PSYCHOPATHOLOGIE EN PSYCHIATRIE
GEMAAKT DOOR: ANKE MATHIJS
1 DIAGNOSTIEK EN CLASSIFICATIE ............................................................................................................. 11
1.1 VAN ZOT NAAR ZIEK ..................................................................................................................................... 11
1.2 MORELE BEHANDELING ................................................................................................................................ 11
1.3 DIAGNOSTIEK ............................................................................................................................................. 13
1.4 CLASSIFICATIE ............................................................................................................................................ 14
1.5 HET MEDISCH MODEL BEKRITISEERD (DUS OOK DSM).......................................................................................... 14
1.5.1 Anti-psychiatrie – THOMAS SZASZ (60’s) ....................................................................................... 14
1.5.2 Sociale psychologie – ROSENNHAN (1973).................................................................................... 14
1.5.3 DSM is niet a-theoretisch – DELESPAUL ET AL (2016) ................................................................... 14
1.5.4 Multivariate Statistiek – categoriaal VS dimensionaal.................................................................. 14
1.5.5 Lage betrouwbaarheid diagnosen ................................................................................................. 15
1.5.6 Consensus is geen wetenschap – SHORTER ................................................................................... 15
2 HET KWETSBAARHEID-STRESSMODEL..................................................................................................... 15
2.1 ERFELIJKHEID ............................................................................................................................................. 16
2.2 HERITABILITEIT ........................................................................................................................................... 16
2.3 POLYGENETISCHE OVERERVING ...................................................................................................................... 16
2.4 KWETSBAARHEID-STRESSMODEL .................................................................................................................... 16
2.4.1 kwetsbaarheid ............................................................................................................................... 17
2.4.2 stress ............................................................................................................................................. 17
2.5 KINDLING EN SENSITISATIE ............................................................................................................................ 17
2.6 PERSOONLIJKHEIDSFACTOREN ....................................................................................................................... 17
3 PSYCHOSE ............................................................................................................................................... 18
3.1 PSYCHOTISCHE EPISODE ............................................................................................................................... 18
3.1.1 wanen ............................................................................................................................................ 18
3.1.2 hallucinaties (waarnemingsstoornissen) ...................................................................................... 19
3.1.3 gedesorganiseerde spraak ............................................................................................................ 22
3.1.4 gedesorganiseerd/chaotisch gedrag (of abnormaal motorisch gedrag) ....................................... 22
3.1.5 negatieve symptomen ................................................................................................................... 22
3.2 PSYCHOSESPECTRUM ................................................................................................................................... 22
3.3 SCHIZOFRENIE ............................................................................................................................................ 23
3.3.1 symptomen .................................................................................................................................... 24
3.3.2 (subtypes) ...................................................................................................................................... 25
3.3.3 verloop........................................................................................................................................... 26
3.4 SCHIZOFRENIFORME STOORNIS ...................................................................................................................... 27
3.5 DE VROEGE STADIA VAN PSYCHOSE ................................................................................................................. 27
3.6 SCHIZOAFFECTIEVE STOORNIS ........................................................................................................................ 28
3.7 WAANSTOORNIS ......................................................................................................................................... 28
3.8 EPIDEMIOLOGIE .......................................................................................................................................... 28
4 DEPRESIEVE STEMMINGSSTOORNISSEN ................................................................................................. 29
4.1 DSM IV → 5 ............................................................................................................................................ 29
4.1.1 categoriale benadering ................................................................................................................. 29
4.1.2 dimensionele benadering .............................................................................................................. 29
1
, 4.2 DEPRESSIEVE EPISODE .................................................................................................................................. 30
4.2.1 affectieve symptomen ................................................................................................................... 30
4.2.2 lichamelijke symptomen ................................................................................................................ 30
4.2.3 cognitieve symptomen .................................................................................................................. 30
4.3 DEPRESSIEVE STOORNISSEN........................................................................................................................... 31
4.3.1 depressie(ve stoornis) – ‘major depressive disorder’ ..................................................................... 31
4.3.2 depressieve stoornis: 9 specifiers .................................................................................................. 31
4.4 DIFFERENTIAALDIAGNOSE ............................................................................................................................. 37
4.4.1 lichamelijke aandoeningen ............................................................................................................ 37
4.4.2 persoonlijkheidsstoornissen .......................................................................................................... 37
