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Causes & Prevention

Dissociative Disorders: Assessment & Treatment

Once stabalized and completed the above they can move on to step 2

Phase 2 focuses on

• Processing traumatic memories

  • Meaning of them
  • Impact of the experiences
  • Identifying and resolving trauma related disturbances
  • Expressing previously avoided emotion (including grief, betrayal, terror, helplessness, rage, and shame)

Phase 3 focuses on

  • Reintegration into life
  • Letting go of the past and focusing on current and future goals

Dissociative & Somatic Disorders

By: Kristin B, Katrina, Stephanie M, Xena, Alondra, Niki P.

Fill In The Blank Answers

Normal Dissociation & Dissociation Disorders

Treatment & Assessment

Dissociation is the disruption of consciousness, memory, awareness of the body and/or of one's self, awareness of the enviornment and/or of one's identity.

Normal dissociation can be mild or moderate and is temporary. It includes day dreaming and "spacing out."

Highway hypnosis occurs when you are driving and you cannot recall how you got to your destination.

Dissociate Identity Disorder is the prescence of two or more distinct personalities in an individual.

Somatic Symptom Disorders

Fill In The Blank Answers

Somatic Symptom Disorder: Features and Epidemiology

Somatic disorders usually involve physical symptoms that are caused by a medical condition.

Psychosomatic is a term used to describe people with physical symptoms that seem to be “all in their head”.

Many people remain in the medical system not the mental health system.

People that would have been previously diagnosed with hypochodriasis would now receive a diagnosis of somatic symptom disorder.

What is Dissociation?

Somatic Symptom Disorders: Assessment

Dissociation is…

The disruption of

• Consciousness

•Memory

• Awareness of body and/or self

• Awareness of environment

• Identity

Fill In The Blank Answers

Continuum of Dissociation and Dissociative Disorders

• Interviews

  • Clinical Assessment

• Questionnaires

• Comprehensive Assessment

Dissociation Disorders: Cause and Prevention

Causes & Prevention

Conclusion

Risk factors:

  • key brain changes
  • trauma

Diathesis-stress fashion

  • Somatic & Dissociative Disorders are both unique and intreging disorders

  • With a variety of treatment strategies both psychological and biological one can over come their diagnosis

  • With the help of educating future parents on the effects of child maltreatment and mental health as a whole, it is possible to help prevent the increase dianosis of these disorders

The two main risk factors for dissociate disorders are key brain changes and trauma.

Brain changes in individuals are mainly dealt with the disintegration of consciousness, memory, and identity.

Individuals will detach themselves from a traumatic event in order to cope with it.

Preventing traumatic events that lead to dissociate disorders can be a helpful way to prevent dissociative disorders.

Epidemiology

Dissociative Disorders: Dissociative Amnesia

Characteristics

Somatic Symptom Disorder: Assessment

Interviews- gather information about people with somatic symptom disorders.

Questions should involve a detailed history of physical and psychological problems.

Somatic symptom disorders can be complex, long standing and often begin in childhood and adolescence.

  • Clinical Assessment- is a patient assessment that was developed to be administered at the initial patient interview and to monitor treatment progress.
  • The Clinician-Related Severity- is a 3-term measure that assesses severity of the individual's excessive concerns and/or preoccupations with the somatic symptom(s).

  • forgetting personal information
  • significant distress and affects social, occupational and functional abilities
  • one or several severe episodes of forgetfulness or equally severe episodes
  • memory can come back suddenly or gradually

Types of Dissociative Amnesia:

Somatic Symptom Disorder: Assessment & Treatment

  • Difficult to evaluate

  • Often co morbid with other mental disorders

  • Often associated with trauma

  • Not caused by substance abuse or medical conditions

  • 2 to 3.4% in America

  • Average 10% of the clinical population and community population have a dissociation disorder across North America, Turkey, The Netherlands, Germany, Switzerland, and Finland

  • Localized Amnesia
  • Selective Amnesia
  • Generalized Amnesia
  • Continuous Amnesia
  • Systematized Amnesia
  • Dissociative Fugue

Fill In The Blank Answers

Game Time!

