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Dissociative and Somatoform Disorders 022505


Dissociative Disorders involve some sort of dissociation (separation) of, or ... Usually characterized by limited, but apparently purposeful, travel ... – PowerPoint PPT presentation

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Title: Dissociative and Somatoform Disorders 022505

Dissociative and Somatoform Disorders02-25-05
Dissociative Disorders
  • Dissociative Disorders involve some sort of
    dissociation (separation) of, or changes in, a
    part of the persons sense of identity,
    consciousness, or memory
  • Often linked to trauma and anxiety

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Dissociative Amnesia
  • Partial or total memory loss for important
    personal information, usually occurring after a
    stressful experience
  • Localized amnesia (most common) all events
    during a limited period of time
  • Selective amnesia selected events during a
    limited period of time or specific incident
  • Generalized amnesia total no memory of previous

Dissociative Fugue
  • Confusion and/or amnesia about personal identity
    accompanied by leaving home
  • Typically occurs after a severe stress
  • Usually characterized by limited, but apparently
    purposeful, travel
  • In some cases, a person may assume a new identity
    and build a new life

Depersonalization Disorder
  • Feelings of unreality concerning the self and the
  • Involves no disturbance of memory
  • Often triggered by stress
  • Unusual sensory experiences persons limbs may
    seem drastically changed in size voice may sound
    strange may feel as if outside body may feel
    mechanical (like a robot)

Dissociative Identity Disorder
  • Formerly Multiple Personality Disorder
  • At least two distinct personalities (different
    modes of being and feeling and acting) that
    exist independently of each other and that are in
    control at different times
  • Gaps in memory are common because personalities
    may have no contact with the others

Dissociative Identity Disorder
  • Personalities may each have independent behavior
    patterns, memories, and relationships may even
    have different handedness, eyeglass
    prescriptions, allergies
  • Usually begins in childhood often associated
    with childhood abuse more common in women than
  • Often comorbid with other disorders such as
    depression, borderline personality disorder

Etiology of Dissociative Disorders
  • Psychodynamic view Repression is used to block
    stressful/traumatic experiences and memories from
  • Pathological dissociation may result from an
    interaction between a persons tendency toward
    self-hypnosis and acute stress

Psychodynamic Model of DID
Etiology of Dissociative Disorders
  • Behavioral view Dissociation is an avoidance
    response that protects the person from stressful
    events and memories
  • Iatrogenic view Dissociative symptoms may be
    produced or maintained through selective
    attention, suggestion, reinforcement, and /or
    expectations of the therapist
  • Feigning/faking must also be considered

Treatment/Courseof Dissociative Disorders
  • Psychoeducational, cognitive-behavioral, and/or
    supportive therapy typically address primary as
    well as comorbid symptoms (e.g., depression,
  • Dissociative Amnesia Fugue typically remit
  • Hypnosis may be utilized in the treatment of
    Dissociative Identity Disorder

Somatoform Disorders
Somatoform Disorders
  • Experience of somatic (bodily) symptoms for which
    no physiological basis can be found
  • Symptoms are not considered under voluntary
    control individual believes the symptoms are
    real. Thus, somatic disorders are NOT
    malingering (faking a disorder to achieve some
    gain) or Factitious Disorders (deliberately
    inducing physical symptoms with no apparent

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Somatization Disorder
  • Complaints of multiple physical symptoms (e.g.,
    pain, gastrointestinal, sexual, neurological)
    that have no apparent physical basis
  • Typically characterized by persistent seeking of
    medical care and doctor-shopping

Conversion Disorder
  • Complaints of physical problems or impairments of
    sensory or motor functions controlled by the
    voluntary nervous system, all suggesting a
    neurological disorder but with no underlying
  • Example symptoms partial/complete paralysis,
    seizures, coordination disturbances, anesthesias,
    visual impairment
  • Symptoms may be physiologically impossible (e.g.,
    glove anesthesia)

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Pain Disorder
  • Complaints of severe pain that has no
    physiological or neurological basis, is greatly
    in excess of that expected with an existing
    condition, or lingers long after a physical
    injury has healed
  • Complaints of pain may be vague, not localized

  • Persistent preoccupation with fears of having a
    serious disease, even in the face of physical
    evaluations that reveal no organic problems
  • Patients appear to be oversensitive to physical
    sensations and make more catastrophic
    interpretations of symptoms
  • Often co-occurs with anxiety and mood disorders

Body Dysmorphic Disorder
  • Preoccupation with an imagined physical defect in
    a normal-appearing person, or an excessive
    concern with a slight physical defect
  • Common concerns hair, nose, face, eyes differ
    by gender
  • Frequent checking in mirror consultation with
    plastic surgeons activity limitations

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Etiology of Somatoform Disorders
  • Psychodynamic view Defense against the awareness
    of unconscious emotional issues
  • Behavioral view Reinforcement of the sick
    role avoidance of unpleasant situations or
  • Diathesis-Stress Model

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Treatment of Somatoform Disorders
  • Psychodynamic treatment psychoanalysis and
  • Cognitive-behavioral treatments (exposure and
    response prevention systematic desensitization
    cognitive therapies)
  • Family systems therapy
  • Biological treatment SSRIs

Culture and Somatization
  • People from non-Western cultures tend to express
    distress somatically (e.g., depression, anxiety
    headaches, abdominal distress, body pains, sleep
    disturbance, appetite change, fatigue,
    restlessness, etc. )
  • Stigma of psychological/mental disorders
  • Examples Neurasthenia among Chinese, Chawaj
    among Maya
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