. Little is known; may include
i. Familial history of illness
ii. Stressful life events
iii. Sensitivity to physical sensations
iv. Experience suggesting that there are benefits to illness (e.g. attention)
g. Treatment
i. CBT is the best treatment
ii. Redue the tede to isit uerous edial speialists dotor
shoppig
iii. Assig gatekeeper phsiia
iv. Reduce supportive consequences of talk about physical symptoms
2. Illness anxiety disorder
a. Clinical description
i. Physical complaints without a clear cause
ii. Severe anxiety about the possibility of having a serious disease
iii. Strong disease conviction
iv. Medical reassurance does not seem to help
b. Very similar to DSM-IV hypochondriasis
c. Statistics
i. Prevalence estimated between 1-5%
ii. Onset at any age
iii. Sex ratio equal
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iv. Runs a chronic course
d. Culturally specific disorders similar to illness anxiety disorder
i. Koro (Asia)fear that genitals are retracting into abdomen
ii. Dhat (India)attributed to semen loss
iii. Kyol goeu (Cambodia)parts of body are blocked
e. Causes
i. Cognitive perceptual distortions
ii. Familial history of illness
f. Treatment
i. Challenge illness-related misinterpretations
ii. Provide more substantial and sensitive reassurance and education
iii. Stress management and coping strategies
iv. CBT is generally effective
v. Antidepressants offer some help
1. Comorbid with depression; depression can cause physical
symptoms that look like these
3. Conversion disorder (functional neurological symptom disorder)
a. Clinical description
i. Physical malfunctioning of sensory or motor functioning (e.g. blindness
or difficulty speaking (aphonia))
ii. Lack physical or organic pathologyno physical reason or cause
iii. Persos a sho la elle idifferee
iv. Retain most normal functions, but lack awareness
b. Statistics
i. Rare, with a chronic intermittent course
ii. Often comorbid with anxiety and mood disorders
iii. Seen primarily in females
iv. Onset usually in adolescence
v. Common in some cultural and/or religious groups
c. Causes
i. Not well understood
1. Freudian psychodynamic view is still common, though
unsubstantiated
a. Past traua or uosious oflit is oerted to a
more acceptable manifestation, i.e. physical symptoms
2. Primary/secondary gains
a. Freud thought primary gain was the escape from dealing
with a conflict
b. Secondary gainsattention, sympathy, etc.
d. Treatment
i. Similar to somatic symptom disorder
ii. If onset after a trauma, may need to process trauma or treat
posttraumatic symptoms
iii. Remove sources of secondary gain
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