8/12/2014

1
PSYCHOL 2005 Foundations of Health and
Lifespan Developmental Psychology
Mental Health: LECTURE 1
Somatic, Dissociative and
Eating Disorders
12/8/14
Dr Rachel Roberts
Rachel.roberts@adelaide.edu.au
Room 523 Hughes Building
Mental Health: AIMS
Introduction to mental health disorders
including
Somatic, dissociative, and eating disorders,
substance abuse and gambling problems
Aboriginal mental health
National Standards for Mental Health
Services
including evidence based practice, MH careers
FOCUS on issues for consumers and carers
MENTAL HEALTH: Outline
LECTURE 1 13/8/14 Dr Rachel Roberts
Mental health disorders: Somatic, Dissociative and Eating Disorders
LECTURE 2 20/8/14 Ms Kylie Harrison
Consumer presentation Kylie Harrisons story is about severe Bipolar
Disorder and her journey of recovery
LECTURE 3 20/8/14 Dr Rachel Roberts
National Standards for Mental Health Services, evidence
based practice
Career options in mental health (not examinable)
LECTURE 4 27/8/14 Ms Tamara Robins Clin Psych
Mental health disorders: Substance abuse and Gambling
problems
LECTURE 5 27/8/14 Ms Yvonne Clark Clin Psych
Aboriginal mental health
8/12/2014
2
MENTAL HEALTH: Outline
Mental health SDL
Carers and families of people with mental health problems
Mental health tutorial
Review of anxiety disorders and introduction to issues relating to carers and
families of people with mental health problems
All content (lectures, SDL and tutorial) is examinable.
If you are concerned about
someones mental health?
University Counselling Service
http://www.adelaide.edu.au/counselling_centre
Ground Floor, Horace Lamb Building, North Terrace Campus
Crisis Care (family crisis, domestic violence) 111 611
ACIS (24-hr service for mental health emergencies) 131
465
Yarrow Place (rape and sexual assault service) 8226
8787
LifeLine (24-hr phone counselling) 131 114
Domestic Violence Helpline 1800 800 098
Your GP
Disorders
Somatic symptom and related disorders
Illness anxiety disorder
Conversion disorder
Dissociative disorders
Eating disorders
Anorexia nervosa, Bulimia nervosa
8/12/2014
3
Somatic symptoms and related
disorders (DSM-5 category)
Illness Anxiety Disorder (was Hypochondriasis in
DSM-IV))
Conversion disorder
Somatic symptoms and related
disorders
Share the feature of prominence of somatic
symptoms associated with significant distress
and impairment
Factors that contribute to these disorders
Genetic and biological vulnerability (eg sensitivity to
pain)
Early traumatic experiences
Learning (eg attention obtained from illness, lack of
reinforcement of nonsomatic expressions of distress
Cultural and social norms (that devalue and
stigmatise psychological suffering as compared with
physical suffering)
Conversion Disorder
A One or more symptoms of altered voluntary
motor or sensory function
B Clinical findings provide evidence of
incompatibility between the symptom and
recognised neurological or medical conditions
C The symptom 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 or warrants medical evaluation
8/12/2014
4
Illness Anxiety Disorder
Preoccupation with having or acquiring a serious
illness
Somatic symptoms are not present, or if
present, are only mild in intensity
There is a high level of anxiety about health,
and the individual is easily alarmed about
personal health status
The individual performs excessive health-related
behaviours (eg checking body for signs of
illness) or exhibits maladaptive avoidance (eg
avoids appointments with doctor)
Dissociative Disorders
Characterised by a disruption of and/or
discontinuity in the normal integration of
consciousness, memory, identity, emotion,
perception, body representation, motor
control and behaviour.
Dissociative symptoms can potentially
disrupt every area of psychological
functioning
Dissociative symptoms are
experienced as:
Unbidden intrusions into awareness and
behaviour
Inability to access information or to
control mental functions that normally are
readily amenable to access or control (eg
amnesia)
Frequently found after trauma
PTSD also has dissociative symptoms such as
amnesia, flashbacks, numbing, and
depersonalisation
8/12/2014
5
Dissociative Amnesia
Inability to recall important personal
information, usually of a traumatic or stressful
nature, that is inconsistent with ordinary
forgetting
The symptoms cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning
Can be distinguished from brain disorders and
substance abuse
Dissociative Identity Disorder (DID)
Previously known as Multiple Personality Disorder
Two or more distinct personalities appear to exist in one
person and appear to control behaviour
Only one personality evident at one time
Each emerging personality contrasts with the original
self
Each personality has a unique identity, name, and
behaviour pattern
The symptoms are not a normal part of a broadly
accepted cultural or religious practice
Dissociative Identity Disorder (DID)
Some believe DID might serve a survival
function- most people diagnosed with DID are
women with a history of severe abuse over
extended periods during childhood
Schultz et al., (1989) reported a questionnaire
survey of 448 clinicians who had worked with
people with DID and also depression
Compared clients reports of abuse- almost all
people diagnosed with DID had a history of
abuse (98%)
8/12/2014
6
Dissociative Identity Disorder
QuestionnaireItemDID(%)Depression(%)
AbuseIncidence 98 54
Type(s)
Physical 82 24
Sexual 86 25
Psychological 86 42
Neglect 54 21
Allofabove 47 6
Physical&Sexual 74 14
Diagnostic Controversy
The inclusion of DID in the DSM-IV (and now
DSM 5) has been controversial
Reports of DID increased markedly in the
1970s. Why?