4.4.3 beginnende dementie .................................................................................................................... 37
4.4.4 burn-out......................................................................................................................................... 37
4.4.5 rouw .............................................................................................................................................. 38
4.5 VERLOOP .................................................................................................................................................. 39
4.6 PERSISTERENDE DEPRESSIEVE STOORNIS (DYSTHYMIE) ........................................................................................ 39
4.7 PREMENSTRUELE STEMMINGSSTOORNIS .......................................................................................................... 39
4.8 ETIOPATHOGENESE ..................................................................................................................................... 40
4.8.1 invloed van persoonlijkheid ........................................................................................................... 40
4.8.2 invloed van stress .......................................................................................................................... 40
4.8.3 stress en hippocampus (atrofie) .................................................................................................... 41
4.8.4 depressie en hippocampus (atrofie) .............................................................................................. 41
4.8.5 invloed van genetica...................................................................................................................... 42
4.8.6 waarom leidt stress tot depressie bij persoon A en niet bij persoon B? ........................................ 42
4.8.7 cave! .............................................................................................................................................. 42
4.9 EPIDEMIOLOGIE .......................................................................................................................................... 43
5 BIPOLAIRE STOORNISSEN ....................................................................................................................... 44
5.1 HISTORISCHE SCHETS ................................................................................................................................... 45
5.1.1 aretaeus van cappadocië (circa ad 150) ........................................................................................ 45
5.1.2 falret & baillarger (1854)............................................................................................................... 45
5.1.3 das manisch-depressiven irresein (1896) (Kraeplin) ...................................................................... 45
5.1.4 unipolair vs bipolair (Jules Angst (1966))....................................................................................... 45
5.2 STEMMINGSEPISODEN ................................................................................................................................. 45
5.2.1 manische episode .......................................................................................................................... 45
5.2.2 hypomanie of manische episode ................................................................................................... 46
5.2.3 (gemengde episode) = ‘met gemengde kenmerken’ (als specifier) ............................................... 47
5.3 BIPOLAIRE I EN II STOORNIS ........................................................................................................................... 49
5.4 BIPOLAIRE-SPECTRUMSTOORNIS .................................................................................................................... 49
5.5 ‘RAPID CYCLING’ OF ‘SNEL-SCHOMMELEN’ ....................................................................................................... 50
5.6 DIFFERENTIAALDIAGNOSE EN COMORBIDITEIT ................................................................................................... 51
5.6.1 borderline persoonlijkheidsstoornis .............................................................................................. 51
5.6.2 adhd .............................................................................................................................................. 52
5.6.3 verslaving ...................................................................................................................................... 52
5.7 POSTPARTUMPSYCHOSE (PPP) ....................................................................................................................... 53
5.8 VERLOOP .................................................................................................................................................. 53
5.9 EPIDEMIOLOGIE .......................................................................................................................................... 56
6 ANGSTSTOORNISSEN .............................................................................................................................. 57
6.1 INLEIDING ................................................................................................................................................. 57
6.1.1 gelijkenissen tussen angststoornissen ........................................................................................... 57
2
, 6.1.2 verschillen tussen angststoornissen .............................................................................................. 57
6.2 SPECIFIEKE FOBIE (DMS 5) ............................................................................................................................ 57
6.2.1 kenmerken ..................................................................................................................................... 57
6.2.2 verloop........................................................................................................................................... 58
6.3 SOCIALE ANGSTSTOORNIS (SOCIAL PHOBIA) ...................................................................................................... 58
6.3.1 kenmerken ..................................................................................................................................... 58
6.3.2 situaties die sociale angst uitlokken .............................................................................................. 58
6.3.3 gegeneraliseerd vs niet-gegeneraliseerd ....................................................................................... 59
6.3.4 verloop........................................................................................................................................... 59
6.3.5 differentiaaldiagnose .................................................................................................................... 59
6.3.6 comorbiditeit met alcohol ............................................................................................................. 60
6.4 PANIEKSTOORNIS ........................................................................................................................................ 60
6.4.1 kenmerken ..................................................................................................................................... 60
6.4.2 differentiaaldiagnose, comorbiditeit en verloop ........................................................................... 61
6.4.3 is een paniekaanval een hyperventilatieaanval?........................................................................... 61
