Exam 3 study guidePART ONEI. Somatization Disordera. Diagnostic Criteriai. History of many physical complaints beginning before the age of 30 which occur over several years and result in treatment being sought, or significant impairment in important areas of functioningii. 4 pain symptoms – 2 gastrointestinal symptoms other than pain – 1 sexual/reproductive symptom – 1 pseudoneurological symptom (paralysis, vision, balance, breathing, etc)iii. Not fully explained by a known medical condition or the effects of a substanceiv. Substantial impairment in social or occupational functioningv. Concern about the symptoms – not necessarily what they meanvi. Symptoms become the persons identityb. Etiologyi. Rareii. Onset is usually in adolescenceiii. Unmarried, low socioeconomic status women – ratio is 2:1 female to maleiv. Chronicv. Family history of illness during childhood – heritable basisvi. Linked to anti-social personality disorder – men get ASPDwhile women get somatization disorder – the two disorders share a weak neurobiologically based behavioral inhibition system – patients are very impulsivevii. Social isolation c. Treatmenti. Difficult to treatii. CBT is best treatmentiii. Reduce the tendency to visit numerous medical specialists by assigning a “gatekeeper” physicianiv. Reduce supportive consequences of talk about physical symptomsII. Conversion Disordera. Diagnostic Criteriai. One or more conditions affecting voluntary motor or sensory function (paralysis, blindness, difficulty speaking[aphonia]) without corresponding physical pathologyii. La belle indifference iii. Retain most normal functions but lack awarenessiv. Conversion Disorder verse malingering/factitious disordersb. Etiologyi. Rare with chronic intermittent courseii. Comorbid with anxiety and mood disordersiii. Mostly in females – but has been seen in males who have been in combat but symptoms usually will go away on own iv. Onset in adolescencev. Common in some cultural/religious groups – evidence of contact with God – held to high esteem – does not qualify for the disordervi. Freudian psychodynamic view – experience trauma/conflict then repress those feelings to which theyare converted into physical symptomsvii. Address primary and secondary gainsc. Treatmenti. Similar to somatization disorderii. Attend to the traumaiii. Remove sources of secondary gainiv. Reduce supportive consequences of talk about physical symptomsIII. Hypochondriasisa. Diagnostic Criteriai. Preoccupation with fears of having a serious disease – severe anxietyii. Preoccupation persist despite appropriate medical evaluation and reassurance – physical complaints without a clear causeiii. Preoccupation is not of delusional intensity and is not restricted to concern over physical appearanceiv. Clinically significant distress or impairment because of preoccupationv. Strong disease convictionvi. Duration of at least 6 monthsb. Etiologyi. Prevalence between 1% and 5%ii. Onset at any ageiii. Sex ratio equaliv. Chronic coursev. Cognitive perceptual distortions – faulty interpretation ofphysical sign or sensations – leads to a perceived threat –which leads to increased focus on body, checking behavior and reassurance seeking – leads to preoccupation – which leads to misinterpretation of bodysensations – leads back to perceived threatvi. Family history of illness during childhood - geneticsvii. Stressful life eventviii. Social/interpersonal influence – if you are sick you get a lot of attention and are able to avoid work or other responsibilities c. Treatmenti. Challenge illness-related misinterpretationii. Provide more substantial and sensitive reassurance and educationiii. Stress management and coping strategiesiv. CBT – also teaching patients how to create ”symptoms” by focusing attention on them and learn how these symptoms are under their own controlv. Antidepressants are of some helpIV. Body Dysmorphic Disordera. Diagnostic Criteriai. Preoccupation with an imagined defect in appearance or gross exaggeration of a slight physical anomaly – “imagined ugliness”ii. Preoccupation causes significant distress or impairment in functioningiii. No accounted for by another mental disorderiv. Often display ideas of reference for the imagined defectv. Suicidal ideation and behavior are commonvi. Often there are attempts to correct the defectb. Etiologyi. Top locations are face (nose, teeth, eyes, eyebrows, shape, chin, lips etc.) skin and hair ii. More common than previously thoughtiii. 4% - 28% of college studentsiv. Sex ratio is equal between gendersv. Onset usually between 14 and 19vi. Most do not marry and seek out plastic surgeryvii. Lifelong chronic courseviii. Little is known but does tend to run in familiesix. Similar to OCD c. Treatmenti. Parallels treatment for OCDii. Medications (SSRI’s) that block reuptake of serotonin iii. Exposure and response prevention iv. Plastic surgery is often unhelpfulV. What are the central features of the somatoform disorder? Preoccupation with health and or body appearance and functioning – no medical condition is causing the physical complaints - ------- What does soma mean? BodyVI. What is Pain Disorder and why is it included in this group of disorders?a. Pain Disorder is a somatoform disorder featuring true pain butfor which psychological factors play an important role in onset, severity, or maintenance. Pain in one or more sites in the body that is associated with significant distress or impairment. May have been a clear physical reason for pain (got shot, amputation) but psychologically maintain the pain and anxiety focused on the experience of pain. The pain is real and it truly hurts the patient. Prevalence is 5%-8%-12%. VII. Describe some ways that a person with a conversion disorder might differ for an individual with a biologically caused physical malfunctiona. Biologically caused physical malfunction might be that a person was in a wreck and got nerve damage and is paralyzed but a conversion disorder would be an individual who had a stressor and internalized the anxiety and formed a paralysis but it is not linked to any biological cause (nerve damage)VIII. Describe factitious disorder and malingering. How are they different from one another?a. Malingering – deliberate faking of a physical or psychological disorder motivated by gain (get disability, win law suit) – if there was no marked stressor in the individuals life then that might