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Chapter 6 Somatoform and Dissociative Disorders

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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow ... Previously known as dysmorphophobia. Preoccupation with imagined defect in appearance ... – PowerPoint PPT presentation

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Title: Chapter 6 Somatoform and Dissociative Disorders


1
Chapter 6Somatoform and Dissociative Disorders
2
An Overview of Somatoform Disorders
  • Soma Meaning Body
  • Overly preoccupied with health or body appearance
  • Physical complaints without a medical condition
  • Types of DSM-IV Somatoform Disorders
  • Hypochondriasis
  • Somatization disorder
  • Conversion disorder
  • Pain disorder
  • Body dysmorphic disorder

3
Hypochondriasis An Overview
  • Overview and Defining Features
  • Severe anxiety The possibility of having a
    disease
  • Strong disease conviction
  • Medical reassurance does not seem to help
  • Facts and Statistics
  • Good prevalence data are lacking
  • Onset at any age
  • Runs a chronic course

4
Hypochondriasis Causes and Treatment
  • Causes
  • Cognitive perceptual distortions
  • Familial history of illness
  • Treatment
  • Challenge illness-related misinterpretations
  • Provide more substantial and sensitive reassurance

5
Hypochondriasis Causes and Treatment
  • Figure 6.1 Integrative model of causes in
    hypochondriasis (based on Warwick Salkovskis,
    1990).

6
Somatization Disorder (Briquets Syndrome) An
Overview
  • Overview and Defining Features
  • Extended history of physical complaints before
    age 30
  • Substantial social and occupational impairment
  • Concerned with the symptoms, not what they might
    mean
  • Symptoms become the persons identity
  • Facts and Statistics
  • Rare condition
  • Onset usually in adolescence
  • Mostly affects unmarried, low SES women
  • Runs a chronic course

7
Somatization Disorder Causes and Treatment
  • Causes
  • Familial history of illness
  • Relation with antisocial personality disorder
  • Weak behavioral inhibition system
  • Treatment
  • No treatment exists with demonstrated
    effectiveness
  • Reduce tendency to visit numerous medical
    specialists
  • Assign gatekeeper physician
  • Reduce supportive consequences of talk about
    symptoms

8
Conversion Disorder An Overview
  • Overview and Defining Features
  • Physical malfunctioning
  • Lack physical or organic pathology
  • Malfunctioning often involves sensory-motor areas
  • Persons show la belle indifference
  • Retain most normal functions, but lack awareness
  • Facts and Statistics
  • Rare condition, with a chronic intermittent
    course
  • Seen primarily in females
  • Onset usually in adolescence
  • Not uncommon in some cultural and/or religious
    groups

9
Conversion Disorder Causes and Treatment
  • Causes
  • Freudian psychodynamic view is still popular
  • Focus on past trauma and conversion
  • Address primary / secondary gain
  • Detachment from the trauma and negative
    reinforcement
  • Treatment
  • Similar to somatization disorder
  • Core strategy is attending to the trauma
  • Remove sources of secondary gain
  • Reduce supportive consequences of talk about
    symptoms

10
Body Dysmorphic Disorder(Imagined Ugliness)
An Overview
  • Overview and Defining Features
  • Previously known as dysmorphophobia
  • Preoccupation with imagined defect in appearance
  • Either fixation or avoidance of mirrors
  • Suicidal ideation and behavior are common
  • Often display ideas of reference for imagined
    defect
  • Facts and Statistics
  • More common than previously thought
  • Seen equally in males and females
  • Onset usually in early 20s
  • Most remain single, and many seek out plastic
    surgeons
  • Usually runs a lifelong chronic course

11
Doug
12
Body Dysmorphic Disorder Causes and Treatment
  • Causes
  • Little is known
  • Shares similarities with obsessive-compulsive
    disorder
  • Treatment
  • Parallels that for obsessive-compulsive disorder
  • Medications (i.e., SSRIs) provide some relief
  • Exposure and response prevention is also helpful
  • Plastic surgery is often unhelpful

13
An Overview of Dissociative Disorders
  • Overview
  • Involve severe alterations or detachments
  • Affect identity, memory, and/or consciousness
  • Severe form of normal perceptual experiences
  • Depersonalization Distortion in perception of
    reality
  • Derealization Losing a sense of the external
    world
  • Types of DSM-IV Dissociative Disorders
  • Depersonalization Disorder
  • Dissociative Amnesia
  • Dissociative Fugue
  • Dissociative Trance Disorder
  • Dissociative Identity Disorder