6.5 AGORAFOBIE (‘PLEINVREES’, VERMIJDINGSGEDRAG) .......................................................................................... 61
6.6 GEGENERALISEERDE ANGSTSTOORNIS.............................................................................................................. 62
6.6.1 kenmerken ..................................................................................................................................... 62
6.6.2 differentiaaldiagnose en comorbiditeit ......................................................................................... 62
6.7 VERLOOP .................................................................................................................................................. 63
6.8 EPIDEMIOLOGIE .......................................................................................................................................... 63
7 DWANGSTOORNISSEN ............................................................................................................................ 63
7.1 OBSESSIEF-COMPULSIEVE STOORNIS (OCD)...................................................................................................... 63
7.1.1 kenmerken en diagnostische criteria ............................................................................................. 63
7.1.2 heeft een patiënt met dwandstoornis ziekte-inzicht? ................................................................... 64
7.1.3 differentiaaldiagnose .................................................................................................................... 64
7.1.4 dwangstoornis: thematische clusters ............................................................................................ 64
7.1.5 dwang vs drang vs impuls ............................................................................................................. 65
7.1.6 comorbiditeit ................................................................................................................................. 65
7.2 VERLOOP .................................................................................................................................................. 65
7.3 OCS-GERELATEERDE STOORNISSEN ................................................................................................................. 66
7.4 EPIDEMIOLOGIE .......................................................................................................................................... 66
8 TRAUMA- EN STRESSORGERELATEERDE STOORNISSEN .......................................................................... 67
8.1 TRAUMA ................................................................................................................................................... 67
8.1.1 type i- en type ii-trauma ................................................................................................................ 67
8.1.2 fight and flight ............................................................................................................................... 67
8.2 ACUTE STRESSSTOORNIS (ACSS) ..................................................................................................................... 67
8.3 POSTTRAUMATISCHE STRESSSTOORNIS (PTSS) ................................................................................................... 68
8.3.1 herbelevingen ................................................................................................................................ 68
8.3.2 vermijding...................................................................................................................................... 68
8.3.3 negatieve veranderingen in cognitie en stemming ....................................................................... 68
8.3.4 arousal ........................................................................................................................................... 68
8.3.5 wie zal eerder ptss ontwikkelen als er confrontatie is met trauma? ............................................. 69
8.4 COMPLEXE PTSS.......................................................................................................................................... 69
9 DISSOCIATIEVE STOORNISSEN ................................................................................................................ 69
9.1 DISSOCIATIEVE IDENTITEITSSTOORNIS (DIS) ...................................................................................................... 70
9.2 DISSOCIATIEVE AMNESIE OF PSYCHOGENE AMNESIE ........................................................................................... 71
3
, 9.3 DEPERSONALISATIESTOORNIS ........................................................................................................................ 71
9.4 DEREALISATIESTOORNIS ............................................................................................................................... 71
9.5 COMORBIDITEIT.......................................................................................................................................... 71
10 PSYCHOLOGISCHE EN PSYCHIATRISCHE PROBLEMEN BIJ LICHAMELIJKE SYMPTOMEN ....................... 72
10.1 SOMATISCH-SYMPTOOMSTOORNIS (SSS) ......................................................................................................... 72
10.1.1 criteria volgens dsm ...................................................................................................................... 72
10.2 CHRONISCH-VERMOEIDHEIDSSYNDROOM (CVS) ................................................................................................ 73
10.2.1 criteria ........................................................................................................................................... 73
10.2.2 verloop........................................................................................................................................... 73
10.3 ZIEKTEANSGTSTOORNIS (ILLNESS ANXIETY DISORDER) ......................................................................................... 73
10.3.1 lijkt erg op dsm-iv hypochondrie ................................................................................................... 74
10.3.2 verloop........................................................................................................................................... 74
10.4 CONVERSIESTOORNIS (FUNCTIONEEL-NEUROLOGISCH-SYMPTOOMSTOORNIS) ......................................................... 74
10.5 NAGEBOOTSTE STOORNIS (PATHOMIMIE OF ‘FACTITIOUS DISORDER’) .................................................................... 75
10.6 ZIEKTEWINST ............................................................................................................................................. 76
10.7 EPIDEMIOLOGIE .......................................................................................................................................... 76
11 EETSTOORNISSEN ............................................................................................................................... 77
11.1 NORMAAL EETGEDRAG................................................................................................................................. 77
11.2 WANNEER WORDT EETGEDRAG EEN PROBLEEM? ............................................................................................... 77
11.3 ESSENTIËLE ASPECTEN BIJ EETSTOORNISSEN ...................................................................................................... 77
11.4 ANOREXIA NERVOSA .................................................................................................................................... 77
