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Chapter 5 Somatoform and Dissociative Disorders

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... Types of DSM-IV Somatoform Disorders Hypochondriasis Somatization disorder Conversion disorder Pain disorder Body dysmorphic disorder Hypochondriasis ... – PowerPoint PPT presentation

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Title: Chapter 5 Somatoform and Dissociative Disorders


1
Chapter 5 Somatoform and Dissociative Disorders
2
Somatoform Disorders
  • Soma Meaning Body
  • Preoccupation with health and/or body appearance
    and functioning
  • No identifiable medical condition causing the
    physical complaints

3
Somatoform Disorders (continued)
  • Types of DSM-IV Somatoform Disorders
  • Hypochondriasis
  • Somatization disorder
  • Conversion disorder
  • Pain disorder
  • Body dysmorphic disorder

4
Hypochondriasis
  • Clinical Description
  • Physical complaints without a clear cause
  • Severe anxiety about the possibility of having a
    serious disease
  • Strong disease conviction
  • Medical reassurance does not seem to help

5
Hypochondriasis (continued)
  • Statistics
  • Good prevalence data are lacking
  • Onset at any age
  • Runs a chronic course

6
Hypochondriasis Causes and Treatment
  • Causes
  • Cognitive perceptual distortions
  • Familial history of illness
  • Treatment
  • Challenge illness-related misinterpretations
  • Provide more substantial and sensitive
    reassurance
  • Stress management and coping strategies

7
Fig. 5.1, p. 176
8
Somatization Disorder
  • Clinical Description
  • Extended history of physical complaints before
    age 30
  • Substantial impairment in social or occupational
    functioning
  • Concern about the symptoms, not what they might
    mean
  • Symptoms become the persons identity

9
Somatization Disorder (continued)
  • Statistics
  • Rare condition
  • Onset usually in adolescence
  • Mostly affects unmarried, low SES women
  • Runs a chronic course

10
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 the tendency to visit numerous medical
    specialists

11
Somatization Disorder Causes and Treatment
(continued)
  • Assign gatekeeper physician
  • Reduce supportive consequences of talk about
    physical symptoms

12
Conversion Disorder
  • Clinical Description
  • 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

13
Conversion Disorder (continued)
  • Statistics
  • Rare condition, with a chronic intermittent
    course
  • Seen primarily in females
  • Onset usually in adolescence
  • Common in some cultural and/or religious groups

14
Conversion Disorder Causes
  • Causes
  • Freudian psychodynamic view is still popular
  • Emphasis on the role of past trauma and
    conversion
  • Detachment from the trauma and negative
    reinforcement
  • Address primary/secondary gain

15
Conversion Disorder Treatment
  • 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

16
Body Dysmorphic Disorder
  • Clinical Description
  • Previously known as dysmorphophobia
  • Preoccupation with imagined defect in appearance
  • Often display ideas of reference for imagined
    defect
  • Suicidal ideation and behavior are common

17
Body Dysmorphic Disorder (continued)
  • 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

18
Body Dysmorphic Disorder Causes
  • Causes
  • Little is known Disorder tends to run in
    families
  • Shares similarities with obsessive-compulsive
    disorder

19
Body Dysmorphic Disorder Treatment
  • Treatment
  • Treatment parallels that for obsessive compulsive
    disorder
  • Medications (i.e., SSRIs) that work for OCD
    provide some relief
  • Exposure and response prevention is also helpful
  • Plastic surgery is often unhelpful

20
An Overview of Dissociative Disorders
  • Overview
  • Involve severe alterations or detachments
  • Affects identity, memory, or consciousness
  • Depersonalization Distortion is perception of
    reality
  • Derealization Losing a sense of the external
    world

21
An Overview of Dissociative Disorders (continued)
  • Types of DSM-IV Dissociative Disorders
  • Depersonalization Disorder
  • Dissociative Amnesia
  • Dissociative Fugue
  • Dissociative Trance Disorder
  • Dissociative Identity Disorder

22
Depersonalization Disorder An Overview
  • Overview and Defining Features
  • Severe and frightening feelings of unreality and
    detachment
  • Feelings dominate and interfere with life
    functioning
  • Primary problem involves depersonalization and
    derealization

23
Depersonalization Disorder An Overview
(continued)
  • Facts and Statistics
  • High comorbidity with anxiety and mood disorders
  • Onset is typically around age 16
  • Usually runs a lifelong chronic course

24
Depersonalization Disorder Causes and Treatment
  • Causes
  • Cognitive deficits in
  • Attention, short-term memory, spatial reasoning
  • Deficits related to tunnel vision and mind
    emptiness
  • Such persons are easily distracted
  • Treatment
  • Little is known

25
Dissociative Amnesia An Overview
  • Dissociative Amnesia
  • Includes several forms of psychogenic memory loss
  • Generalized vs. localized or selective type

26
Dissociative Fugue An Overview
  • Dissociative Fugue
  • Related to dissociative amnesia
  • Take off and find themselves in a new place
  • Unable to remember the past
  • Unable to remember how they arrived at new
    location
  • Often assume a new identity

27
Dissociative Amnesia and Fugue Causes
  • Statistics
  • Usually begin in adulthood
  • Show rapid onset and dissipation
  • Occur most often in females
  • Causes
  • Little is known
  • Trauma and stress can serve as triggers

28
Dissociative Amnesia and Fugue Causes and
Treatment
  • Treatment
  • Most get better without treatment
  • Most remember what they have forgotten

29
Dissociative Trance Disorder An Overview
  • Clinical Description
  • Symptoms resemble other dissociative disorders
  • Dissociative symptoms and sudden changes in
    personality
  • Changes often attributed to possession by a
    spirit
  • Presentation varies across cultures

30
Dissociative Trance Disorder Causes, and
Treatment
  • Facts and Statistics
  • More common in females than males
  • Causes
  • Often attributable to a life stressor or trauma
  • Treatment
  • Little is known

31
Dissociative Identity Disorder (DID) An Overview
  • Clinical Description
  • Formerly known as multiple personality disorder
  • Defining feature is dissociation of personality
  • Adoption of several new identities (as many as
    100)
  • Identities display unique behaviors, voice, and
    posture

32
Dissociative Identity Disorder (DID) An
Overview (continued)
  • Unique Aspects of DID
  • Alters Different identities or personalities
  • Host The identity that keeps other identities
    together
  • Switch Quick transition from one personality to
    another

33
Dissociative Identity Disorder (DID) An
Overview (continued)
  • 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 lifelong, chronic course

34
Dissociative Identity Disorder (DID) Causes
  • Causes
  • Histories of horrible, unspeakable, child abuse
  • Closely related to PTSD
  • Mechanism to escape from the impact of trauma

35
Dissociative Identity Disorder (DID) Treatment
  • Treatment
  • Focus is on reintegration of identities
  • Identify and neutralize cues/triggers that
    provoke memories of trauma/dissociation

36
Diagnostic Considerations in Somatoform and
Dissociative Disorders
  • Separating Real Problems from Faking
  • Malingering Deliberately faking symptoms
  • False Memories and Recovered Memory Syndrome
  • Related Conditions Factitious Disorder
  • Factitious Disorder by Proxy

37
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
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