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Somatoform and Dissociative Disorders

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Title: Somatoform and Dissociative Disorders


1
Somatoform and Dissociative Disorders
  • Barlow and Durand
  • Chapter 6

2
Somatoform Disorders
3
Hypochondriasis
  • Clinical Description physical complaints
    without an apparent cause.
  • Reassuring from physicians does not help because
    the threat seems so real

4
Comorbid Disorders with Hypochondriasis
  • Anxiety Disorders
  • Mood Disorders

5
Characteristics of Hypochondriasis
  • Anxiety that is expressed in a particular way
    bodily symptom preoccupation
  • They come to the attention of MHPs only after
    having seen their family physician

6
DSM-IV-TR Differences between Hypochondriasis and
illness phobia
  • Illness Phobia
  • Afraid of getting the disease
  • Avoid places of perceived contagion
  • Hypochondriasis
  • Anxious that they actually have the disease
  • Go to get checked and rechecked
  • No avoiding because they already have it

7
Illness Phobia and Hypochondriasis
8
DSM-IV-TR Differences Between Hypochondriasis and
Panic Attacks
  • Panic Attacks
  • Fear immediate Symptoms related to catastrophes
  • Continue to believe that Panic Attacks will kill
    them, but learn quickly to stop going to doctors
  • Focus on 10-15 SNS Sx that relate to Panic
    Attacks
  • Hypochondriasis
  • Focus on long term processes of illness and
    disease (cancer AIDS)
  • Seek out many second and third opinions, but
    remain unconvinced and unreasured
  • Wide ranges of concerns

9
Statistics on Hypochondriasis
  • 1-4 of medical patients are diagnosed with
    Hypochondriasis
  • Sex Ratio

10
Process of Hypochondriasis
  • 1. Physician must rule out
  • 2. Mental Health Professional must determine the
  • 3. Must be aware of

11
Causes of Hypochondriasis?
12
Causes of Hypochondriasis?
13
Treatment for Hypochondriasis
  • Very little
  • CBT focus on identifying and challenging
    illness related misinterpretations of physical
    sensations and showing patients how to create Sx
    by focusing attention on parts of the body

14
Treatment for Hypochondriasis
  • Stress Management
  • Uncovering Unconscious conflicts (psychodynamic)
  • Reassurance extensive reassurance by

15
Somatization Disorder
  • Used to be
  • Clinical Description
  • More impaired than hypochondriasis. Not so much
    afraid that they have a disease more concerned

16
Somatization Disorder Cont.
  • They do not feel the urgency to take action
  • However, they feel continually ill or weak
  • Entire life revolves around the symptoms
  • They are not sure who they are without them -
    identity

17
Statistics on Somatization Disorder
18
Statistics on Somatization Disorder
  • 2 to1 female
  • Comorbid disorders are often anxiety disorders
    and mood disorders
  • Chronic
  • Common and uniform throughout the world

19
Causes of Somatization Disorder?
  • Minor
  • Minor
  • Heredity studies are very inconclusive
  • Behavior learned in a maladaptive family setting
  • A dysfunction in the

20
Interesting Similarities between ASPD and
Somatization Disorder
  • ASPD
  • Primarily male
  • Early in life
  • Chronic
  • Lower SES
  • Difficult to treat
  • Marital Discord
  • Drug/Alcohol abuse
  • Suicide attempts
  • Aggressive/Impulsive/Lack of emotion
  • Somatization Disorder
  • Primarily female
  • Early in life
  • Chronic
  • Lower SES
  • Difficult to treat
  • Marital discord
  • Drug/Alcohol Abuse
  • Suicide attempts
  • Impulsive/Novelty seeking/Provocative Sexual
    Behavior

21
Treatment for Somatization Disorder
  • Difficult
  • Provide
  • Reduce
  • Reduce
  • Communication/Interaction Skills

22
Conversion Disorder
  • Departs from somatization disorder because less
    pain symptoms and much more severe problems
    (hospitalizations)
  • Has to do with physical malfunctioning such as
    paralysis, blindness, aphonia

