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Chapter 7

chapter 7

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 7: Somatoform and Dissociative Disorders Somatoform disorders: individual complains of bodily symptoms that suggest a physical defect or dysfunction- rather dramatic in nature- but for which no physiological basis can be found Dissociative disorders: individual experiences disruption of consciousness, memory and identity The onset of both disorders is assumed by many to be related to some stressful experience and the two can co-occur SOMATOFORM DISORDERS Psychological problems take a physical form; the physical symptoms have no physiological explanation and are not under voluntary control; they are thought to be linked to psychological factors, presumably anxiety, and are assumed to be psychologically caused. Bodily symptoms fall in two groups : arousal of ANS and accompanied with pallable distress in the form of anxiety and depression and the other group reflects thoughts and intentions that are not consciously recognized Pain disorders: psychological factors play main role in onset, maintenance and severity of pain Person experiences pain that causes significant distress and impairment; patient is unable to work and become dependent on painkillerstranquillizers The pain may have temporal relation to some conflict or stress, or it may allow individual to avoid some unpleasant activity and to secure attention and sympathy not otherwise available Pain is not a simple sensory experience therefore deciding when pain becomes a somatoform is difficult Differentiation can be achieved in the way in which pain is described by the patient; a patient with physically based pain localize it more specifically and give more sensory description and link their pain more clearly to situations that increase or decrease it Body dysmorphic disorder: preoccupation with imagined or exaggerated defects in physical appearance Some patients with disorder may spend hours each day checking on their defect, looking in the mirror Others take the steps to avoid being reminded of the defect by eliminating mirrors from their homes or camouflaging the defect- these concerns are distressing and lead to frequent consultations with plastic surgeons Occurs mostly in women; begins in late adolescence and is comorbid with depression, social phobia, eating disorders and thoughts of suicide BDD is chronic and only 9% of patients experience remission over the course of one year Can be misdiagnosed as OCD or delusional disorder therefore preoccupation with imagined defects in physical appearance may therefore not be a disorder itself, but a symptom that occur in several disorders Hypochondriasis : preoccupation with fears of having serious illness, despite medical reassurance to the contrary Begins in early adulthood and has a chronic course; frequent consumers of medical services and not likely to have mood or anxiety disorders They overreact to ordinary physical sensations and minor abnormalities such as irregular heartbeat, sweating, coughing, sore spot or stomach ache More likely than others to attribute physical sensations to an illness Patient make catastrophic interpretations of symptoms such as believing red spot on skin is skin cancer www.notesolution.com 5% of general population; Often co-occur with anxiety and mood disorders Health anxiety: health-related dears and beliefs, based on interpretations, or more often misinterpretations of body signs and symptoms as being indicative of serious illness Health anxiety would be present in both hypocondriasis and an illness phobia Hypochondriasis is a fear of having an illness. An illness phobia is a fear of contracting an illness Illness attitudes scale (IAS) is one self-report measure that is used commonly by researchers to assess health anxiety; intended to be 9-factor scale; IAS reliable for 1) worry about illness and pain (illness fears) 2) disease conviction (illness beliefs) 3) health habits (safety seeking behaviours) 4) symptoms interference with lifestyle (disruptive effects) IAS was used to confirm link bw health anxiety and trait neuroticism; general neurotic syndrome regarded as contributing factor in etiology of health anxiety along with more specific factors such as cognitive mechanisms After controlling medical morbidity, health anxiety has moderately heritable and environmental factors rather than genetic factorhealth anxiety is mostly learned Cognitive factors featured in model of health anxiety: 1) critical precipitating incident 2) previous experience of illness and related medical factors 3) presence of inflexible or negative cognitive assumptions 4) severity of anxiety o Health anxiety will increase as a function of related increases in 1) perceived likelihood or probability of illness 2) perceived cost, awfulness and burden of illness o Health anxiety will decrease as function of 1) perceived ability to cope 2) perceived presence of rescue factors Conversion Disorder: sensory and motor symptoms without any physiological cause Physiologically normal ppl experience sensory or motor symptoms such as sudden vision and paralysis, suggesting an illness related to neurological damage of some sort, although body organs and NS are found to be fine Sufferers experience paralysis of armslegs; seizures and coordination disturbances; a sensation of prickling, tingling or creeping on skin; insensitivity to pain or loss of impairment of sensory sensations called anaesthesias Vision may be impaired Aphonia: loss of voice and all but whispered speech Ansonia: loss or impairment of sense of smell Appear suddenly in stressful situations, allowing individual to avoid some activity or responsibility or to receive badly wanted attention Anxiety and psychological conflict are believed to convert into physical symptoms Hysteria was originally used to describe conversion disorders Symptoms develop in adolescence or early adulthood after undergoing life stress Episode may end abruptly but returns sooner or later; either in its original form or with symptoms of different nature and site; prevalence is less than 1 % and more women are given the diagnosis Frequently comorbid with Axis I diagnoses such as depression, substance abuse and personality disorders (borderline and histrionic personality disorders) Hysterical anaesthesias do not make anatomical sense www.notesolution.com
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