11.4.1 criteria volgens de dsm-5 .............................................................................................................. 78
11.4.2 verklaringsmodellen ...................................................................................................................... 78
11.4.3 kenmerken ..................................................................................................................................... 79
11.4.4 verloop........................................................................................................................................... 82
11.4.5 differentiaaldiagnose en comorbiditeit ......................................................................................... 82
11.5 BOULIMIA NERVOSA .................................................................................................................................... 83
11.5.1 kenmerken ..................................................................................................................................... 83
11.5.2 verloop........................................................................................................................................... 83
11.5.3 differentiaaldiagnose .................................................................................................................... 83
11.6 EETBUISTOORNIS ........................................................................................................................................ 84
11.6.1 verwikkelingen............................................................................................................................... 84
11.7 EPIDEMIOLOGIE .......................................................................................................................................... 84
11.8 EETSTOORNISSEN: GELIJKENISSEN EN VERSCHILLEN ............................................................................................ 84
12 MIDDELENGERELATEERDE EN VERSLAVINGSSTOORNISSEN ................................................................ 85
12.1 VERSLAVING .............................................................................................................................................. 85
12.1.1 wat is een verslaving? ................................................................................................................... 85
12.1.2 hoe geraken we verslaafd? (initiatiefase) ..................................................................................... 85
12.1.3 beloningsysteem............................................................................................................................ 86
12.2 STOORNISSEN IN HET GEBRUIK (SUBSTANCE USE DISORDERS) ............................................................................... 87
12.2.1 verminderde controle .................................................................................................................... 87
12.2.2 verminderd sociaal functioneren ................................................................................................... 87
12.2.3 risicovol gedrag ............................................................................................................................. 87
12.2.4 farmacologische criteria ................................................................................................................ 87
12.2.5 comorbiditeit ................................................................................................................................. 88
12.3 STOORNISSEN DOOR EEN MIDDEL (SUBSTANCE-INDUCED DISORDERS).................................................................... 89
12.4 ALCOHOL/ETHANOL .................................................................................................................................... 89
4
GEMAAKT DOOR: ANKE MATHIJS
1 DIAGNOSTIEK EN CLASSIFICATIE ............................................................................................................. 11
1.1 VAN ZOT NAAR ZIEK ..................................................................................................................................... 11
1.2 MORELE BEHANDELING ................................................................................................................................ 11
1.3 DIAGNOSTIEK ............................................................................................................................................. 13
1.4 CLASSIFICATIE ............................................................................................................................................ 14
1.5 HET MEDISCH MODEL BEKRITISEERD (DUS OOK DSM).......................................................................................... 14
1.5.1 Anti-psychiatrie – THOMAS SZASZ (60’s) ....................................................................................... 14
1.5.2 Sociale psychologie – ROSENNHAN (1973).................................................................................... 14
1.5.3 DSM is niet a-theoretisch – DELESPAUL ET AL (2016) ................................................................... 14
1.5.4 Multivariate Statistiek – categoriaal VS dimensionaal.................................................................. 14
1.5.5 Lage betrouwbaarheid diagnosen ................................................................................................. 15
1.5.6 Consensus is geen wetenschap – SHORTER ................................................................................... 15
2 HET KWETSBAARHEID-STRESSMODEL..................................................................................................... 15
2.1 ERFELIJKHEID ............................................................................................................................................. 16
2.2 HERITABILITEIT ........................................................................................................................................... 16
2.3 POLYGENETISCHE OVERERVING ...................................................................................................................... 16
2.4 KWETSBAARHEID-STRESSMODEL .................................................................................................................... 16
2.4.1 kwetsbaarheid ............................................................................................................................... 17
2.4.2 stress ............................................................................................................................................. 17
2.5 KINDLING EN SENSITISATIE ............................................................................................................................ 17
2.6 PERSOONLIJKHEIDSFACTOREN ....................................................................................................................... 17
3 PSYCHOSE ............................................................................................................................................... 18
3.1 PSYCHOTISCHE EPISODE ............................................................................................................................... 18
3.1.1 wanen ............................................................................................................................................ 18
3.1.2 hallucinaties (waarnemingsstoornissen) ...................................................................................... 19
3.1.3 gedesorganiseerde spraak ............................................................................................................ 22
