Transcript Somatoform and Dissociative Disorders

Somatoform and Dissociative
Disorders
Chapter 5
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
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
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)
Somatoform Disorders
• Causes of hypochondriasis
Somatoform Disorders
• Somatization disorder
– Briquet’s 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)
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
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
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
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
Dissociative Disorders
• Derealization
– Loss of sense of the reality of the external world
• Depersonalization
– Loss of sense of your own reality
• 5 types
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Depesonalization disorder
Dissociative amnesia
Dissociative fugue
Dissociative trance disorder
Dissociative identity disorder
Dissociative Disorders
• Depersonalization disorder
– Severe feelings of depersonalization
dominate the individual’s 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))
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 one’s past
(new identity)
– Occur in adulthood and usually end abruptly
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
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%
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)
Dissociative Disorders
• Treatment
– Dissociative amnesia and fugue
• Get better on their own
• Coping mechanisms to prevent future episodes
– DID
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Reintegration of identities
Neutralization of cues
Confrontation of early trauma
hypnosis