Chapter 6 Somatoform and Dissociative Disorders

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Chapter 6Somatoform and Dissociative Disorders
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An Overview of Somatoform Disorders

• Soma Meaning Body
• Overly preoccupied with health or body appearance
• Physical complaints without a medical condition
• Types of DSM-IV Somatoform Disorders
• Hypochondriasis
• Somatization disorder
• Conversion disorder
• Pain disorder
• Body dysmorphic disorder

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Hypochondriasis An Overview

• Overview and Defining Features
• Severe anxiety The possibility of having a
  disease
• Strong disease conviction
• Medical reassurance does not seem to help
• Facts and Statistics
• Good prevalence data are lacking
• Onset at any age
• Runs a chronic course

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Hypochondriasis Causes and Treatment

• Causes
• Cognitive perceptual distortions
• Familial history of illness
• Treatment
• Challenge illness-related misinterpretations
• Provide more substantial and sensitive reassurance

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Hypochondriasis Causes and Treatment

• Figure 6.1 Integrative model of causes in
  hypochondriasis (based on Warwick Salkovskis,
  1990).

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Somatization Disorder (Briquets Syndrome) An
Overview

• Overview and Defining Features
• Extended history of physical complaints before
  age 30
• Substantial social and occupational impairment
• Concerned with the symptoms, not what they might
  mean
• Symptoms become the persons identity
• Facts and Statistics
• Rare condition
• Onset usually in adolescence
• Mostly affects unmarried, low SES women
• Runs a chronic course

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Somatization Disorder Causes and Treatment

• Causes
• Familial history of illness
• Relation with antisocial personality disorder
• Weak behavioral inhibition system
• Treatment
• No treatment exists with demonstrated
  effectiveness
• Reduce tendency to visit numerous medical
  specialists
• Assign gatekeeper physician
• Reduce supportive consequences of talk about
  symptoms

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Conversion Disorder An Overview

• Overview and Defining Features
• Physical malfunctioning
• Lack physical or organic pathology
• Malfunctioning often involves sensory-motor areas
• Persons show la belle indifference
• Retain most normal functions, but lack awareness
• Facts and Statistics
• Rare condition, with a chronic intermittent
  course
• Seen primarily in females
• Onset usually in adolescence
• Not uncommon in some cultural and/or religious
  groups

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Conversion Disorder Causes and Treatment

• Causes
• Freudian psychodynamic view is still popular
• Focus on past trauma and conversion
• Address primary / secondary gain
• Detachment from the trauma and negative
  reinforcement
• Treatment
• Similar to somatization disorder
• Core strategy is attending to the trauma
• Remove sources of secondary gain
• Reduce supportive consequences of talk about
  symptoms

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Body Dysmorphic Disorder(Imagined Ugliness)
An Overview

• Overview and Defining Features
• Previously known as dysmorphophobia
• Preoccupation with imagined defect in appearance
• Either fixation or avoidance of mirrors
• Suicidal ideation and behavior are common
• Often display ideas of reference for imagined
  defect
• Facts and Statistics
• More common than previously thought
• Seen equally in males and females
• Onset usually in early 20s
• Most remain single, and many seek out plastic
  surgeons
• Usually runs a lifelong chronic course

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Body Dysmorphic Disorder Causes and Treatment

• Causes
• Little is known
• Shares similarities with obsessive-compulsive
  disorder
• Treatment
• Parallels that for obsessive-compulsive disorder
• Medications (i.e., SSRIs) provide some relief
• Exposure and response prevention is also helpful
• Plastic surgery is often unhelpful

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An Overview of Dissociative Disorders

• Overview
• Involve severe alterations or detachments
• Affect identity, memory, and/or consciousness
• Severe form of normal perceptual experiences
• Depersonalization Distortion in perception of
  reality
• Derealization Losing a sense of the external
  world
• Types of DSM-IV Dissociative Disorders
• Depersonalization Disorder
• Dissociative Amnesia
• Dissociative Fugue
• Dissociative Trance Disorder
• Dissociative Identity Disorder