23
Conversion Disorder
  • Most suggest a neurological disease that affects
    the sensory nervous motor systems
  • Can effect

24
Freud
  • Said the anxiety resulting form unconscious
    conflicts was converted to physical Sx to find
    expression. This way the individual could
    discharge some anxiety without experiencing it.
  • He also said

25
Conversion Disorder
  • Sx often precipitated by stress
  • People with conversion disorder can usually
    function normally but they are truly unaware of
    this ability
  • For example

26
Malingering
  • Faking for gain
  • This must not be present in order for any of
    these disorders to be diagnosed

27
Closely Related Disorders
  • Factitious Disorder
  • No obvious gain
  • Sick Role and Attention

28
Fictitious Disorder by Proxy
  • Munchausen Syndrome
  • Family member usually the mother makes child sick
    to get attention for herself (sympathy)

29
Statistics on Conversion Disorders
  • Common comorbid disorder is somatization disorder
  • 1-30 of cases
  • 10-20 cases

30
Statistics on Conversion Disorders
  • Primarily female
  • Frequent in males at times of extreme stress
  • Onset adolescence
  • Lower education
  • Lower SES

31
Causes of Conversion Disorders?
  • Freud Said
  • 1. Experience trauma (unacceptable conflict)
  • 2. Person represses conflict
  • 3. Anxiety increases and threatens to emerge so
    person converts it into physical Sx
  • 4. Thereby relieves pressure of having to deal
    with it
  • Most tend to agree with this because we have no
    better alternative at this time

32
Treatment of Conversion Disorders
  • Identify and attend to the traumatic or
  • Remove sources of secondary gain
  • Get rid of reinforcements family needs to help
    here

33
Pain Disorder
  • There may be initially a clear physical reason
    for the pain, but psychological factors maintain
    the pain
  • The pain is not better accounted for by a mood,
    anxiety, or psychotic disorder
  • The pain is real it hurts regardless of the cause

34
Body Dysmorphic Disorder (BDD)
  • imagined ugliness
  • A preoccupation with some

35
BDD Cont.
  • Clinical Description
  • Many people with this disorder become fixated
    with mirrors
  • They check over and over to see if there has been
    any change
  • Some avoid mirrors all together

36
BDD Cont.
  • Suicide is frequent with BDD
  • Ideas of Reference
  • Can become house bound

37
DSM-IV-TR Differences Between OCD and BDD
  • OCD
  • Patients for the most part know their thoughts
    are unreasonable or irrational
  • BDD
  • Patients believe their thoughts are totally
    reasonable and rational

38
Statistics on BDD
39
Statistics on BDD
  • Caucasians, Asians, and Hispanics experience BDD
    more than African Americans
  • Slightly more
  • Age of onset
  • Usually reluctant to seek treatment

40
Culture and BDD
  • Cultural practices everywhere mutilate or change
    the body in different ways
  • However, BDD occurs when the person goes against
    current cultural practices
  • It is not abnormal if it is culturally acceptable

41
Causes of BDD?
  • Psychoanalytic
  • OCD/BDD

42
Treatment of BDD
  • There are only two treatments that have been
    found to be effective with BDD
  • SSRIs
  • Exposure and response prevention CBT
  • 80 improved with CBT

43
BDD and Plastic Surgery
  • Surgeons are supposed to assess for and deny
    patients with BDD
  • They should be consulting with psychologists
  • These patients do not benefit from surgery

44
BDD and Plastic Surgery
  • They return for more surgery
  • File malpractice suits
  • Sometimes their perceived ugliness factor
    increases after surgery
  • 2-25 of patients that request plastic surgery
    may have BDD

45
Dissociative Disorders
  • Individuals who feel detached from their
    surroundings almost as if day dreaming or living
    in slow motion
  • Most likely to happen after

46
Example of Dissociative Experience
  • You stay up all night
  • Cramming for an exam
  • The next day you feel like you are living in slow
    motion
  • This is a dissociative state
  • Because you know the cause of it, it may not seem

