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Somatoform and Dissociative Disorders

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Title: What is Dissociation? Author: Jorden Cummings Last modified by: Maureen Cummings Created Date: 10/19/2008 1:44:45 AM Document presentation format – PowerPoint PPT presentation

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Title: Somatoform and Dissociative Disorders


1
Somatoform and Dissociative Disorders
2
Somatoform Disorders
  • Concerns with appearance or functioning of body
  • Absence of medical condition
  • Hypochondriasis
  • Somatization Disorder
  • Conversion Disorder
  • Pain Disorder
  • Body Dysmorphic Disorder

3
Hypochondriasis
  • Anxiety over belief one has a disease, without
    evident cause
  • Reassurance from doctors no help, in the
    long-term
  • Misinterpretation of bodily signals as disease
  • Disorder realized after physician visits

4
Hypochondriasis - Statistics
  • Little information
  • Prevalence estimate 3
  • Equal in men and women, age groups

5
Causes of Hypochondriasis
  • Enhanced sensitivity to illness cues
  • Increased awareness and fright
  • Faulty thoughts/interpretation of physical signs
    (cognition)
  • Context of stressful life events
  • often involving death or illness

6
Causes of Hypochrondriasis
  • Family/genetic influences
  • Might be unspecific anxiety
  • Children report symptoms of parents
  • Disproportionate incidence of disease in family
  • Social influence
  • Attention paid to sick relatives

7
Treatment of Hypochrondriasis
  • Little information regarding treatment
  • Cognitive therapy
  • Exposure to symptoms
  • Decreased reassurance seeking re symptoms
  • Stress management program

8
Somatization Disorder
  • History of physical complaints, occurring over
    years
  • Result in treatment being sought or impairment
  • 4 pain symptoms
  • 2 GI symptoms
  • 1 sexual symptom
  • 1 pseudo-neurologic symptom
  • Not explained by medical condition
  • Complaints not intentionally produced or feigned

9
Somatization Disorder - Statistics
  • Rare
  • Continuum
  • 20 estimated prevalence in primary care settings
  • Adolescent age of onset

10
Causes and Treatment
  • History of family illness
  • Few research studies
  • Difficult to treat

11
Conversion Disorder
  • Physical malfunctioning, suggesting neurological
    impairment, with no medical cause
  • E.g., blindness, paralysis
  • Rare
  • Causes - trauma
  • Insight focused treatment, identifying trauma

12
Conversion Disorder vs. Malingering
  • Conversion patients are indifferent to symptoms
  • Precipitated by stress - 52-93 cases
  • Can function normally, but often unaware of this
    ability or sensory input
  • E.g., avoiding objects in visual field

13
Body Dysmorphic Disorder
  • Preoccupation with imagined defect in appearance
  • Suicidality common
  • Focused on self and defect (similar to social
    anxiety)
  • Can significantly disrupt life

14
Body Dysmorphic Disorder - Statistics
  • Difficult to estimate prevalence
  • Chronic course
  • Often seek plastic surgery or other medical
    attention
  • 2 of plastic surgery patients?
  • Little information on cause

15
Dissociative Disorders
16
What is Dissociation?
  • Derealization Losing sense of reality of the
    external world
  • Common to some degree for everyone (a great
    example of dimensionality)

17
Dissociative Disorders
  • Incredibly puzzling category of mental disorder
  • Disruption of normal integration of
  • Consciousness
  • Memory
  • Perception
  • Separating from identity

18
Types of Dissociative Disorders
  1. Depersonalization Disorder
  2. Dissociative Amnesia
  3. Dissociative Fugue
  4. Dissociative Trance Disorder
  5. Dissociative Identity Disorder

19
Dissociative Amnesia
  • Loss of autobiographical memory
  • E.g. the loss of one event memory
  • Not due to brain damage
  • Usually in response to trauma (which is
    forgotten)
  • Spontaneous recovery
  • Prevalence unknown
  • Controversy over existence

20
Dissociative Fugue
  • Amnesia for past sudden moving
  • Most are not very long-term
  • Confusion re identity
  • Assumption of a new identity
  • May last hours to months
  • Prevalence estimated 1 in 500
  • Usually in response to stressor

21
Treating Dissociative Amnesia and Fugue
  • Supportive therapy
  • Usually recover on own
  • Fugue often needs couples/family therapy
  • Feelings of abandonment
  • At risk of relapse when stressed
  • Preventive approaches helpful
  • Stress management skills

22
Dissociative Identity Disorder
  • Formerly Multiple Personality Disorder
  • Presence of 2 distinct identities
  • Recurrently control an individual
  • Alters Host Personality
  • Alters Host Personality may/may not be aware of
    what is going on

