week 4

1. What age child is most often the victim of a patient with Factitious Disorder by Proxy? 2. Why?

1. Most are young children (75% less than 6 years old) 2. most trusting, don't really question why they are sick

1. Describe Dissociative Fugue. How long does it usually last? 2. What occurs prior to many occurrences of Dissociative Fugue?

1. People forget their personal identities and details of their past and flee to a new location. usually lasts hours to days but cases have lasted months 2. severe stress

What is the typical length of time that Conversion Disorder lasts?

a few weeks

Dissociative Disorders:

a significant change in memory or identity that leaves an individual feeling dazed and with a sense of a change in reality. Part of the person's memory or identity seems to be DISSOCIATED (detached) or separated from the rest 1. Dissociative Amnesia 2. Dissociative Identity Disorder 3. Depersonalization - Derealization Disorder

What are the treatment goals for DID

help client understand the illness, recover memory gaps, integrate the sub-personalities into one functioning personality

Are men or women more likely to suffer from Illness Anxiety Disorder?

men=women

At what age does Illness Anxiety Disorder typically start

most often early adulthood

Is the patient with Factitious Disorder by Proxy most commonly the mother or father of the child?

mother (mother is the perpetrator in about 77+%)

Do people with Conversion disorder purposely produce their symptoms

no, conversion disorder do no consciously want or purposely produce their symptoms.

Define "Malingering."

intentionally feigning illness to achieve external gain

What is thought to be the most common cause of Dissociative Amnesia?

is associated with severe trauma - war, natural disasters, childhood abuse

Describe the psychodynamic view of the development of DID

repression- people fighting off anxiety by unconsciously preventing painful memories from reaching awareness Amnesia = massive repression. DID is thought to be the result of a lifetime of excessive repression.

Define "Psychophysiological Disorders."

term used to describe psychological factors that cause or worsen genuine physical ailments

What has typically occurred before the onset of Conversion Disorder?

typically appears suddenly at times of stress

Explain Dissociative Amnesia (Slide 52 and 61)

unable to recall important personal events People are unable to recall important information, usually of an upsetting nature, about their lives. not caused by physical factors

How common is Conversion Disorder?

very rare

What are the four types of Dissociative Amnesia? Describe each disorder. Which is most common?

(Localized, Selectiv amnesia , Generalized amnesia, Continuous amnesia, (Dissocitive fugue)) =(L, Sa, Ga, Ca, (Df)) 1. localized - most common - a person loses all memory of events that took place within a limited period of time almost always beginning at the time of the disturbing experience. The forgotten time is called the amnestic episode. 2. Selective Amnesia -2nd most common form. They remember some but not all events within a given time. 3. Generalized Amnesia - In some cases the amnesia extends back to long before the trauma. These people may lose who they are and not recognize family/friends 4. Continuous Amnesia - here the lack of memory continues into the present. The client forgets new and ongoing experiences as well as those before or during the trauma. rare except in organic causes (vs. psychogenic causes) memory loss focuses on personal info not encyclopedic info. they can still text or drive.. -Dissociative Fugue (the type of dissociative amnesia)- People forget their personal identities and details of their past and flee to a new location. Some people travel far, take a new name, start a new line of work, new relationships, and even display a new personality (usually more outgoing.)

Describe dissociative identity disorder

1. Client develops 2 or more distinct personalities called sub-personalities or alternate personalities 2. Each personality has their own set of memories, behaviors, thoughts, and emotions. 3. Usually, one personality called the primary or host personality appears most often

1. Describe Depersonalization-Derealization Disorder. 2. At what age is a person most likely to experience this. What are some of the triggers for this disorder?

1. Derealization - characterized by feeling the external world is unreal. -They know there is something wrong with their perceptions 2. occurs most often in adolescents/young adults-rarely in people over 40.• comes on suddenly, may be triggered by extreme fatigue, physical pain, intense stress or recovery from substance abuse.

1. Describe Self-Hypnosis and how this may relate to the development of DID. 2. At what age are people very susceptible to Self-Hypnosis?