47
Dissociative States
  • Derealization perception alters so you lose
    your sense of reality temporarily
  • Depersonalization

48
Depersonalization Disorder
  • Feelings of unreality are so severe and
    frightening that they dominate an individuals
    life and prevent normal functioning

49
Statistics on Depersonalization Disorder
  • Mean age of onset
  • Chronic
  • Slightly more
  • Mood and Anxiety disorders

50
Dissociative Amnesia
  • Two types

51
Generalized Amnesia
  • People who are unable to remember anything,
    including who they are

52
Localized or Selective Amnesia
  • A failure to recall specific events, usually
    traumatic, that occur during a specific period of
    time
  • Examples war or car wreck

53
Dissociative Fugue
  • Memory loss revolves around a very specific
    incident
  • Individual usually just take off and later find
    themselves in a new place, unable to remember how
    they got there or why

54
Dissociative Fugue
  • During these trips people sometimes assume a new
    identity or at least become confused about their
    current one

55
Amnesia and Fugue
  • Usually occur in adulthood
  • Different types occur in many cultures
  • Treatment
  • Treatment can help increase personal coping
    skills and reduce stress

56
Dissociative Trance Disorder
  • Associated with stress or trauma that is current
  • Very self explanatory

57
Dissociative Trance Disorder
  • Most common in women
  • In some cultural contexts this is not abnormal
  • Examples

58
Dissociative Trance Disorder
  • When the state is undesirable then it is abnormal
  • Not common in western cultures
  • Among the most common forms of

59
Dissociative Identity Disorder (DID)
  • Multiple Personalities
  • May adopt as many as 100 simultaneously existing
    personalities
  • Some are complete with their own behaviors, tones
    of voices, an gestures
  • These personalities are referred to as alters

60
Dissociative Identity Disorder (DID)
  • The DSM-IV-TR states the person must have amnesia
  • Aspects of the personality are dissociated from
    the person

61
DID Characteristics
  • The person who becomes the patient is the host
  • The first personality to seek treatment seldom is
    the original personality of the person
  • Many of at least one impulsive alter who handles
    sexuality and generates income

62
DID Characteristics
  • Cross-gendered alters are not uncommon
  • The transition from one personality to another is
    called a switch
  • Switches are usually instantaneous (though
    usually made more dramatic in movies)

63
DID Characteristics
  • Physical transformations can occur such as
    posture, facial expressions, patterns of facial
    wrinkles, even physical disabilities and changes
    in handedness

64
Can DID Be Faked?
  • Yes it can be faked (Hillside Strangler)
  • How can you tell if the individual is faking DID?
  • Suggest something that DID personalities usually
    do not do, and see if the individual creates this

65
Can DID Be Faked?
  • Look back before they were motivated to get
    whatever it is they are trying to get now
  • Look for differences in personalities that are
    hard to fake like heart rate, handedness, eye
    movement differences, visual acuity, GSR, EEG,
    fMRI

66
Statistics on DID
  • Average number of alters is
  • 9 to 1
  • Childhood onset (as young as 4 usually around 7)

67
Statistics on DID
  • Almost all cases of DID have included horrific
    child abuse (97)
  • DID has auditory hallucinations at times however
    the voices are reported to come from inside the
    head not outside like in psychotic states also
    they are aware that these are hallucinations

68
Statistics on DID
  • Studies show that DID occurs in a variety of
    cultures
  • 21 different countries have reported cases of DID

69
Causes of DID?
  • Child abuse 97
  • DID is rooted in a natural tendency to escape or
    dissociate from negative effects of severe trauma
    or abuse
  • Lack of social support in these cases
  • Suggestibility

70
Research is Showing
  • DID to be a very extreme subtype of PTSD

71
Treatment for DID
  • Long-term Psychotherapy
  • 5 of 20 achieve full integration of personalities
  • Therapy works on identifying cues and triggers
    that provoke memories of the trauma and
    neutralize them

72
Treatment for DID
  • Confront and relive the traumas in order to gain
    control (PTSD)
  • Relive until it is simply a terrible memory
    rather than a current event
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