Somatic Symptom Disorders: Causes and Prevention

Studies have shown that identical twins have a ____ chance of developing Somatic Symptom Disorders and fraternal twins had a ____chance.

Individuals with this disorder adopt _______________ or ______________ explanations for their symptoms.

Prevention strategies for Somatic Symptom Disorders include __________ individuals; attending to their ________________; helping them cope with disorders, symptoms etc.; and _____________ anxiety management.

Somatic Symptom Disorder: Assessment

Questionaires- use of screening instruments for assessing

the presence and severity of somatic symptoms.

Comprehensive Assessment- requires the recognition that psychiatric problems often co-occur in patients with medical problems. The criteria emphasizes the degree to which a patient's thoughts, feelings and behaviours about their somatic symptoms are disproportionate or excessive.

Biological Risk Factors

Brain Changes

  • disintegration of consciousness, memory, and identity
  • key brain areas: -amygdala

-locus coeruleus

-thalamus

-hippocampus

-anterior cingulate cortex

-frontal cortex

Somatic Symptom Disorders three main assessments include: Interviews, Questionaires, and Comprehensive Assessments.

Somatic Symptom Disorders can be complex and long standing, it often begins in childhood and adolescence.

Cognitive Therapy allows for identificaiton and modification of unhelpful benefits about symptoms and disease.

Factitious disorders refer to deliberate production of physical or psychological symptoms.

Dissociative Disorders

Dissociative Disorders: Dissociative Identity Disorder

  • detachment

control responses

adapt accordingly

experience little emotional response, blunted pain

experiences, decrease in relevant thoughts

  • depersonalization/derealization disorder

Characteristics

  • Most severe dissociation disorder
  • Formally known as multiple personality disorder
  • Presence of two or more distinct personalities
  • Inability to recall important personal information
  • Recurrent gaps in recollection of everyday events

connection problems between brain areas

Fill In The Blank Answers

Different relationships between the multiple personalities:

  • Two-way amnesiac relationship
  • One-way amnesiac relationship
  • Mutually aware relationship

Psychological treatments

• The treatment involves overcoming different phases of a trauma focused psychotherapy that tends to the spectrum of symptoms.

• These symptoms may include: Anxiety, Depression, distress, dissociation and PTSD.

Fill In The Blank Answers

Somatic Symptom Disorders: Cause and Prevention

Treatment studies have proven the multi-phasic type of treatment to be effective

Dissociation Disorders: Assessment and Treatment

Somatic Disorders: Treatment

Treatment for all dissociative disorders involves 3 phases

Phase 1 focuses on:

• Stabalizing safety issues

• Enhancing symptom control

• Containing impulses

• Educationg about trauma treatment

• It is usually the longest phase + most important

• Some may remain in stage for years due to

o Disruptive relationships

o Debilitating psychiatric/ medical occurances

Environmental

Risk Factors

Memory Changes

  • experiencing extreme negative events

Medical treatment

  • Medicine is not the most common treatment for dissociative disorder, however; it is used in combination with a psychological intervention as we have seen above

  • It is typically taken to help aid in controlling the multitude of symptoms

  • It does not help cure In any way, only helps to make it more bearable.

  • key changes:

Studies have shown that identical twins have 10% chance developing Somatic Symptom Disorders and fraternal twins have a 29% chance.

Individuals with this disorder adopt biological or illness explanations for their symptoms.

Prevention strategies for Somatic Symptom Disorders include educating individuals; attending to their bodily changes; helping them cope with disorders, symptoms, etc.; and practicing anxiety management.

compartmentalization

difficulty retrieving information

Trauma

A psychological treatment involves overcoming different phases of trauma, focused psycotherapy that tends to the spectrum of symptoms.

These symptoms include: anxiety, depression, dissociation, and PTSD.

Psychological treatment studies have shown that this method of treatment s effective.

Medicine is an intervention for dissociate disorder as a form of medical treatment.

