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Chapter 8

Ch. 8 - Soma Disso.pdf

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Richard B Day

 Somatoform disorders Dissociative disorders  Physical symptoms and complaints  Disruptions in someone's consciousness, memory, without any evidence of physical identity or perception pathology  Mind can engage in complex mental activity in  Preoccupied with an aspect of their channels split off from or independent of conscious health, so there is impairment in awareness functioning  Often show implicit memory and implicit perceptions  Not faking and have no control over  Unaware processing in areas of memory and their symptoms perception Common in all cultural groups studied  Once under anxiety disorders, under neurosis  DSM 3 - became separate categories from anxiety  Hypochondriasis  Preoccupied with their fears of contracting a serious disease or that they have a disease, even though they don't o Not reassured by medical clearance  Misinterpret bodily signs and symptoms  Believe the thoughts are appropriate and reasonable  Epidemiology o 2 - 7% prevalence  Most common somatoform disorder o Equally common in men and women o Start at any age, but early adulthood is most common  Causalfactors o Past experiences with illness lead to the development of a set of dysfunctional assumptions about symptoms and diseases o Attentional bias for illness-related information - University of Regina o Look forconfirming evidence and discount disconfirming evidence that they are healthy o See themselves as weak and unable to tolerate effort or exercise o University of British Columbia  Secondary reinforcement and learning experiences via environmental factors  Although there is a genetic component to health anxiety, it is more strongly influenced by environmental factors  Treatment o CBT  Regular C and B stuff  Response prevention  Don't check your body and don't seek reassurance  The most health anxious people prefer CBT over meds  Brief Timeline  6- 16 sessions o SSRIs may also be short-term effective  Less preferred than CBT  SomatizationDisorder  Formerly known as Briquet's syndrome  Many different complaints of physical ailments over several years beginning before age 30  Seek out treatment or big impairment in functioning, not explained by medicine  Not intentionally produced or faked  Patient must also list 4 other symptom criteria  Four pain symptoms  Two gastrointestinal symptoms c. One sexual symptom d. One pseudoneurological symptom  Pain suggestive of a neurological condition  All criteria cannot be explained and if there is a real condition the complaints are in excess of the true symptoms  Difference between somatization and hypochondriasis o Similarity Difference Both are preoccupied with physical Convinced they have an organic disease - symptoms hypochondriasis Have symptoms Hypochondriasis = one or a few primary symptoms Somatization = multiple symptoms Epidemiology  o Begins in adolescence o 3 - 10 x more common in women o More in low SES o Lifetime prevalence = 0.2 - 2% in women and less than 0.2% in men o Usually chronic, but recent studies show a large number of spontaneous remission  Causalfactors o May run in families o Linkage between antisocial personality disorder in men and somatization disorder in women (p. 288)  May be linked via impulsivity trait o Interaction between personality, cognitive and learning variables  High in neuroticism  From certain families - models who complain of pain and receive care and avoid responsibility o Selectively attend to bodily sensations and see them as somatic symptoms  Catastrophize about minor bodily complaints o Think they are weak and unable to handle stress or physical activity o Elevated levels of cortisol  Did not show normal habituation to a psychological stressor  Cultural o Kirmayer and Young - McGill  Common in all cultural groups and societies studied  Differences may reflect:  Cultural styles of expressing distress  Cultural beliefs and practices  Culture's healthcare system  Treatment o Extremely difficult to treat o CBT may be very helpful if combined with medical management  Physician sees patient regularly and does exams on the new complaints  Avoids diagnostic tests and medications etc.  