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Somatoform and Dissociative Disorders

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Title: Somatoform and Dissociative Disorders


1
Somatoform and Dissociative Disorders
2
Somatoform Disorders
  • Somatoform Disorders- Conditions involving
    physical complaints of disabilities that occur
    without any evidence of physical pathology to
    account for them.
  • Somatization Disorder
  • Hypochondriasis
  • Pain Disorder
  • Conversion Disorder

3
Somatization Disorder
  • Characteristics include
  • Multiple complaints and ailments that extend over
    a long period beginning before age 30
  • These complaints are not explained by physical
    illness or injury.
  • Must include four levels of symptoms
  • Four pain symptoms (different areas of body)
  • Two gastrointestinal symptoms (nausea, bloating)
  • One sexual symptom (sexual dysfunction /
    irregularity)
  • One pseudoneurological symptom (sensory loss)

4
Somatization Disorder II
  • Up to 10x more common in females
  • Evidence is linked with some genetic factors.
  • Possibly the underlying etiology is expressed
    differently in females and males. These being
    somatization and antisocial behavior
    respectively.
  • Evidence is linked to family disoganization such
    as abuse

5
Hypochandriasis
  • Differentiation from Somatization Disorder
  • Onset may be after age 30
  • Focus on having a disease rather than symptoms
  • Unrealistic fears of disease
  • Difficulty in describing exact symptoms (general)
  • Mental orientation of alertness for new symptoms
  • Focus on remedies and studying different
    diseases.
  • Lack of intense fear normally associated with
    having their feared disease
  • Has a 4-9 prevalence in medical practices
  • Malingering- consciously faking symptoms to
    achieve a nonmedical goal.

6
Hypochandriasis
  • Theories
  • Interpersonal
  • I deserve more attention
  • Dont expect as much from me as a person
  • Maintanence by physicians rejection
  • Abuse and Trauma as children

7
Pain Disorder
  • A somatoform Disorder characterized by reported
    pain of sufficient duration and severity to cause
    significant life disruption and the absence of
    medical pathology that would explain the
    experienced pain.
  • Subjectivity of Pain

8
Conversion Disorder
  • A somatoform disorder in which symptoms of some
    physical malfunction or loss of control appear
    without any underlying organic pathology
    originally called hysteria.
  • Secondary gain or excuse enabling escape or
    avoidance of an intolerably stressful situation.

9
Treatment of Somatoform Disorders
  • Caution against medication
  • Support, reassurance, explanations etc..
  • Prognosis generally poor

10
Dissociative Disorders
  • Dissociative Amnesia
  • Memory loss following a stressful experience
  • Dissociative Fugue
  • Memory loss accompanied by leaving home and
    establishing a new identity
  • Depersonalization Disorder
  • Experience of the self is altered
  • Dissociative Identity Disorder
  • At least two distinct ego states

11
Dissociative Amnesia
  • Unable to recall important information usually of
    a traumatic or stressful nature
  • Amnestic episode- forgotten period
  • Dissociative amnesia may be
  • localized losses all memory within a period of
    time (most common)
  • selective- remember some but not all
  • generalized- may forget identity
  • Continuous- unlike others there is not an end

12
Dissociative Amnesia (Cont)
  • Interference is primarily with episodic memory
    (ones autobiographical memory) while semantic
    memory (facts) remains intact

13
Dissociative Fugue
  • Forget personal details, identity, and flee to an
    entirely new location
  • Tend to end abruptly
  • Majority regain most of memories without a
    recurrence
  • Must face consequences of their fugue
  • Illegal or violent activity etc

14
Dissociative Identity Disorder
  • Develop two or more distinct personalities
    (subpersonalities or alternate personalities)
  • Switching- transition from one subpersonality to
    another
  • Primary or Host Personality- that personality
    which appears most often
  • 97 of cases are thought to have experienced abuse

15
  • Women are diagnosed 3 times as often as men
  • Subpersonality Interaction
  • Mutual Amnesia- no awareness of alters
  • Cognizant- each alter is aware of the other (hear
    each others voices and talk among themselves)
  • One-way Amnesic- some are aware of others without
    them being aware of them (most common)
  • Co-conscious- quiet observers with no interaction

16
  • How do subpersonalities differ
  • Vital statistics (age, sex, family history, race)
  • Abilities and Preferences
  • Evidence suggests different physiological
    responses
  • Iatrogenic- unintentionally produced by
    practitioners
  • 100 cases in 1973 and now thousands
  • Increase due to 1) belief that it exists and 2)
    diagnostic procedures tend to be more accurate

17
Etiology / Explanations
  • Psychodynamic
  • Caused by excessive memory repression
  • Behavioral
  • Operant conditioning in which forgetting is
    reinforced by drop in anxiety
  • State-Dependent Learning
  • Extremely rigid state-to-memory links
  • Self-Hypnosis
  • Self induced hypnotic amnesia

18
Treatments for Dissociative Amnesia and Fugues
  • Psychodynamic therapy
  • Hypnotic therapy
  • Drug therapy
  • Sodium pentobarbital (truth serums).
    Medication decreases inhibitions making recall
    more likely but may forget again upon awake.
  • All focus on uncovering memories

19
Treatment Dissociative Dissociative Disorder
  • Three Major Goals
  • 1) Help recognize fully the nature of their
    disorder
  • 2) Recover gaps in their memory
  • 3) Integrate their personalities into one
    functioning personality
  • Fusion- final merging of 2 or more alters

20
  • Goal is integration
  • Help each alter to understand they are part of
    one person
  • Use alters names for convenience not to confirm
    existence of separate autonomy
  • All alters should be treated with fairness
  • Encourage empathy amongst the alters
  • Gentleness and supportiveness are needed in
    consideration of childhood traumas
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