  • certain memories not

remembered by host

personality

  • dissociative identity

disorder and

dissociative amnesia

  • Post-traumatic Stress Disorder

Dissociative Disorders: Depersonalization/Derealization Disorder

  • mutually aware or

one-way amnesiac

relationships

cause: natural or human-made disasters,

threat or assault, witnessing a death

  • irrelevant thoughts and dissociative experiences
  • cause is unclear

possibility: reduced blood flow in the

right frontal-temporal cortex

event revisited through memories, dreams, and flashbacks

  • psychological detachment to cope

Psychological Treatment

  • Cognitive-Behaviour Therapy
  • Cognitive Therapy
  • Behaviour Techniques
  • Primary Behavioural Treatment

  • treatment for PTSD:

reminders of trauma

  • Constant or reoccurring feelings of detachment to your own body

  • Surroundings seem unreal

  • Concentration, memory, occupational and interpersonal functioning impaired

difficult to enjoy life, sleep problems, irritable outbursts, difficulty concentrating, extreme vigilance and an intensified “startle” response

  • third variable: intense family

conflict

  • gaps in recalling events can

also result in every day events

definition of

“self”

Cultural

Factors

Biological Treatment

alternative

personalities

to avoid personal

responsibilities

Factitious Disorders & Malingering

confusions with dissociative fugue

and identity disorder

Psychological Treatments

dissociative trance

disorder

  • Cognitive Behaviour Therapy- manages health anxiety, somatic symptoms, and pain.

  • Cognitive Therapy- allows for identification and modification of unhelpful benefits about symptoms and disease.

  • Behaviour Techniques- is helpful to alter illness and sick role behaviours, resume engagement in normal activities, and promote more effective coping.

  • Primary Behavioural Treatment- involves relaxation training and exposure, response prevention, social skills and assertivenes training.

Consider positive vs negative childhood

Causes of

Dissociative Disorders

Biological Treatment

Prevention of Dissociative Disorders

  • People with somatic symptom disorders often experience comorbid anxiety and depression.

  • When medication is considered necessary, new generation antidepressants such as selective serotonin reuptake (SSRIs) and sereotonin-noradrenaline reuptake inhibitors (SNRIs) are the preferred first-line treatment.

A proposed neurodevelopmental approach explaining factors such as brain & memory changes linked with trauma

Individuals may have learned to filter negetive experiences & disturbing impulses to avoid unwanted feelings

  • these disorders may have helped blocking out disturbing thoughts, ideas and experiences from mind

  • Many cases involve memories of sexual, or physical child abuse

  • Child abuse may lead to permanent neurochemical & structual abnormalities in the brain dealing with cognition + memory

Factitious Disorders and Malingering:

  • Factitious Disorders- refer to deliberate production of physical or psychological symptoms.

  • Munchausen Syndrome- refers to severe fictitious disorder in which a person causes symptoms and claims he/she has a physical or mental disorder.

  • Malingering- refers to deliberate production of psychological symptoms with some external motivation.

Data lacks in prevetion

preventing traumatic events:

  • Child Maltreatment

  • educating children about unsafe situations

  • teaching parents appropriate disciplinary practices

  • providing support groups for parents

  • educating parents about normal child development and high risk situations

Positive

  • children grow postive attachment to caregivers
  • adapt normally to life changes
  • learn rules that apply to life
  • have control over their situation
  • a sense of self developes

Negative

  • lack of positive attachment
  • lack of life experiences
  • not knowing who to trust
  • not knowing basic life rules
  • never developing postive sense of self
  • leads to possible mental disorders

Lack of unified self may relate to changes in orbital frontal cortex, which is responsible for memory and consciousness

Biological Risk Factors for Somatic Symptom Disorder

Overview

Genetics

• More prevalent in family members.

• Identical twins : 10% and fraternal twins: 29%

• Youths with this disorder are usually female and their parents are usually of low socioeconomic status and or educational level.

Brain Changes

• Brain changes in the amygdale, limbic system, hypothalamus, cingulate cortex, prefrontal cortex, and somatosensory cortex are the parts of the brain that deal with emotion and feeling.