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Depersonalization Disorder An Overview

• Overview and Defining Features
• Severe and frightening feelings of unreality and
  detachment
• These dominate and interfere with life
  functioning
• Problem involves depersonalization and
  derealization
• Facts and Statistics
• High comorbidity with anxiety and mood disorders
• Onset is typically around age 16
• Usually runs a lifelong chronic course

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Depersonalization Disorder Causes and Treatment

• Causes
• Cognitive deficits in attention
• Cognitive deficits in short-term memory
• Cognitive Deficits in spatial reasoning
• Deficits related with tunnel vision and mind
  emptiness
• Such persons are easily distracted
• Treatment
• Little is known

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Dissociative Amnesia andDissociative Fugue An
Overview

• Dissociative Amnesia Overview and Defining
  Features
• Several forms of psychogenic memory loss
• Generalized type Inability to recall anything,
  including their identity
• Localized or selective type Failure to recall
  specific (usually traumatic) events
• Dissociative Fugue Overview and Defining
  Features
• Related to dissociative amnesia
• Take off to a new place
• Unable to remember the past
• Unable to remember how they arrived at a new
  location
• Often assume a new identity

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Dissociative Amnesia and Fugue Causes and
Treatment

• Facts and Statistics -- Dissociative Amnesia and
  Fugue
• Usually begin in adulthood
• Both show rapid onset and dissipation
• Both are mostly seen in females
• Causes
• Little is known
• Trauma and life stress can serve as triggers
• Treatment
• Most get better without treatment
• Most remember what they have forgotten

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Dissociative Trance Disorder An Overview

• Overview and Defining Features
• Symptoms resemble those of other dissociative
  disorders
• Dissociative symptoms and sudden changes in
  personality
• Changes are often attributed to possession of a
  spirit
• Presentation differs in important ways across
  cultures
• Facts and Statistics
• More common in females
• Causes
• Often attributable to a life stressor or trauma
• Only abnormal if the trance is considered
  undesirable/pathological by the culture
• Treatment
• Little is known

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Dissociative Identity Disorder (DID) An Overview

• Overview and Defining Features
• Formerly known as multiple personality disorder
• Defining feature Dissociation of personality
• Adopt several new identities (as many as 100)
• Identities show unique behaviors, voice, and
  posture
• Unique Aspects of DID
• Alters The different identities
• Host The identity that keeps other identities
  together
• Switch Quick transition from one personality to
  another

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Dissociative Identity Disorder (DID) Causes
and Treatment

• Facts and Statistics
• Average number of identities is close to 15
• Ratio of females to males is high (91)
• Onset is almost always in childhood
• High comorbidity rates, with a lifelong chronic
  course
• Causes
• Most have histories of horrible, unspeakable,
  child abuse
• Most are also highly suggestible
• DID Mechanism to escape from impact of trauma
• Closely related to PTSD
• Treatment
• Focus is on reintegration of identities
• Identify and neutralize cues/triggers that
  provoke memories of trauma/dissociation

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Diagnostic Considerations in Somatoformand
Dissociative Disorders

• Separating Real Problems from Faking
• Malingering Deliberately faking symptoms
• Related Conditions Factitious disorders
• Factitious disorder by proxy
• False Memories and Recovered Memory Syndrome

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Summary of Somatoform and Dissociative Disorders

• Features of Somatoform Disorders
• Physical problems without on organic cause
• Features of Dissociative Disorders
• Extreme distortions in perception and memory
• Well Established Treatments Are Generally Lacking

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Exploring Somatoform Disorders
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Exploring Somatoform Disorders (cont.)
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Exploring Somatoform Disorders (cont.)
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Exploring Dissociative Disorders
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Exploring Dissociative Disorders
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Exploring Dissociative Disorders
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Exploring Dissociative Disorders
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Exploring Dissociative Disorders