3.1.4 gedesorganiseerd/chaotisch gedrag (of abnormaal motorisch gedrag) ....................................... 22
3.1.5 negatieve symptomen ................................................................................................................... 22
3.2 PSYCHOSESPECTRUM ................................................................................................................................... 22
3.3 SCHIZOFRENIE ............................................................................................................................................ 23
3.3.1 symptomen .................................................................................................................................... 24
3.3.2 (subtypes) ...................................................................................................................................... 25
3.3.3 verloop........................................................................................................................................... 26
3.4 SCHIZOFRENIFORME STOORNIS ...................................................................................................................... 27
3.5 DE VROEGE STADIA VAN PSYCHOSE ................................................................................................................. 27
3.6 SCHIZOAFFECTIEVE STOORNIS ........................................................................................................................ 28
3.7 WAANSTOORNIS ......................................................................................................................................... 28
3.8 EPIDEMIOLOGIE .......................................................................................................................................... 28
4 DEPRESIEVE STEMMINGSSTOORNISSEN ................................................................................................. 29
4.1 DSM IV → 5 ............................................................................................................................................ 29
4.1.1 categoriale benadering ................................................................................................................. 29
4.1.2 dimensionele benadering .............................................................................................................. 29
1
, 4.2 DEPRESSIEVE EPISODE .................................................................................................................................. 30
4.2.1 affectieve symptomen ................................................................................................................... 30
4.2.2 lichamelijke symptomen ................................................................................................................ 30
4.2.3 cognitieve symptomen .................................................................................................................. 30
4.3 DEPRESSIEVE STOORNISSEN........................................................................................................................... 31
4.3.1 depressie(ve stoornis) – ‘major depressive disorder’ ..................................................................... 31
4.3.2 depressieve stoornis: 9 specifiers .................................................................................................. 31
4.4 DIFFERENTIAALDIAGNOSE ............................................................................................................................. 37
4.4.1 lichamelijke aandoeningen ............................................................................................................ 37
4.4.2 persoonlijkheidsstoornissen .......................................................................................................... 37
4.4.3 beginnende dementie .................................................................................................................... 37
4.4.4 burn-out......................................................................................................................................... 37
4.4.5 rouw .............................................................................................................................................. 38
4.5 VERLOOP .................................................................................................................................................. 39
4.6 PERSISTERENDE DEPRESSIEVE STOORNIS (DYSTHYMIE) ........................................................................................ 39
4.7 PREMENSTRUELE STEMMINGSSTOORNIS .......................................................................................................... 39
4.8 ETIOPATHOGENESE ..................................................................................................................................... 40
4.8.1 invloed van persoonlijkheid ........................................................................................................... 40
4.8.2 invloed van stress .......................................................................................................................... 40
4.8.3 stress en hippocampus (atrofie) .................................................................................................... 41
4.8.4 depressie en hippocampus (atrofie) .............................................................................................. 41
4.8.5 invloed van genetica...................................................................................................................... 42
4.8.6 waarom leidt stress tot depressie bij persoon A en niet bij persoon B? ........................................ 42
4.8.7 cave! .............................................................................................................................................. 42
4.9 EPIDEMIOLOGIE .......................................................................................................................................... 43
5 BIPOLAIRE STOORNISSEN ....................................................................................................................... 44
5.1 HISTORISCHE SCHETS ................................................................................................................................... 45
5.1.1 aretaeus van cappadocië (circa ad 150) ........................................................................................ 45
5.1.2 falret & baillarger (1854)............................................................................................................... 45
5.1.3 das manisch-depressiven irresein (1896) (Kraeplin) ...................................................................... 45
5.1.4 unipolair vs bipolair (Jules Angst (1966))....................................................................................... 45
5.2 STEMMINGSEPISODEN ................................................................................................................................. 45
5.2.1 manische episode .......................................................................................................................... 45
5.2.2 hypomanie of manische episode ................................................................................................... 46
5.2.3 (gemengde episode) = ‘met gemengde kenmerken’ (als specifier) ............................................... 47
5.3 BIPOLAIRE I EN II STOORNIS ........................................................................................................................... 49
5.4 BIPOLAIRE-SPECTRUMSTOORNIS .................................................................................................................... 49
