PSYCH 333 1nd Edition Lecture 14 Outline of Last Lecture I What is Dissociation II Dissociative Amnesia III Theories of Dissociative Amnesia IV Depersonalization Derealization Disorder V Theories of Depersonalization Derealization Disorder VI Treatments VII Dissociative Identity Disorder VIII Controversial Diagnosis IX Theories of DID X Treatments for DID Outline of Current Lecture II What are Somatic Symptoms III Somatic Symptom Disorder IV Illness Anxiety Disorder V Somatic Symptom Disorder VI Neurobiological Theories VII Cognitive Behavioral Factors VIII Conversion Disorder IX Etiology of Conversion Disorder X Related Disorders Current Lecture What are Somatic Symptoms o Soma body o Refers to physical symptoms in the body o Mind body connection Placebo effect The mind can directly impact the function of our body o Med student syndrome Having information about symptoms and thinking that they are ill Somatic Symptom Disorders o Illness anxiety disorder o Somatic symptom disorder These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute o Conversion disorder Illness Anxiety Disorder o Formerly hypochondriasis o Excessive worry about becoming ill Excessive when the individual has no reason to worry or that the probability is extremely low unlikely o No or very mild physical symptoms Ex you eat McDonalds and your stomach becomes upset and the individual begins to freak out and think that it is stomach cancer o Easily alarmed about personal health status o Subtypes Care seeking Going to the physician regularly to get checked out Care avoidant Avoiding going to the physician due to a fear of getting an illness at the physician s office o 6 month duration o Associated features Low insight They don t realize that they have a high level of anxiety Not psychologically minded Presents in medical setting Dissatisfaction with medical care Perception that the doctor s aren t taking them seriously Seeks multiple medical opinions tests Negative interactions with health care providers Somatic Symptom Disorder o Somatic symptoms that cause distress dysfunction Symptoms severe enough to keep them from their daily activity o Excessive anxiety about health concerns o Excessive energy time devoted to health concerns o Primary difference from illness anxiety disorder patient experiences actual physical symptoms o Associated features Illness may become a predominant part of the patient s identity Low insight into psychological distress focus primarily on physical distress High utilization of medical care including specialist Often has several doctors Sensitivity to interoceptive cues Assuming that they have another symptom May spend significant time checking body for abnormalities Negative interaction with health care providers High risk of suicide Believing that they are never going to get better Neurobiological Theories o Increased activation of brain regions involved in processing unpleasant sensations Anterior cingulate cortex Physical sensations Anterior insula Pain and disgust response Somatosensory cortex o Psychological distress activates similar areas of the brain Emotional distress makes pain more severe o Treatments Antidepressants Tricyclics imipramine amitriptyline SNRIs duloxetine venlafaxine Can help alleviate pain and psychological distress Medication is not the primary treatment May be difficult to Rx medications interactions Cognitive Behavioral Factors o Cognitive factors Sensitivity misinterpretation of interoceptive cues Catastrophization Attributing their mild illness to the most severe diagnosis e g cancer Salience of health related information o Behavioral factors Sick role avoid work social obligations etc Abstinence from behaviors that improve health e g exercise Example their arm hurts so they don t use their arm which makes them lose muscle strength which causes their arm to hurt again Seeking reassurance from others Reinforcement of illness behavior attention disability benefits o Treatment Identification of emotions that trigger physical symptoms Distress tolerance skills Change cognitions regarding somatic symptoms Slowly re introduce and reinforce healthy behavior while removing reinforcers for sick behaviors May involve coordinating with family members and physicians Conversion Disorder o Onset of neurobiological symptom that is inconsistent with a medical disorder o Voluntary motor or sensory function Muscles movement vision sensation etc Blindness paralysis seizures etc Glove paralysis impossible psychogenic seizure no EGG activity during seizure or after Etiology of Conversion Disorder o Psychodynamic Conversion convert psychological symptoms to physical symptoms Role of the unconscious Repression of primal urges Predominantly sexual urges Motivation influence severity of symptoms o Social and cultural factors Focus on psychological distress in culture Attitudes towards sexuality o Treatment Psychodynamic therapy Some literatures on CBT EMDR hypnosis and biofeedback Few RCTs Needs further research Related Disorders o Factitious disorders Faking physical or psychological symptoms No obvious external rewards for this behavior Two subtypes Imposed on self o Induces their own symptoms Imposed on another o Parent says or induces symptoms in their child o Malingering Faking physical or psychological symptoms Obvious external reward for behavior Winning a court case going home from the military etc