23
Dissociative Identity Disorder
  • Alters who are unaware have lapses in memory
    unaccounted for
  • Own constellation of behavior, voice tone,
    gestures
  • Different reactions to medications, eyeglass
    prescriptions
  • May claim to be different in age, gender, race,
    family history

24
Alters Awareness of Each Other
  • Mutually amnesic
  • Mutually cognizant
  • One-way amnesic

25
Dissociative Identity Disorder
  • Preceded by headaches
  • Rare 1 of general population
  • Few believe prevalence is that high
  • Higher rates of diagnosis?
  • Better identification?
  • Overused?
  • Iatrogenic?

26
Dissociative Identity Disorder
  • Course is unpredictable and varies
  • May be long time b/w treatment diagnosis (e.g.
    6-7 years)
  • Little insight

27
What Causes Dissociative Disorders?
  • Trauma (child abuse, etc)
  • Child abuse as first onset -gt coping in children
  • Massive repression
  • Commonly report child abuse
  • 90 of patients report child abuse

28
Problems with Trauma Dissociation
  • Reports are
  • Self-report
  • Retrospective
  • 1/3 report abuse prior to age 3
  • Autobiographical memory rarely accurate before 5
  • Why no evidence of alters during childhood?

29
Causes of Dissociative Disorders
  • Suggestibility
  • How are people who develop dissociative disorders
    different from those who develop PTSD?
  • Those who develop are better _at_ dissociating
  • Suggestibility personality trait re ease of
    accepting ideas proposed by others

30
Suggestibility
  • Highly suggestible people
  • Have more detailed fantasy lives
  • Respond more dramatically to hypnosis
  • The Autohypnotic Model of DID
  • Select people use self-hypnosis as defense
    against emotional trauma
  • Retreat into a trance during trauma that is
    protective and provides amnesia

31
Autohypnotic Model of DID
Trauma (Repeated)
Self-hypnosis
Alters Form
Suggestible Personality
32
Flaws in the Autohypnotic Model
  • Why develop only with abuse?
  • Not war related. Not in bullying
  • Involves a betrayal of trust?
  • How exactly do alters develop from hypnotic
    state?
  • May be little/no evidence of alters until
    adulthood

33
Neurobiology DID
  • Neurobiology seems to support multiple, distinct
    states of awareness in one brain
  • Changes in skin conductance, heartbeat
  • Allergies
  • Endocrine function

34
Trauma Narratives DID (Simone Reinders,
University of Groningen)
  • 11 DID patients - story from life (traumatic vs.
    nontraumatic)
  • Recording of subjective biological reactions

35
  • Neutral Personality
  • Reacted as if neutral memory
  • Claimed not to remember
  • Trauma Personality
  • Subjective and cardiovascular reaction
  • Different brain activation pattern
  • Reported memory of event

36
Neurobiological Differences (Waldvogel, Ullrich,
Strasburger, Munich Germany)
  • Case study of dissociated patient with 15-years
    of blind male alter
  • Sighted personality EEG reaction to
    checkerboard pattern
  • Reduced visual activity in blind personality
  • Neurobiological summary DID is a lack of
    integration, cohesiveness?

37
Treating DID
  • No controlled treatment studies
  • Agree People cannot function well with alters
  • Disagree How to integrate alters
  • Identify map alters, then integrate
  • Mapping alters may create more?
  • Others argue - ignore, and will go away

38
Treating DID
  • Important to establish trust
  • Usually unsuccessful treatment history
  • Secretive about symptoms
  • Skepticism from other providers

39
Culture and DID
  • Rare until late 1980s
  • 1st case 1817, by 1960s lit review 77 cases
  • 1970s 300 cases, doubled in 1980s
  • Why the rapid increase? Is it real?
  • Increase is largely North American
  • Rare in France, where theorists played a big role

40
Controversies Surrounding DID
  • Could Therapists Shape DID?
  • Sociocognitive model of DID (Spanos)
  • Symptoms shaped by available info therapist
    responses
  • To avoid responsibility?
  • Interest due to rarity
  • Normal social reinforcement
  • Ignore to treat

41
Controversies Surrounding DID
  • Recovered Memories
  • Use recovered memory techniques to assess
  • People repress painful memories of abuse
  • Therapists encourage recovery of memory

42
Evidence Against Recovered Memories
  1. Little scientific evidence for repressed memories
  2. Can implant false memories in children/adults
  3. Techniques used to implant same as therapists use
    to recover
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