精神病学教学课件：somatoform and dissociative disorders

1、Somatoform and Dissociative Disorders I. Somatoform Disorders Sick Role Have you ever “played sick” in order to get out of something? How did that work out (did you get what you wanted)? Sick attention (friends, family, medical) = secondary gains Likely link between secondary gains and somatoform di

2、sorders Some medical condition may actually exist Some features Somatoform disorders are mental illnesses not faking their symptoms Doctors need to perform many tests to rule out other possible causes Somatization Disorder Historical perspective In the medical/clinical nomenclature since the mid-160

3、0s Known as “Hysteria,” “hypochondriasis,” and “melancholia” until 1800s when mental disorders were differentiated Briquets syndrome, named for the French physician who initially defined it in 1859 Term “somatization disorder” was first used in DSM-III (1980) Somatization Disorder The symptoms invol

4、ve several different organs and body systems. The patient may report a combination of: pain neurologic problems gastrointestinal complaints sexual symptoms B. Somatization (cont.) DSM-IV criteria A. History of many physical complaints beginning before age 30 occurring over several years resulting in

5、 treatment being sought or significant impairment in functioning 2. DSM-IV criteria (cont.) B. Each of the following met at some point during disorder: 1) 4 pain symptoms 2) 2 gastrointestinal symptoms 3) 1 sexual symptom 4) 1 pseudoneurological symptom 2. DSM-IV criteria (cont.) C. Either: 1) sympt

6、oms in Criterion B cannot be fully explained by a known GMC(general medical condition) or 2) when a GMC does exist, the symptoms in Criterion B are in excess of what would be expected based on medical facts D. Symptoms not intentionally feigned or produced Somatization： Additional descriptive inform

7、ation Report of symptoms usually colorful or exaggerated; factual info usually lacking Lab findings do not support somatic complaints Treatment sought from several doctors at once Statistics and course Lifetime prevalence: 0.2 2% in women less than 0.2% in men Rates affected by rater, method of asse

8、ssment, and demographic variables: Non-physicians diagnose it less frequently In primary medical care settings, rate is 4.4 20% Typical demographic is lower SES unmarried woman Somatization : Statistics and course Somatization : Statistics and course (cont.) Onset is usually before 25 (must have sym

9、ptoms before 30) Course is chronic and rarely remits completely Somatization : causes a) familial/genetic Clear link between somatization and antisocial personality disorder Genetic influence (30-50%) on somatization symptoms b) Social learning Parents may reinforce somatic complaints in children ga

10、in attention (sick role) Research shows somatization features and help seeking for illness in parents of somatizing children Causes (cont.) c) Cultural Cultural differences in type of symptoms Different rates across cultures Possible differences in the use of somatic references in communication (not

11、 a disorder, just differences in communication?) d) Societal More acceptance of medical vs. psychological problems Somatization ：Treatment No treatment shown to be effective Behavioral approach limit doctor visits Use a gatekeeper physician Train patient to relate to others without using physical co

12、mplaints Conversion Disorder Sensory Symptoms: Motor Symptoms: Visceral Symptoms Hypochondriasis People with this type are preoccupied with concern they have a serious disease. They may believe that minor complaints are signs of very serious medical problems. For example, they may believe that a com

13、mon headache is a sign of a brain tumor. Body dysmorphic disorder People with this disorder are obsessed with - or may exaggerate - a physical flaw. Patients may also imagine a flaw they dont have. Pain disorder People who have pain disorder typically experience pain that started with a psychologica

14、l stress or trauma. Somatoform and Dissociative Disorders II. Dissociative Disorders Overview Disorders are marked by disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. dissociative amnesia, dissociative fugue, dissociative identity d

15、isorder, depersonalization disorder dissociative disorder not otherwise specified. dissociative amnesia an inability to recall information about ones life that cannot be accounted for by other diseases. dissociative fugue is an unexpected and unexplained migration from ones home characterized by an inability to recall any of ones past. dissociative identity disorder fracturing of the self into two or more distinct personalities. depersonalization disorder a recurring feeling that one is detached from ones self or ones body. Summary Somatoform disord