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Reveiw Week 3 Final with Questions REVIEW 3 SOMATIZATION AND RELATED DISORDERS SOMATIZATION AND RELATED DISORDERS SOMATIZATION ▸ Psychological problems or concerns that are converted into and communicated as physical distress ▸ Anxiety is either Conscious or Unconscious ▸ Physical Illness is Real SOMATIZATION AND RELATED DISORDERS - SSD SOMATIC SYMPTOM DISORDER A. One or more somatic symptoms that are distressing or result in significant disruption of daily life B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following 1. Disproportionate and persistent thoughts about the seriousness or one’s symptoms 2. Persistently high level of anxiety about health or symptoms 3. Excessive time and energy devoted to these symptoms or health concerns C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months) SOMATIZATION AND RELATED DISORDERS - SSD TREATMENT ▸ Regular office visits with the same physician ▸ Psychotherapy ▸ Validate the patient’s feelings/experience of symptoms SOMATIZATION AND RELATED DISORDERS - ILLNESS ANXIETY DISORDER ILLNESS ANXIETY DISORDER A. Formerly hypochondriasis B. Preoccupation with having or acquiring a serious illness C. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (strong FH), the preoccupation is clearly excessive or disproportionate D. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status (preoccupation with idea one is sick) E. The individual performs excessive health-related behaviors (checking body) or exhibits maladaptive avoidance (avoids doctors) F. Illness preoccupation present for at least 6 months G. Illness preoccupation not better explained by another mental disorder SOMATIZATION AND RELATED DISORDERS - ILLNESS ANXIETY DISORDER TREATMENT ▸ Cognitive Behavioral Therapy ▸ Medication ▸ SSRI (may help) SOMATIZATION AND RELATED DISORDERS - CONVERSION CONVERSION DISORDER “FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER” A. One or more symptoms of altered voluntary motor or sensory function B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions C. The symptoms or deficit is not better explained by another medical or mental disorder D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning E. Primary Gain SOMATIZATION AND RELATED DISORDERS - CONVERSION TREATMENT ▸ Psychotherapy ▸ Medications ▸ Treating comorbid anxiety and depression ▸ Physical therapy SOMATIZATION AND RELATED DISORDERS - FACTITIOUS DISORDER FACTITIOUS DISORDER (IMPOSED ON SELF) A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception B. Individual presents to others as ill, impaired, or injured C. Deceptive behavior is evident even in the absence of obvious external rewards D. Behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder E. Secondary Gain SOMATIZATION AND RELATED DISORDERS - FACTITIOUS DISORDER FACTITIOUS DISORDER (IMPOSED ON ANOTHER) A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception B. Individual presents another individual (victim) to others as ill, impaired, or injured C. Deceptive behavior is evident even in the absence of obvious external rewards D. Behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder E. Secondary Gain DEFENSE MECHANISMS DEFENSE MECHANISMS BECOMING A SELF ▸ Mimicry: imitation of another’s behavior ▸ Introjection: a loved or hated person, or part of a person, is incorporated into one’s self, but retains the identify of the original person ▸ Identification: taking over of attitudes and behaviors of significant others, and experiencing those attributes as part of one’s own identity DEFENSE MECHANISMS IMMATURE DEFENSES ▸ Repression ▸ Intellectualization ▸ Denial ▸ Isolation ▸ Displacement ▸ Splitting ▸ Reaction Formation ▸ Projective Identification ▸ Projection ▸ Rationalization DEFENSE MECHANISMS - IMMATURE REPRESSION ▸ Involuntarily withholding an idea of feeling from conscious awareness ▸ A 20-year-old does not remember going to counseling during his parents’ divorce 10 years earlier. DISPLACEMENT ▸ Redirection of emotions or impulses from original subject to a neutral, more acceptable, substitute ▸ A teacher is yelled at by the principal. Instead of confronting the principal directly, the teacher goes home and criticizes her husband’s dinner selection. DEFENSE MECHANISMS - IMMATURE REACTION FORMATION ▸ Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite ▸ A patient with sexual thoughts and fantasies enters a monastery PROJECTION ▸ Attributing to others one’s own