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Chapter 6- Disassociative Disorders.docx

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PSYC 353
Richard Yi

Chapter 6 10/4/12 Disassociative Disorder p. 155 Somatoform Disorders - Group of disorders that Include physical symptoms w/o known organic cause o not due to a substance/ psychological disorder o not intentionally feigning (diff type of disorder) - Cause clinical impairment and distress o Seek medical intervention/ treatment o Occupational/ social/ other impairment o Clinically- significant distress - Often encouraged in general medical settings Conversion Disorder - loss of functioning in some parts of body - Symptom or deficit affecting voluntary motor/ sensory function - Psychological factors are judged to be associated with the symptoms - Not intentionally produced or feigned - Not fully explained by alternatives - Clinically significant - Not limited to pain or sexual dysfunction Motor Symptoms or deficits (ticks), Sensory Deficit (blindness, itching, numbing, burning), seizures or convulsions, mixed presentation Conversion Disorder: Associated Features - Concern regarding symptoms o La Belle Indifference- the client shows no affect or concern over the implications of their symptoms o Histrionic/ Dramatic presentation- experience disorder (overreact, sky is falling) - Highly suggestible (symptoms result of stress but can be resolved if stressors removed, what’s going on around affects symptoms) - Major Depressive Disorder, Personality Disorder, Dissociative Disorder Conversion Disorder Epidemiology Prevalence: women 2-10 times more likely to present symptoms - 5-17% in children Course: - 10-35 years of age - Generally acute - Typical duration of about 2 weeks - Recurrence common in one year Symptoms don’t typically conform to known anatomical pathways - Paralysis (how to distinguish btwn organically cause (not conversion disorder) or a cause associated w/ CD, if inconsistent and have on and off paralysis ) o If claim have paralysis but slightly move arm when getting dressed, not organic - Difficulty Swallowing- should be difference between swallowing different food - Anesthesia- lose feeling in parts of body, should follow in specific pattern - Psuedoseizures Risks - Higher in relatives and females, low SES, less educated about medical/ psychological concepts, rural populations, developing regions Symptoms affect culturally acceptable forms of distress - Falling/ blacking out (acceptable in Souther US and Caribbean) - May not be conversion, but common aspect of religious or healing ritual Better prognosis with - Acute onset - Identifiable precipitant at onset - Short interval between onset and treatment - Above average intelligence - No medical or psychological disorder - Good premorbid functioning Etiology - Psychoanalytic: repression, unconscious conflict - Behavioral: behavioral excesses or deficits following a stressful event that are reinforced - Systems Theory: onset during times of stress/ conflict o Express helplessness, reinforced by caretakers - Neurological o Disorder of attention/ vigilance o Cortical inhibition of sensory stimulation o Selective depression of awareness of bodily function/ attention o Lateralization (right cerebral hemisphere)- 70% left side affected Somatization Disorder- physical symptoms affecting many diff areas of body - Four pain symptoms in at least four different sites or functions o Two gastrointestinal symptoms- nausea o One sexual symptom- erectile dysfunction o One pseudoneurological symptom- paralysis - Occur over a period of several years - Result in treatment being sought or significant impairment - *Convergence deals with deficit of sensory or motor function, somatization has physical symptoms Associated Features - Colorful, exaggerated stories of symptoms - Vague histories - Prominent anxiety and depressed mood - Secondary substance abuse - Personality disorders - Mortality Epidemiology - Prevalence .2- 2% in women, less than that in men - Onset in childhood/ teens - Chronic and fluctuating: rarely remits completely - Risk for African American ethnicity, females, low SES/ Education, rural background Undifferentiated Somatoform Disorder - Criteria (must meet these terms) - Only one or more physical complaints (fatigue, loss of appetite, Gastro Intestinal, or urinary complications) - Duration must be at least 6 months - Not somatoform disorder Epidemiology - Unpredictable and variable, may even become a GMC or mental disorder - Risk in young females and low SES (Socio Economic Status) Pain Disorder- complaints about pain w/ no physical cause - Pain in one or more anatomical site for 6 months, w/ no organic cause - Pain is the predominant focus of presentation - Not feigned - Sufficient severity to warrant clinical attention - Psych factors judged to have important role -Somatization doesn’t necessarily refer to pain TYPES Pain Disorder Associated w/ Psychological factors Pain Disorder Associated w/ both Psychological and Medical Factors Specify if: - Acute (last less than 6 months) - Chronic (6 months or more) Pain Disorder Associated w/ General Medical Condition - Not considered a mental disorder - If psych factors are present, no major role Associated Features - Unemployment, disability, family problems, inactivity, social isolation, sleep problems, substance abuse and dependence (Prescription use 25%) - Depression, anxiety, suicide, doctor shopping, requests for surgery, resistance to medical health referrals Epidemiology - Prevalence: not clear, females twice likely - Course: onset at any time, often midlife, most acute pain resolved in short time - Prognosis Better with o Ability to accept pain and give up efforts to control (don’t try to control) o Participation in regularly scheduled activities o Fewer number of painful body areas o Less medical symptoms o Treatment of comorbid mental disorders Hypochondriasis: chronic worry that one has a disease - Preoccupation with thoughts of having a serious disease, and persists despite evaluation - Misinterpretation of body symptoms, poor insight - Belief is not of delusional intensity (delusional disorder, somatic types) - Disturbance lasts at least 6 months Associated Features - Doctor shopping, negative doctor- patient relationships, fears of aging and death, resist mental health referrals, social/ family/ work problems, anxiety, depression, somatoform disorders Epidemiology - Prevalence: males= females - Course: peak onset in 30s for males, 40s for females o Often chronic - Risks: if had serious illness in childhood, past disease or death in family member - Prognosis good w/: acute onset, brief duration, mild symptoms, presence of GMC Etiology - Psychoanalytic o Sexual drives w/o outlet become symptoms
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