1. Dissociative d/o may be a form of self-hypnosis??? in which people hypnotize themselves to forget trauma. 2. age 4-6.

Somatoform (Somatic Symptom) Disorders:

1. Factitious Disorder 2. Conversion Disorder 3.Somatic Symptom Disorder 4. Illness Anxiety Disorder

1. Describe State-Dependent Learning and 2. how this may relate to the development of DID

1. If you learn something in one mood you will remember it better if you are in the same mood 2. When a situation produces a particular level of arousal, a person is more likely to recall memories linked to that same level of arousal. so Maybe?? people who experience dissociative disorders have state-to memory links that are super rigid Maybe their thoughts, memories and skills are tied exclusively to a specific arousal state. In DID, perhaps different arousal levels may produce entirely different groups of memories, thoughts and abilities - that is different subpersonalities.

Treatment of Illness Anxiety Disorder (think of this as an anxiety disorder)

1. Meds -primarily SSRI's 2. CBT - Exposure and Response prevention (ID, challenge, replace)

1. What is the average number of sub-personalities seen with DID in women? 2. In men?

1. Women= 15 sub-personalities 2. Men= 8 for men

1. What are the three DSM-5 criteria for Conversion Disorder? 2. Do the symptoms affect voluntary or involuntary motor and /or sensory functioning?

1. a. one or more defects that have effected voluntarily or sensory control b. symptoms are inconsistent with known neurologic or medical diseases d. distress or impairment 2.voluntary motor or sensory functioning

Name 3 Dissociative Disorders

1. dissociative amnesia - 4 types, dissociative fugue 2. dissociative identity disorder 3. depersonalization - derealization disorder

Describe the criteria for Factitious disorder

1. lying when talking about talking a physical or mental disorder, even in the absence of reward 2. presentation of as ill, impaired, or injury

What is the most common treatment for Dissociative amnesias

1. psychodynamic therapy 2.Hypnotic therapy

What are the risk factors for the development of Factitious Disorder? (Who is most likely to develop this disorder?)

1. received extensive med treatment as children 2. abuse/neglect as a child 3. have worked as a nurse, lab tech, aide

What are the two types of Somatic Symptom Disorder? Explain the differences.

1. somatization pattern- Large and varied number of bodily symptoms. - Symptoms have some (but little) physical basis Often include pain symptoms(headache, chest pain) GI symptoms (diarrhea,) sexual symptoms (erectile or menstrual difficulties,) or neurological symptoms (paralysis) -tends to run in families. 20% of close female relatives share this diagnosis - 2. predominant pain pattern- people with conversion d/o or the somatization pattern of somatic d/o may also experience pain but here PAIN is the key feature the concerns and disruption caused by the pain is disproportionate to its severity and seriousness often develops after an illness or trauma that has caused significant pain.

1. Define Depersonalization. 2.Define Derealization

1. the senses that one's own mental functioning or body is unreal or detached 2. an alteration in perception or experience of the external world so that it seems unreal in some way.

What are the most common symptoms of victims of patients with Factitious Disorder by Proxy?

25% of known siblings are dead, 61% of sibs had/ have symptoms similar to the known victim

Dissociative Identity Disorder

A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Also called multiple personality disorder.

Convergence disorder

A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. no neurological basis typically appears suddenly at times of stress and lasts a few weeks affect voluntary motor or sensory functioning women: men 2:1

Define "Derealization"

Derealization = an alteration in perception or experience of the external world so that it seems unreal in some way.

1. lying about physical or mental illness 2. presentation of someone as sick (the victim) parents or caregivers makeup or produce physical illnesses in children (usually) leading to painful tests, medications, surgeries.... in order to gain the attention of medical providers and others the mortality rate of 6%-30%. ? most lethal form of abuse

Describe the criteria for Factitious Disorder by Proxy?

Describe the behavioral view of the development of DID

Dissociation d/o's are an escape behavior that begins when a child experiences a trauma, finds relief when the mind drifts elsewhere, leading to a decrease in anxiety which leads to further forgetting.

Define "Dissociative" disorder

Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.