unacceptable impulses, thoughts, and desires ▸ A patient with sexual thoughts and fantasies enters a monastery DEFENSE MECHANISMS - IMMATURE RATIONALIZATION ▸ Proclaiming logical, socially approved reasons for our past, present, or proposed behavior. ▸ After getting fired, the patient explains that “the job was not important anyway” INTELLECTUALIZATION ▸ Using facts and logic to emotionally distance oneself from a stressful situation ▸ In therapy, a patient who has cancer only focuses on the survival rates of their particular cancer. DEFENSE MECHANISMS - IMMATURE ISOLATION ▸ Separating feelings from ideas and events ▸ A patient describes a murder in graphic detail without any emotional content. SPLITTING ▸ Perceiving oneself or others as either all good or all bad, rather than experiencing ambivalently (good and bad) ▸ A patient praises the doctors for being the best on the inpatient unit, and states that the outpatient providers are horrible, the worst. DEFENSE MECHANISMS - IMMATURE PROJECTIVE IDENTIFICATION ▸ A person induces, by projection, their own feelings in another person, and that person unknowingly acts out those feelings. ▸ A friend is upset because they believe that they have put on weight, and projects those feelings onto you asking, “Have you put on weight?” After this comment you become concerned about your own weight and start believing you have put on weight (when in fact you have not). DEFENSE MECHANISMS MATURE DEFENSES ▸ Suppression ▸ Sublimation ▸ Humor ▸ Altruism DEFENSE MECHANISMS - MATURE SUPPRESSION ▸ A deliberate, conscious effort to control and conceal disturbing thoughts, feelings or acts. ▸ A student who is worried about a championship game, consciously chooses to not worry about it until it is time to play. SUBLIMATION ▸ Diverting basic drives or impulses into socially appropriate channels. ▸ A frustrated medical student channels his anger and negative emotions into sporting events and home improvement projects. DEFENSE MECHANISMS - MATURE HUMOR ▸ Seeing the funny side of situations as a means of diffusing negative affects such as anxiety. ▸ A medical student who found out they failed the Step exam, texts friend meme to alleviate the stress and anxiety of the situation. ALTRUISM ▸ Taking a negative experience and turning it into a socially positive one. ▸ A patient who has been in a deadly motor vehicle accident as a teen, spends many days advocating for safe driving amongst high school students. PERSONALITY DISORDERS PERSONALITY DISORDERS ATTACHMENT TYPES ▸ Secure Attachment ▸ Insecure - Ambivalent Attachment ▸ Not engaged in caregiver, angry and cannot use the contact to comfort during the reunion ▸ Inconsistent caregiver ▸ Insecure - Avoidant Attachment ▸ Not engaged in the caregiver, the reunion is not effective ▸ Insecure - Disorganized Attachment ▸ Uncertain, disorganized response to caregiver leaving (ambivalent extreme) PERSONALITY DISORDERS PERSONALITY DISORDER ▸ Personality patterns that are so inflexible and pervasive that they become maladaptive and cause significant impairment in function or subjective pain and distress ▸ Onset: Adolescence ▸ Course: Persistent through Adulthood ▸ Clusters ▸ A: odd or eccentric ▸ B: dramatic, emotional, erratic ▸ C: anxious or fearful PERSONALITY DISORDERS CLUSTER A “WEIRD” - ACCUSATORY, ALOOF, AWKWARD ▸ Paranoid (Accusatory) ▸ Pervasive distrust, suspiciousness and unwarranted tendency to interpret people’s actions as deliberately demeaning or threatening. ▸ Schizoid (Aloof) ▸ Pervasive pattern of detachment from social relationships and a restricted range of emotional experience and expression. ▸ Schizotypal (Awkward) ▸ Pervasive pattern of detachment from social and interpersonal deficits as well as cognitive or perceptual distortions and eccentricities of behavior. ▸ Magical Thinking PERSONALITY DISORDERS CLUSTER B “WILD” - BEST, BAD, BORDERLINE, FLAMBOYANT ▸ Narcissistic (Best) ▸ Pervasive pattern of grandiosity, in fantasy or behavior, need for admiration and lack of self-esteem ▸ Antisocial (Bad) ▸ Pervasive pattern of disregard for and violation of the rights of others occurring since age 15 in someone at least 18 (criminals) ▸ Borderline ▸ Pervasive pattern of instability of affect, interpersonal relationships, and self-image, and marked impulsivity ▸ Histrionic (flamBoyant) ▸ Pervasive pattern of excessive emotionality and attention seeking PERSONALITY DISORDERS
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