Diagnostic criteria for DID spelled out clearly for
the first time
Clinicians only started reporting DID when
interest in the disorder grew
The 1973 publication of Sybil
Schreiber, F.R. (1973). Sybil
Warner Pub.
8/12/2014
7
Diagnostic Controversy
Rate of diagnosis in US has increased
dramatically; very rarely diagnosed in UK,
Australia, J apan
Some psychologists believe the disorder is
underreported; others do not believe in the
disorder at all
High proportion of DID cases diagnosed by small
number of clinicians
The possibility of therapist-created DID (via
hypnosis, line of questioning)
Eating Disorders
Anorexia nervosa
Bulimia nervosa
Associated with a range of physical health problems and
reduced psychological well-being
Associated with a negative body image, and chronic but
not necessarily successful dietary restraint
Eating and exercise patterns often abnormal
Hunger, appetite and satiety may be disturbed
Eating disorders
Anorexia nervosa
Persistent energy intake restriction
Intense fear of gaining weight or becoming
fat or persistent behaviour that interferes with
weight gain (even though underweight)
Disturbance in self-perceived weight or shape
http://www.psychnet-uk.com/dsm_iv/anorexia.htmAccessed 2/7/09
8/12/2014
8
Anorexia nervosa
Ago of onset is usually in early to late
adolescence
Mortality rate is among the highest of all
mental health disorders with most deaths
due to the medical complications of
starvation or suicide
5-10% of people with AN die per decade of
illness
Outcome- recovery generally lengthy, and
for a significant proportion incomplete
Anorexia nervosa: associated
problems
Problems related to the medical and
psychological complications of starvation
Self starvation associated with affect to
every organ system, irregular heart beats,
heart failure, metabolic disturbance
Effects of human starvation
Classic study of human starvation by Keys et al (1950) in
US
36 healthy young men, alternative to military service, 6
months of restriction of food intake, lost on average
25% of body weight
Psychological effects- severe depression, mood swings,
irritability, anger outbursts, compulsive behaviours, self-
harming, obsessional thoughts of food and eating,
hoarding of food, changes in eating habits (more salt,
spices), binge eating that persisted for months after re-
feeding, became isolated and withdrawn due to focus on
food
8/12/2014
9
Eating disorders
Bulimia nervosa
Characterised by eating binges (periods of
intense out-of-control eating) followed by
purges (to rid the body of excess calories)
e.g., self-induced vomiting, misuse of
laxatives, fasting
Self evaluation that is unduly influenced by
body shape and weight
Bulimia nervosa: associated
medical problems
Purging related depletion in the electrolyes of
potassium, chloride and sodium, electrolyte
disturbance found in 50% of people with BN
results in weakness, tiredness, depression,
irregular heartbeats, sudden death.
Ulceration of mouth and throat and dental
deterioration from exposure to gastric acid from
vomiting
Abdominal pain from binge eating
Amenorrhoea and menstrual irregularities
Eating disorders
Approx 10 times more women than men
experience eating disorders
Eating disorders associated with serious
medical consequences
Women in high school and tertiary
education have higher prevalence of
eating disorders than non-students
8/12/2014
10
Eating disorders
Evidence for contributions to risk of
developing an eating disorder
Genetic influences
Psychological factors
Low self esteem, negative affect (eg anxiety),
perfectionism
Cultural influences
Expectations for ideal weight from society and
media, e.g., womens magazines have more
emphasis on weight loss than mens magazines
Treatment of Anorexia nervosa
No consensus over the most effective
psychological treatment
Few controlled studies evaluating treatment
effectiveness due to low prevalence and long-
term nature of most treatments
High drop out rates
Research suggests promising therapy
approaches- motivational enhancement therapy,
cognitive behaviour therapy, family therapy
Treatment of Bulimia nervosa
more research of treatment effectiveness
than AN
CBT is treatment of choice BUT many do
not respond to treatment suggesting need
to improve treatment approaches
8/12/2014
11
Treatment of Bulimia nervosa
Interpersonal psychotherapy (IPT) also
demonstrates effectiveness
Primary focus of IPT is to help identify and
change current interpersonal problems (eg
conflict) that are assumed to be
maintaining the eating disorder (via poor
self esteem, negative affect)
Additional Readings
Reiger, E. (Ed.) (2011). Abnormal psychology: leading researcher
perspectives. North Ryde: McGraw-Hill
Chapter 5 Somatoform and dissociative disorders
Chapter 6 Eating disorders
Note that these references all refer to DSM-IV diagnosis categories,
some of which are different in DSM-5
Preparation for next week
Schizophrenia is characterized by delusions,
hallucinations, disorganized speech and behaviour, and
other symptoms that cause social or occupational
dysfunction.
Bipolar disorder has a clinical course characterized by
one or more manic episodes. Often, individuals have had
one or more major depressive episodes.
Features of mania: High Energy Levels, Positive Mood,
Irritability, Inappropriate Behaviour, Creativity, Mystical
Experiences
for more info see info on Black Dog Institute website
www.blackdoginstitute.org.au