True or False: Most people recover on their own from DID

False

Describe the DSM-V criteria for Illness Anxiety Disorder

Fear of illness, mild if any symptoms, anxiety about health, excessive body checking, 6 months= F, M, A, E, 6 1. fear of having or developing an illness 2. symptoms are absent or only mild, if any 3. anxiety and easy triggered alarm about one's health 4. performance of excessive health- related behaviors 5. needs to last 6 months

Describe how sub-personalities differ in DID.

If, Ap, Pr= if, apples pop, pigs respond 1. Identifying features (IF ) - age, gender, race, history 2. Abilities/preferences (Apples Pigs) - one may speak a foreign language, or play piano..... they like different friends, foods, music. different educational levels 3. Physiological responses (Pigs respond) - different blood pressures, responses to stress.

Contrast "malingering" with "factitious disorder"

Malingering is when you get compensation for a faked physical or mental illness, but with a factitious disorder, you are only doing it for attention aka there is no outside gain. Malingering = intentionally feigning illness to achieve external gain such as financial compensation, leaving military service, obtaining medications for reasons of abuse... V.S. Factitious Disorder = intentionally feigning illness from a wish to be a patient

Why are medications used with extreme caution in patients with Factitious Disorder

Meds used only if depression or anxiety is a major factor but need to be careful as there is a serious risk of misuse of meds Primary treatment is to modify the person's behavior so a CBT approach is usually tried high risk of self-harm, substance abuse

What is the historic name for factitious disorder?

Munchausen syndrome

Explain the connection between abuse and DID

Often associated with severe child abuse often sexual abuse occurring very early.

Dissociative Amnesia

People are unable to recall important information, usually of an upsetting nature about their lives. not caused by physical factors five types 1. localized 2. Selective Amnesia 3. Generalized Amnesia 4. Continuous Amnesia 5. Dissociative Fugue

Explain Somatic Symptom Disorder.

People with somatic symptoms d/o become excessively distressed, concerned, and anxious about bodily symptoms that they are experiencing and their lives are greatly disrupted by the symptoms. The person's concerns are disproportionate to the symptoms.

Somatic Symptom Disorder

People with somatic symptoms d/o become excessively distressed, concerned, and anxious about bodily symptoms that they are experiencing and their lives are greatly disrupted by the symptoms. The persons concerns are disproportionate to the symptoms.

Previous name for Illness Anxiety Disorder

Previously known as HYPOCHONDRIASIS

What is the major difference between Somatic Symptom Disorder and Illness Anxiety Disorder?

Somatic symptom disorder, SSD, is a state where a person experiences physical symptoms and disproportionately negative thoughts about these symptoms such that either or both can disrupt their life. Illness anxiety disorder, or IAD, is a disorder where a person is overly preoccupied with having or getting a disease.

True/False: Most clients recover from Dissociative amnesias on their own.

True. most clients recover on their own

Are women or men more likely to experience DID

Women women:men 3:1

Is it believed that Conversion and Somatic Disorders are primarily the results of biological/biochemical or psychological factors?

believed to primarily result from psychological factors.

Factitious Disorder

clients deliberately create symptoms of an illness. Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick.

illness anxiety disorder

experience chronic anxiety about their health and are convinced they have or are developing a serious medical illness despite an absence of substantial physical symptoms. Previously known as HYPOCHONDRIASIS

People who purposely produce their symptoms are said to have which disorder?

factitious disorder

depersonalization/ derealization disorder

feel they are detached from their own minds or bodies and often feel they are observing themselves from the outside

Describe treatments for Conversion and Somatic Disorders.

focus on CAUSE, underlying anxiety? Exposure treatment, Medications, Suggestion, Reinforcement =C,Ua,Et,M,S,R 1. clinician usually focuses on the CAUSES (trauma, anxiety) 2. psychodynamic therapists would focus on the underlying anxiety. 3. behavioral therapists would likely use an exposure treatment - exposing the client to the trauma that was first associated with the symptoms expecting the client to become less anxious with repeated exposures 4. medications- antidepressants with anti-anxiety qualities SSRI's 5. some therapists use SUGGESTION - telling patients their symptoms will resolve. (a cognitive approach) 6. REINFORCEMENT increase rewards for healthy behaviors and decreases rewards for "sickness" symptoms (a behavioral approach)