Chapter 6 Somatic Symptom

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Chapter 6 Somatic Symptom RelatedDisorders
Dissociative Disorders
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Somatic Symptom Related Disorders

• Soma Meaning Body
• Preoccupation with physical disorders
• Excessive or maladaptive response to or
  associated health concernsIncludes the following
  5 disorders
• Somatic symptom disorder
• Illness anxiety disorder
• Psychological Factors affecting medical condition
• Conversion disorder
• Factitious disorder

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Somatic Symptom Disorder
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Illness Anxiety Disorder

• Formerly called hypochondriasis
• Physical symptoms are not presently experienced
  or are mild
• Severe anxiety about the possibility of having a
  serious disease
• Strong disease conviction
• Medical reassurance does
  not seem to help

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Illness Anxiety Disorder

• 1 to 5
• 6.7 median rate of medical patients
• Causes
• Cognitive perceptual distortions
• Familial history of illness
• Treatment
• Challenge illness-related misinterpretations
• Provide more substantial and sensitive
  reassurance
• Stress management and coping strategies

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Conversion Disorder(Functional Neurological
Symptom Disorder)

• Physical malfunctioning
• Lack physical or organic pathology
• Malfunctioning often involves sensory-motor areas
• Retain most normal functions,
  but lack awareness
• Freudian explanation
• Emphasis on the role of past trauma
• Not same as malingering (faking)

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Factitious Disorders

• Intentionally produced symptoms
• No obvious benefit
• Factitious disorder imposed on another known
  previously as Munchausen syndrome by proxy
• Intentionally produced symptoms in another person

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Dissociative Disorders

• Involve severe alterations or detachments
• Affects identity, memory, or consciousness
• Depersonalization Distortion is perception of
  ones own reality
• Derealization Losing a sense of the external
  world
• Severe and frightening feelings of unreality and
  detachment
• Feelings dominate and interfere with life
  functioning

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Depersonalization-Derealization Disorder

• Facts and Statistics
• High comorbidity with anxiety and mood disorders
• Onset is typically around age 16
• Usually runs a lifelong chronic course
• Causes
• Cognitive deficits in attention, short-term
  memory, spatial reasoning
• Such persons are easily distracted
• May begin with no trigger or stress/trauma
• Treatment
• Little is known

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Dissociative Amnesia

• Dissociative Amnesia
• Includes several forms of psychogenic
  memory loss
• Most common dissociative disorder
• Generalized vs. localized or selective type
• Dissociative Fugue (sub-type of 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

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Dissociative Amnesia

• 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
• Treatment
• Most get better without treatment
• Most remember what they have forgotten

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Dissociative Identity Disorder (DID)

• Has at least 2 or more distinct identities
  (personality states)
• Identities display unique behaviors, voice, and
  posture
• Alters Different identities or personalities
• Host The identity that keeps other identities
  together
• Can it be faked?
• Hillside strangler case
• Controversial diagnosis

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Dissociative Identity Disorder (DID)

• Average number of identities is close to 15 (as
  many as 100)
• Ratio of females to males is high (91)
• Onset is almost always in childhood
• High comorbidity rates lifelong, chronic course
• Considered rare

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Dissociative Identity Disorder (DID)

• Causes
• Histories of horrible, unspeakable, child abuse
  or other trauma
• Closely related to PTSD
• Mechanism to escape from the impact of trauma
• Treatment
• Focus is on reintegration of identities
• Identify and neutralize cues/triggers that
  provoke memories of trauma/dissociation