CBT works on better coping, adjustment and discourages illness related things  Reduce secondary gain they get from physicians and family  The most effective treatment to date does not decrease psychological stress o SSRI's may also be helpful  Pain disorder  Persistent and severe pain in one or more areas of the body  Note: pain is very real and can hurt a lot, and is a subjective experience  Acute or chronic  Two subtypes o Pain with only psychological (psychogenic) and pain with psychological and medical  Epidemiology o Prevalence is unknown  Diagnosed most in pain clinics o More frequent in women over men o Very often comorbid with anxiety and mood disorders (usually first)  Treatment o Easier to treat than somatization o CBT is very useful  Relaxation training  Support and validation the pain is real  Reinforce no-pain behaviours o Tricyclic antidepressants can help reduce pain intensity, independent of effecton mood  ConversionDisorder  La belle indifference only actually occurs in 30 - 50% of patients o Was used as a major diagnostic tool back in the day o Now thought this is equally common in all people with medical concerns  Feel they are victims of the symptoms  Past o Was one of several disorders grouped under the term hysteria o Freud  The anxiety threatens to become conscious, so it is unconsciously converted into a bodily disturbance  Allows the patient to express the conflict  Primary gain  Reduction in anxiety and intrapsychic conflict was the gain that maintained the condition  Still had many sources of secondary anxiety  Current o Physical symptoms give them an excuse to avoid stressful situations o Primary gain = escape or avoidance of a stressful situation o Secondary gain = sympathy and attention maintains the disability  Decreasing prevalence o 1 - 3% for clinical settings o General population estimated at 0.005% o 2 - 10 x more common in women o Why?  Advances in the medical field have facilitated the determination of organic causes for physical dysfunctions  Loses it's defensive function if it can be proven wrong with our current knowledge of physical problems  4 categories of symptoms o Sensory  Most often visual, auditory or feeling (anesthesia) o Motor  Aphonia = speech-related, talk only in a whisper though they can cough normally 3. Seizures 4. Mixed from the first 3  Virtually all the symptoms of conversion disorder can be temporarily reduced or reproduced by hypnotic suggestion  Diagnosis help  Fail to have all the symptoms of the disease  Selective nature of the dysfunction (i.e.. Sensory)  Symptoms can be removed during hypnosis  Treatment o No reinforcements for abnormal behaviours o Behavioural treatment for motor symptoms  10/10 regained their walking in 12 days and most maintained this for 2 years o Adding hypnosis may also be useful  Factitious disorder by proxy - Munchausen's Syndrome by Proxy o Person seeking medical help falsely reports or even induces symptoms in another person, usually a child o 10% of this form of child abuse may lead to death o Perpetrator (usually has a lot of knowledge) takes a long time to admit the truth  14 months o Very hard to diagnose for fear of legal trouble  Covert video surveillance of mother and child during hospitalizations  56% of the (23/41 suspected cases) were discovered via surveillance  Shouldconversiondisorderbe classifiedasa dissociativedisorder o Was classified together as subtypes of hysteria o In DSM 3 - which focused on behavioural disorders, it became categorized with somatoform disorder o Argue it should be with dissociative  The symptoms reported mimic neurological symptoms, just like dissociative do  Amnesia obviously occurs via the nervous system Also have disruptions in explicit perception and action   No conscious recognition they can hear or feel or walk or talk  Argue the central feature of dissociative should become 'disruption of normally integrated functions of consciousness  Bodydysmorphicdisorder  Obsessed with some perceived or imagined flaw or flaws in their appearance o Checking behaviours and avoidance is common (50% employment rate)  Reassurance about not having deficits from family never reassure them or temporary relief  Undergo plastic surgery and still are unhappy o 75% seek non psychiatric treatment  Focused on anything o Skin 73% Hair 56% Nose 37% Eyes 20% Legs 18% Face size/shape 12%   Muscle dysmorphic o Mostly seen in males o Desire for more muscles -->excessive weight lifting, high protein foods and steroids  Epidemiology o 1 - 2% of the general population o Up to 8% of people with depression o Equal in men and women o Adolescence onset  Relationship to OCD and eating disorders o OCD  Have obsessions and compulsions like OCD  Brain regions implicated overlap  Same treatments also work  Overlap in causes o Eating disorders  Body distortions in both  Why is it now being investigate? o Prevalence may have increased in recent years o Most people with this condition never seek psych help  Shame and secrecy o Disorder has received more media attention so more people seek help  Biopsychosocialapproach o Partly genetically based personality predisposition  Neuroticism o In sociocultural c
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