• In some cases these parts may be overactive causing individuals with Somatic Symptom to perceive things that aren’t really happening.

  • Dissociative Disorder:
  • Normal Dissociation & Dissociative Disorders
  • Features & Epidemiology
  • Causes & Prevention
  • Assessment & Treatment
  • Conclusion
  • Historical introduction

  • Somatic Disorder:
  • Features & Epidemiology
  • Causes & Prevention
  • Assesment & Treatment

  • Factitious Disorders & Malingering

Causes

  • There are many key factors that contribute to Somatic Symptom Disorder:
  • Genetics
  • Brain changes
  • Illness behaviour
  • Cognitive factors
  • Cultural

“Stress as a predisposing factor for somatoform disorders”

Environmental Factors Con't

Environmental Risk Factors for Somatic Symptom

Illness Behaviour and Reinforcement

• Illness behaviour refers to the behaviours an individual does when sick.

Ex: Lying in bed, taking medication etc.

• Peers including family and friends reinforce these behaviours by providing sympathy, attention or even comfort.

• Individuals with Somatic Symptom look for social reinforcement

Cultural Factors

• Individuals of non-Western nations express feelings of things such as depression as physical symptoms more in comparison to Western nations.

• Cultures everywhere have “cultural idioms of distress” which categorize illnesses as “normal.”

Ex: Vietnamese notion of “phong tap”, this refers to general aches, pain and distress.

1.) Experienced difficulties communicating problems…

2.) Avoidance culture in emotional reactions, suppressing their needs etc…

3.) Disconnected their stress reaction awareness from stressful bodily sensations by using avoidant behaviors e.g. by being highly active.

-Journal of Psychosomatic Research

Cognitive Factors

• Individuals with this disorder adopt “biological or illness explanations for their symptoms.”

• The changes in physical sensations the individual experiences feel more severe than they really are.

Prevention

  • Prevention strategies for Somatic Symptom include:
  • Educating Individuals
  • Attending to bodily changes
  • Helping youth cope with disorders, symptoms etc.
  • Providing sufficient health care
  • Practicing anxiety management

Epidemiology of Somatic Symptom Disorders:

Somatic Symptom Disorders: What are they?

• Many people may engage in this behaviour which is seen when someone communicates distress through physical symptoms, and decide to pursue medical help for those symptoms.

• A person with this disorder can experience unusual/ odd physical symptoms with no physical cause.

• Moderate symptoms can include nausea and vomiting. Severe symptoms can include sudden blindness or deafness.

• Psychosomatic is also a termed used to describe people with physical symptoms that seem to be “all in their head”.

• Many people remain in the medical system not the mental health system.

  • Function Neurological Symptom Disorder may be present in only 0.3 percent of the general population and 2.4 percent for body dysmorphic disorder.
  • The most common medically unexplained symptoms across cultures are gastrointestinal problems and "strange" skin sensations.
  • Medically unexplained symptoms are more common among people in non-Western countries.

.

Historical Introduction

Body Dysmorphic Disorder:

• People with this disorder are preoccupied with some imaginary or slight “defect” in their appearance.

• They are distressed and impaired in their daily functioning, and may even undergo several surgeries to alter their appearance.

• Several researchers consider the disorder being closely linked to obsessive-compulsive disorder.

• Somatic symptom and dissociative disorders were seen as being related but now they are seen as two distinct disorders, and now researchers study them in this way.

• Somatic symptom disorders usually involve physical symptoms that are not caused by a medical condition.

• Dissociative disorders involve a disturbance of consciousness, memory or identity.

• In the past people believed that both disorders were the result of a psychological factor(s).ymp

• Psychodynamic theorists believed that strange or erratic behaviours resulted from unconscious conflicts related to personal trauma

Fuctional Neurological Symptom Disorder (previously known as conversion disorder):

• People with this disorder experience motor or sensory problems that suggest a neurological or medical disorder, even though one is not present.

• The neurological examination is used for this disorder.

• Many people with this disorder may be unconcerned about their symptoms, which may indicate other psychological factors such as attention-seeking behaviour.

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