5.5 ‘RAPID CYCLING’ OF ‘SNEL-SCHOMMELEN’ ....................................................................................................... 50
5.6 DIFFERENTIAALDIAGNOSE EN COMORBIDITEIT ................................................................................................... 51
5.6.1 borderline persoonlijkheidsstoornis .............................................................................................. 51
5.6.2 adhd .............................................................................................................................................. 52
5.6.3 verslaving ...................................................................................................................................... 52
5.7 POSTPARTUMPSYCHOSE (PPP) ....................................................................................................................... 53
5.8 VERLOOP .................................................................................................................................................. 53
5.9 EPIDEMIOLOGIE .......................................................................................................................................... 56
6 ANGSTSTOORNISSEN .............................................................................................................................. 57
6.1 INLEIDING ................................................................................................................................................. 57
6.1.1 gelijkenissen tussen angststoornissen ........................................................................................... 57
2
, 6.1.2 verschillen tussen angststoornissen .............................................................................................. 57
6.2 SPECIFIEKE FOBIE (DMS 5) ............................................................................................................................ 57
6.2.1 kenmerken ..................................................................................................................................... 57
6.2.2 verloop........................................................................................................................................... 58
6.3 SOCIALE ANGSTSTOORNIS (SOCIAL PHOBIA) ...................................................................................................... 58
6.3.1 kenmerken ..................................................................................................................................... 58
6.3.2 situaties die sociale angst uitlokken .............................................................................................. 58
6.3.3 gegeneraliseerd vs niet-gegeneraliseerd ....................................................................................... 59
6.3.4 verloop........................................................................................................................................... 59
6.3.5 differentiaaldiagnose .................................................................................................................... 59
6.3.6 comorbiditeit met alcohol ............................................................................................................. 60
6.4 PANIEKSTOORNIS ........................................................................................................................................ 60
6.4.1 kenmerken ..................................................................................................................................... 60
6.4.2 differentiaaldiagnose, comorbiditeit en verloop ........................................................................... 61
6.4.3 is een paniekaanval een hyperventilatieaanval?........................................................................... 61
6.5 AGORAFOBIE (‘PLEINVREES’, VERMIJDINGSGEDRAG) .......................................................................................... 61
6.6 GEGENERALISEERDE ANGSTSTOORNIS.............................................................................................................. 62
6.6.1 kenmerken ..................................................................................................................................... 62
6.6.2 differentiaaldiagnose en comorbiditeit ......................................................................................... 62
6.7 VERLOOP .................................................................................................................................................. 63
6.8 EPIDEMIOLOGIE .......................................................................................................................................... 63
7 DWANGSTOORNISSEN ............................................................................................................................ 63
7.1 OBSESSIEF-COMPULSIEVE STOORNIS (OCD)...................................................................................................... 63
7.1.1 kenmerken en diagnostische criteria ............................................................................................. 63
7.1.2 heeft een patiënt met dwandstoornis ziekte-inzicht? ................................................................... 64
7.1.3 differentiaaldiagnose .................................................................................................................... 64
7.1.4 dwangstoornis: thematische clusters ............................................................................................ 64
7.1.5 dwang vs drang vs impuls ............................................................................................................. 65
7.1.6 comorbiditeit ................................................................................................................................. 65
7.2 VERLOOP .................................................................................................................................................. 65
7.3 OCS-GERELATEERDE STOORNISSEN ................................................................................................................. 66
7.4 EPIDEMIOLOGIE .......................................................................................................................................... 66
8 TRAUMA- EN STRESSORGERELATEERDE STOORNISSEN .......................................................................... 67
8.1 TRAUMA ................................................................................................................................................... 67
8.1.1 type i- en type ii-trauma ................................................................................................................ 67
8.1.2 fight and flight ............................................................................................................................... 67
8.2 ACUTE STRESSSTOORNIS (ACSS) ..................................................................................................................... 67
8.3 POSTTRAUMATISCHE STRESSSTOORNIS (PTSS) ................................................................................................... 68
8.3.1 herbelevingen ................................................................................................................................ 68
8.3.2 vermijding...................................................................................................................................... 68
8.3.3 negatieve veranderingen in cognitie en stemming ....................................................................... 68
