Somatoform and Dissociative Disorders

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Somatoform and Dissociative Disorders

• Chapter 5

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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
  neurosis
• in psychoanalytic theory neurotic disorders
  result from underlying unconscious conflicts,
  anxiety that resulted from those conflicts and
  ego defense mechanisms

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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

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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
  hypochondriasis
• 1 to 14 of medical patients
• treatment usually invoves cognitive-behavioral
  therapy and general stress management treatment
  (gain retained after 1 year follow-up)

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Somatoform Disorders

• Causes of hypochondriasis

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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
  produced
• 20 of patients in primary care setting
• develops during adolescence (majority women)
• may be connected to Antisocial personality
  disorder
• difficult to treat (reassurance, stress
  reduction, more adoptive methods of interacting
  with family are encouraged)

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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
  course
• Seen primarily in females, with onset usually in
  adolescence
• Not uncommon in some cultural and/or religious
  groups

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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

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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
  defect
• 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
  surgeons

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Somatoform Disorders

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

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Dissociative Disorders

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

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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
  disorders
• Cognitive profile (cognitive deficits in
  attention, STM, spatial reasoning, perception
  (3D))

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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
  identity)
• Occur in adulthood and usually end abruptly

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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

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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

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Dissociative Disorders

• Dissociative Identity Disorder
• Auditory hallucinations (coming from inside their
  heads)
• 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)

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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