PS 280- (5) Somatic Symptoms & Dissociative Disorder

Dissociative Disorders are:

Dissociative [blank_start]Identity[blank_end] Disorder (DID): DSM-5: -at least [blank_start]2[blank_end] distinct personalities exist within the person -2 or mot of these personalities repeatedly take control of individuals behaviour -failure to recall important personal information too substantial to be accounted for forgetness -not due to psychoactive substance or general medical condition

[blank_start]Host[blank_end] vs [blank_start]Alters[blank_end]: -host need not be aware of alters -each personality (alter) may be distinct & have different behaviours -Average # of alters = [blank_start]13[blank_end] (some cases 100+) -transition from one alter to another is called a [blank_start]switch[blank_end]; trigger = stress (cue from environment)

Symptoms of DID: -Another person existing inside- [blank_start]90%[blank_end] -Voices talking- [blank_start]87%[blank_end] -Amnesia for childhood- [blank_start]83%[blank_end] -Referring to self as "we" or "us"- [blank_start]74%[blank_end] -Blank spells- 68% -being told of unremembered events- 63% -feelings of unreality- 57% -strangers know the patient- 44% -noticing that objects are missing- 42% -coming out of a blank spell in a strange place- 36% -objects are present that cannot be accounted for- 31% -different handwriting styles - 28%

Etiology (causation) of DID:

Dissociative Amnesia is the inability to recall important personal information

Dissociative Amnesia: -real & complete memory loss- in the absence of [blank_start]physical[blank_end] or medical cause -often only [blank_start]personal[blank_end] info lost -[blank_start]Sudden[blank_end] onset, usually in response to traumatic or stressful experience -different from (VS) real brain injury & amnesia

Types of Dissociative Amnesia: 1. [blank_start]Localized[blank_end] Amnesia: fail to remember info during a specific time period (most common) 2. [blank_start]Selective[blank_end] Amnesia: only parts of the trauma are recalled 3. [blank_start]Continuous[blank_end] Amnesia: forget info from a specific date until present time 4. [blank_start]Systematized[blank_end] Amnesia: only certain categories of info are forgotten 5. [blank_start]Generalized[blank_end] Amnesia: forget entire life

Dissociative Amnesia with or without (specifier) Dissociative Fugue:

De[blank_start]personalization[blank_end] Disorder: feeling of being detached from oneself De[blank_start]realization[blank_end] Disorder: feeling of being detached from one's surroundings

Depersonalization Disorder: -feel as though one is in a dream, outside of one's body -[blank_start]sudden[blank_end] onset -"no impairment in memory or identity confusion" For diagnosis: -experiences are persistent or [blank_start]recurrent[blank_end] -marked distress Etiology: -note: abuse, trauma, war ([blank_start]coping[blank_end] mechanism)

Psychodynamic Theory:

Learning & Cognitive Theories:

Diathesis-Stress Model:

Treatment: Dissociative Identity Disorder (DID) -difficult to treat treatment involves: -[blank_start]reintegration[blank_end]: safely relive traumatic experiences & make them conscious -[blank_start]medications[blank_end]: e.g. anti-anxiety & anti-depressants Depersonalization Disorder: treatment involves: -medications: [blank_start]SSRI[blank_end]s- deal with anxiety & depression

(1&2 important) 1. [blank_start]Somatic[blank_end] Symptom Disorder: characterized by: distress about having physical symptoms for which there is [blank_start]no[blank_end] physical cause -high levels of anxiety about health or symptoms -feeling this way for [blank_start]>6[blank_end] months 2. [blank_start]Illness[blank_end] Anxiety Disorder: -excessive concern about serious illness -longstanding ([blank_start]6+[blank_end]months) fears of having a serious illness, despite assurance that these fears are groundless -misinterprets [blank_start]minor[blank_end] bodily symptoms as evidence of a serious disease

3. [blank_start]Conversion[blank_end] Disorder: -loss or impairment of physical function but [blank_start]no[blank_end] physical cause: formerly hysteria -motor or sensory functioning symptoms are usually fascinating: -motor deficits -conversion stocking or glove anesthesia Note- symptoms often [blank_start]do not[blank_end] match the medical conditions they suggest 4. [blank_start]Factitious[blank_end] Disorder: distinguished from: [blank_start]Malingering[blank_end]: purposefully adopts the sick role and complains of symptoms to achieve a particular end (e.g. getting out of a midterm) Factitious Disorder: psychological disorder characterized by the intentional fabrication of or physical symptoms for no apparent gain *Most common form= [blank_start]munchausen[blank_end] Syndrome

[blank_start]Etiology[blank_end] of Factitious Disorder: [blank_start]Psychodynamic[blank_end] Theory: -emotions converted into physical symptoms -symptoms may be functional (e.g. paralysis of arm) [blank_start]Learning[blank_end] Theories: -reinforcing properties of the sick role -relief of responsibility -attention, empathy [blank_start]Cognitive[blank_end] Mechanisms (re attention to somatic events): -interpretation of the meaning & significance of these events (e.g. catastrophizing) -uncontrollable preoccupation with somatic experiences [blank_start]Formative[blank_end] Experiences: -personal experience with personal illness -socialization & prior experience with illness [blank_start]Treatment:[blank_end] behavioural approach: reward attempts to assume responsibility & remove sources of reinforcement (stress management) Cognitive Restructuring: avoid catastrophizing Antidepressants: SSRIs for hypochondrias