8.3.4 arousal ........................................................................................................................................... 68
8.3.5 wie zal eerder ptss ontwikkelen als er confrontatie is met trauma? ............................................. 69
8.4 COMPLEXE PTSS.......................................................................................................................................... 69
9 DISSOCIATIEVE STOORNISSEN ................................................................................................................ 69
9.1 DISSOCIATIEVE IDENTITEITSSTOORNIS (DIS) ...................................................................................................... 70
9.2 DISSOCIATIEVE AMNESIE OF PSYCHOGENE AMNESIE ........................................................................................... 71
3
, 9.3 DEPERSONALISATIESTOORNIS ........................................................................................................................ 71
9.4 DEREALISATIESTOORNIS ............................................................................................................................... 71
9.5 COMORBIDITEIT.......................................................................................................................................... 71
10 PSYCHOLOGISCHE EN PSYCHIATRISCHE PROBLEMEN BIJ LICHAMELIJKE SYMPTOMEN ....................... 72
10.1 SOMATISCH-SYMPTOOMSTOORNIS (SSS) ......................................................................................................... 72
10.1.1 criteria volgens dsm ...................................................................................................................... 72
10.2 CHRONISCH-VERMOEIDHEIDSSYNDROOM (CVS) ................................................................................................ 73
10.2.1 criteria ........................................................................................................................................... 73
10.2.2 verloop........................................................................................................................................... 73
10.3 ZIEKTEANSGTSTOORNIS (ILLNESS ANXIETY DISORDER) ......................................................................................... 73
10.3.1 lijkt erg op dsm-iv hypochondrie ................................................................................................... 74
10.3.2 verloop........................................................................................................................................... 74
10.4 CONVERSIESTOORNIS (FUNCTIONEEL-NEUROLOGISCH-SYMPTOOMSTOORNIS) ......................................................... 74
10.5 NAGEBOOTSTE STOORNIS (PATHOMIMIE OF ‘FACTITIOUS DISORDER’) .................................................................... 75
10.6 ZIEKTEWINST ............................................................................................................................................. 76
10.7 EPIDEMIOLOGIE .......................................................................................................................................... 76
11 EETSTOORNISSEN ............................................................................................................................... 77
11.1 NORMAAL EETGEDRAG................................................................................................................................. 77
11.2 WANNEER WORDT EETGEDRAG EEN PROBLEEM? ............................................................................................... 77
11.3 ESSENTIËLE ASPECTEN BIJ EETSTOORNISSEN ...................................................................................................... 77
11.4 ANOREXIA NERVOSA .................................................................................................................................... 77
11.4.1 criteria volgens de dsm-5 .............................................................................................................. 78
11.4.2 verklaringsmodellen ...................................................................................................................... 78
11.4.3 kenmerken ..................................................................................................................................... 79
11.4.4 verloop........................................................................................................................................... 82
11.4.5 differentiaaldiagnose en comorbiditeit ......................................................................................... 82
11.5 BOULIMIA NERVOSA .................................................................................................................................... 83
11.5.1 kenmerken ..................................................................................................................................... 83
11.5.2 verloop........................................................................................................................................... 83
11.5.3 differentiaaldiagnose .................................................................................................................... 83
11.6 EETBUISTOORNIS ........................................................................................................................................ 84
11.6.1 verwikkelingen............................................................................................................................... 84
11.7 EPIDEMIOLOGIE .......................................................................................................................................... 84
11.8 EETSTOORNISSEN: GELIJKENISSEN EN VERSCHILLEN ............................................................................................ 84
12 MIDDELENGERELATEERDE EN VERSLAVINGSSTOORNISSEN ................................................................ 85
12.1 VERSLAVING .............................................................................................................................................. 85
12.1.1 wat is een verslaving? ................................................................................................................... 85
12.1.2 hoe geraken we verslaafd? (initiatiefase) ..................................................................................... 85
12.1.3 beloningsysteem............................................................................................................................ 86
12.2 STOORNISSEN IN HET GEBRUIK (SUBSTANCE USE DISORDERS) ............................................................................... 87
12.2.1 verminderde controle .................................................................................................................... 87
12.2.2 verminderd sociaal functioneren ................................................................................................... 87
12.2.3 risicovol gedrag ............................................................................................................................. 87
12.2.4 farmacologische criteria ................................................................................................................ 87
12.2.5 comorbiditeit ................................................................................................................................. 88
12.3 STOORNISSEN DOOR EEN MIDDEL (SUBSTANCE-INDUCED DISORDERS).................................................................... 89
12.4 ALCOHOL/ETHANOL .................................................................................................................................... 89
4
