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Somatoform and Dissociative Disorders


Dissociative disorders ... may be connected to Antisocial personality disorder ... Treatment parallels that for obsessive compulsive disorder ... – PowerPoint PPT presentation

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Title: Somatoform and Dissociative Disorders

Somatoform and Dissociative Disorders
  • Chapter 5

Basic definitions
  • Somatoform disorders
  • pathological concern of individuals with the
    appearance or functioning of their bodies when
    there is no identifiable medical condition
    causing the physical complaints
  • Dissociative disorders
  • individuals feel detached from themselves or
    their surroundings, and reality, experience, and
    identity may disintegrate
  • Historically, both somatoform and dissociative
    disorders used to be categorized as hysterical
  • in psychoanalytic theory neurotic disorders
    result from underlying unconscious conflicts,
    anxiety that resulted from those conflicts and
    ego defense mechanisms

Somatoform Disorders
  • Soma Meaning Body
  • Preoccupation with health and/or body appearance
    and functioning
  • No identifiable medical condition causing the
    physical complaints
  • Types of DSM-IV Somatoform Disorders
  • Hypochondriasis
  • Somatization disorder
  • Conversion disorder
  • Pain disorder
  • Body dysmorphic disorder

Somatoform Disorders
  • Hypochondriasis
  • severe anxiety focused on the possibility of
    having a serious disease
  • shares age of onset, personality characteristics
    anf running in families with panic disorder
  • illness phobia vs. hypochondriasis
  • 60 of patients with illness phobia develop
  • 1 to 14 of medical patients
  • treatment usually invoves cognitive-behavioral
    therapy and general stress management treatment
    (gain retained after 1 year follow-up)

Somatoform Disorders
  • Causes of hypochondriasis

Somatoform Disorders
  • Somatization disorder
  • Briquets syndrome (100 years ago)
  • patients have a history of many physical
    complaints that can not be explained by a medical
    condition, the complaints are not intentionally
  • 20 of patients in primary care setting
  • develops during adolescence (majority women)
  • may be connected to Antisocial personality
  • difficult to treat (reassurance, stress
    reduction, more adoptive methods of interacting
    with family are encouraged)

Somatoform Disorders
  • Conversion Disorder
  • Physical malfunctioning without any physical or
    organic pathology
  • Malfunctioning often involves sensory-motor areas
  • Persons show la belle indifference
  • Retain most normal functions, but without
    awareness of this ability
  • Statistics
  • Rare condition, with a chronic intermittent
  • Seen primarily in females, with onset usually in
  • Not uncommon in some cultural and/or religious

Somatoform Disorders
  • Conversion disorder (cont.)
  • Freudian psychodynamic view is still popular
    (anxiety converted into physical symptoms)
  • Emphasis on the role of trauma (stress),
    conversion, and primary/secondary gain
  • Detachment from the trauma and negative
    reinforcement seem critical
  • Different from factitious disorder (intentional)
  • Treatment
  • Similar to somatization disorder
  • Core strategy is attending to the trauma
  • Remove sources of secondary gain
  • Reduce supportive consequences of talk about
    physical symptoms

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

Somatoform Disorders
  • Body Dysmorphic Disorder (cont.)
  • Causes
  • Little is known Disorder tends to run in
  • Shares similarities with obsessive-compulsive
  • Treatment
  • Treatment parallels that for obsessive compulsive
  • Medications (i.e., SSRIs) that work for OCD
    provide some relief
  • Exposure and response prevention are also helpful
  • Plastic surgery is often unhelpful

Dissociative Disorders
  • Derealization
  • Loss of sense of the reality of the external
  • Depersonalization
  • Loss of sense of your own reality
  • 5 types
  • Depesonalization disorder
  • Dissociative amnesia
  • Dissociative fugue
  • Dissociative trance disorder
  • Dissociative identity disorder

Dissociative Disorders
  • Depersonalization disorder
  • Severe feelings of depersonalization dominate the
    individuals life and prevent normal functioning
  • It is chronic
  • 50 suffer from additional mood and anxiety
  • Cognitive profile (cognitive deficits in
    attention, STM, spatial reasoning, perception

Dissociative Disorders
  • Dissociative Amnesia
  • Inability to recall personal information, usually
    of a stressful or traumatic nature
  • Generalized vs. selective amnesia
  • Dissociative Fugue
  • Sudden, unexpected travel away from home, along
    with an inability to recall ones past (new
  • Occur in adulthood and usually end abruptly

Dissociative Disorders
  • Dissociative trance disorder
  • Altered state of consciousness in which the
    person believes firmly that he or she is
    possessed by spirits considered a disorder only
    where there is distress and dysfunction
  • Trance and possession are a common part of some
    traditional religious and cultural practices and
    are not considered abnormal in that context
  • Only undesirable trance considered pathological
    within that culture is characterized as disorder

Dissociative Disorders
  • Dissociative Identity Disorder
  • Formerly multiple personality disorder
  • Many personalities (alters) or fragments of
    personalities coexist within one body
  • The personalities or fragments are dissociated
  • Switch (transition form one personality to
    another, includes physical changes)
  • Can be simulated by malingers are usually eager
    to demonstrate their symptoms whereas individuals
    with DID attempt to hide symptoms
  • Very high comorbidity
  • Prevalence about 3

Dissociative Disorders
  • Dissociative Identity Disorder
  • Auditory hallucinations (coming from inside their
  • 97 severe child abuse
  • Extreme subtype of PTSD
  • Onset approximately 9 years
  • Suggestible people may use dissociation as
    defense against severe trauma
  • Real and false memories
  • Temporal lobe pathology (out of body experiences)

Dissociative Disorders
  • Treatment
  • Dissociative amnesia and fugue
  • Get better on their own
  • Coping mechanisms to prevent future episodes
  • DID
  • Reintegration of identities
  • Neutralization of cues
  • Confrontation of early trauma
  • hypnosis