Ch6som
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Transcript of Ch6som
Somatoform Features and Epidemiology
Somatoform Disorders: Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Part 1: Somatoform Disorders
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Emotions
Cognitions
Behaviors
Normal
Optimism regarding health.
No concerns about health.
Attending regular, preventive checkups with a physician.
Mild physical arousal and feeling of uncertainty about certain physical symptoms.
Some worry about health, perhaps after reading a certain magazine article.
Checking physical body a bit more or scheduling one unnecessary physician visit.
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMild
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMildModerate
Moderate physical arousal and greateruncertainty about one’s health.
Strong worry about aches, pains, possibledisease, or appearance. Fleeting thoughts about death or dying.
Scheduling more doctor visits but generally feeling relieved after each one.
Intense physical arousal misinterpreted as a signor symptom of some terrible physical disorder.
Intense worry about physical state or appearance. Intense fear that one has a serious disease. Common thoughts about death or dying.
Regular doctor-shopping and requests for extensive and repetitive medical tests with little or no relief. Checking body constantly for symptoms.
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMildModerateSomatoform Disorder – Less Severe
Extreme physical arousal with great trouble concentrating on anything other than physical state or appearance.
Extreme worry about physical state or appearance.Extreme fear of having a serious potential disease. Frequent thoughts about death and dying.
Avoidance of many social and work activities.Scheduling regular surgeries, attending specializedclinics, or searching for exotic diseases.
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMildModerateSomatoform Disorder – Less SevereSomatoform Disorder – More Severe
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Somatization disorder Pattern of recurring, multiple, clinically significant somatic complaints.
Disorder Essential Features
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Conversion disorder Presence of symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.
Disorder Essential Features
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Pain disorder Pain is the predominant focus of clinical presentation and is of sufficient severity to warrant clinical attention.
Disorder Essential Features
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Hypochondriasis Preoccupation with fears of having, or the idea that one has, a serious disease based on a misinterpretation of one or more bodily signs or symptoms.
Disorder Essential Features
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Body dysmorphic disorder
Preoccupation with a defect in appearance.
Disorder Essential Features
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Prevalence Rates of Major Somatoform Disorders
0.4%Somatization disorder
0.3%Conversion disorder
0.6%Pain disorder
4.8%Hypochondriasis
0.7%Body dysmorphic disorder
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Amygdala
Hypothalamus
Prefrontal cortex Cingulate cortex
Somatosensory cortex
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Illness behavior and reinforcement
Cognitive factors
Cultural factors
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Misperception of symptoms
Feelings of uncontrollability
Over attention to minor bodily changes
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Discuss various topics, not just symptoms.
Schedule regular visits not predicated on complaints.
Develop goals in conjunction with the client.
Discuss how symptoms limit a client’s functioning instead of what might be physically wrong.
Maintain empathy with a client but set limits on behavior.
Acknowledge that the symptoms are real and distressing to the client.
Accept the need to address somatic complaints.
Avoid attempts to convince the client of a psychological cause for symptoms.
Continue to gently refer to the role of tension and stress.
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Antidepressant Medication
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
I am quick to sense the hunger contractions in my stomach.
Even something minor, like an insect bite or a splinter, really bothers me.
I have a low tolerance for pain.
I am often aware of various things happening within my body.
When I bruise myself, it stays noticeable for a long time.
I can sometimes feel the blood flowing in my body.
I can sometimes hear my pulse or my heartbeat throbbing in my ear.
Somatosensory Amplification Scale
Somatoform Features and Epidemiology
SomatoformDisorders:Causes and Prevention
Somatoform Disorders: Assessment and Treatment
Dissociative Disorders: Features and Epidemiology
Dissociative Disorders: Causes and Prevention
Dissociative Disorders: Assessment and Treatment
Severe cognitive distortions
Trauma
Female gender
Low socioeconomic status
Substance use
Eating disorders and depression
Predictors of chronic somatoform disorders