14
Depersonalization Disorder An Overview
  • Overview and Defining Features
  • Severe and frightening feelings of unreality and
    detachment
  • These dominate and interfere with life
    functioning
  • Problem involves depersonalization and
    derealization
  • Facts and Statistics
  • High comorbidity with anxiety and mood disorders
  • Onset is typically around age 16
  • Usually runs a lifelong chronic course

15
Depersonalization Disorder Causes and Treatment
  • Causes
  • Cognitive deficits in attention
  • Cognitive deficits in short-term memory
  • Cognitive Deficits in spatial reasoning
  • Deficits related with tunnel vision and mind
    emptiness
  • Such persons are easily distracted
  • Treatment
  • Little is known

16
Dissociative Amnesia andDissociative Fugue An
Overview
  • Dissociative Amnesia Overview and Defining
    Features
  • Several forms of psychogenic memory loss
  • Generalized type Inability to recall anything,
    including their identity
  • Localized or selective type Failure to recall
    specific (usually traumatic) events
  • Dissociative Fugue Overview and Defining
    Features
  • Related to dissociative amnesia
  • Take off to a new place
  • Unable to remember the past
  • Unable to remember how they arrived at a new
    location
  • Often assume a new identity

17
Dissociative Amnesia and Fugue Causes and
Treatment
  • Facts and Statistics -- Dissociative Amnesia and
    Fugue
  • Usually begin in adulthood
  • Both show rapid onset and dissipation
  • Both are mostly seen in females
  • Causes
  • Little is known
  • Trauma and life stress can serve as triggers
  • Treatment
  • Most get better without treatment
  • Most remember what they have forgotten

18
Dissociative Trance Disorder An Overview
  • Overview and Defining Features
  • Symptoms resemble those of other dissociative
    disorders
  • Dissociative symptoms and sudden changes in
    personality
  • Changes are often attributed to possession of a
    spirit
  • Presentation differs in important ways across
    cultures
  • Facts and Statistics
  • More common in females
  • Causes
  • Often attributable to a life stressor or trauma
  • Only abnormal if the trance is considered
    undesirable/pathological by the culture
  • Treatment
  • Little is known

19
Dissociative Identity Disorder (DID) An Overview
  • Overview and Defining Features
  • Formerly known as multiple personality disorder
  • Defining feature Dissociation of personality
  • Adopt several new identities (as many as 100)
  • Identities show unique behaviors, voice, and
    posture
  • Unique Aspects of DID
  • Alters The different identities
  • Host The identity that keeps other identities
    together
  • Switch Quick transition from one personality to
    another

20
Dissociative Identity Disorder (DID) Causes
and Treatment
  • Facts and Statistics
  • Average number of identities is close to 15
  • Ratio of females to males is high (91)
  • Onset is almost always in childhood
  • High comorbidity rates, with a lifelong chronic
    course
  • Causes
  • Most have histories of horrible, unspeakable,
    child abuse
  • Most are also highly suggestible
  • DID Mechanism to escape from impact of trauma
  • Closely related to PTSD
  • Treatment
  • Focus is on reintegration of identities
  • Identify and neutralize cues/triggers that
    provoke memories of trauma/dissociation

21
Diagnostic Considerations in Somatoformand
Dissociative Disorders
  • Separating Real Problems from Faking
  • Malingering Deliberately faking symptoms
  • Related Conditions Factitious disorders
  • Factitious disorder by proxy
  • False Memories and Recovered Memory Syndrome

22
Summary of Somatoform and Dissociative Disorders
  • Features of Somatoform Disorders
  • Physical problems without on organic cause
  • Features of Dissociative Disorders
  • Extreme distortions in perception and memory
  • Well Established Treatments Are Generally Lacking

23
Exploring Somatoform Disorders
24
Exploring Somatoform Disorders (cont.)
25
Exploring Somatoform Disorders (cont.)
26
Exploring Dissociative Disorders
27
Exploring Dissociative Disorders
28
Exploring Dissociative Disorders
29
Exploring Dissociative Disorders
30
Exploring Dissociative Disorders
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