Transcript Somatoform and Dissociative Disorders

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
Definition?
Common Features
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Lots of Physical Complaints
Appear to be Medical Conditions
But No Identifiable Medical Cause
Pathological Concern about
 Functioning of body or
 Physical appearance
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Cultural Factors
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Five Somatoform Disorders
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Hypochondriasis
Somatization Disorder
Conversion Disorder
Pain Disorder
Body Dysmorphic Disorder
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Physical Complaints/No Known Medical
Cause
Preoccupied with Bodily Symptoms
 Misinterpretation of Symptoms
 Vicious Cycle
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Severe Anxiety About Possibly Having a
Serious Disease
 Strong Disease Conviction
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Differentiated from Illness Phobia
Many Medical Visits and Tests
 Reassurance Doesn’t Help
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Psychological Treatment
Challenge illness-related misinterpretations
 Provide more substantial and sensitive reassurance
 Stress management and coping strategies
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Medical Treatment?
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Many Physical Complaints/No Known
Medical Cause
Concern about Symptoms but Not What They
Mean
Life/Identity Revolves Around Symptoms
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Treatment
 Difficult
to Treat
 No Proven Treatments
 Treatment Focuses on
Reduction
Assign
of Medical Visits
a “Gatekeeper” Physician
Reducing
Secondary Gain
 Physical
Symptoms/No known medical
cause
 Popularized by Freud as…
 Connection
 Physical
 Often
to trauma [Dissociative process?]
Malfunctioning
involves sensory-motor areas
Paralysis,
Blindness, Mutism,
Anesthesia
 La
Belle Indifference
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Treatment
 No
Well Established Treatments
 Address the Trauma
 Remove Sources of Secondary Gain
 Reduce supportive consequences of talk
about physical symptoms
Complaints of pain/no known medical cause
 Pain is Real
 Pain May Initially Have Organic Cause
 Psychological Factors Maintain Pain
 Can Be Debilitating
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Malingering
 Factitious Disorders
 Munchausen’s Syndrome by Proxy
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 Previously
known as
dysmorphophobia
 Preoccupation with Defect in
Appearance
 “Imagined”
 Fixation
Ugliness
or Avoidance of Mirrors
 Ideas of Reference
 Suicidal Ideation and Tendencies
 Treatment
Plastic
surgery?
Medications (i.e., SSRIs) that work for
OCD provide some relief
Exposure and Response Prevention
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DSM-5 Changes
 Conversion Disorder – Same/Similar
 Body Dysmorphic Disorder - Moved to OCD
Section
 Hypochondriasis – Renamed Illness Anxiety
DO, sort of
 Somatic Symptom Disorder (new!)
Combined:
Hypochondriasis, maybe
Somatization Disorder
Pain Disorder
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Somatic symptom disorder (SSD) is characterized by
somatic symptoms that are either very distressing or
result in significant disruption of functioning, as well
as excessive and disproportionate thoughts, feelings
and behaviors regarding those symptoms. To be
diagnosed with SSD, the individual must be
persistently symptomatic (typically at least for 6
months).
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Several important changes have been made from previous
editions of DSM. The DSM-IV disorders of somatization disorder,
hypochondriasis, pain disorder, and undifferentiated somatoform
disorder have been removed, and many, but not all, of the
individuals diagnosed with one of these disorders could now be
diagnosed with SSD. The DSM-IV diagnosis of somatization
disorder required a specific number of complaints from among
four symptom groups. The SSD criteria no longer have such a
requirement; however, somatic symptoms must be significantly
distressing or disruptive to daily life and must be accompanied by
excessive thoughts, feelings, or behaviors.
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Another key change in the DSM-5 criteria is that while medically
unexplained symptoms were a key feature for many of the
disorders in DSM-IV, an SSD diagnosis does not require that the
somatic symptoms are medically unexplained. In other words,
symptoms may or may not be associated with another medical
condition. DSM-5 narrative text description that accompanies the
criteria for SSD cautions that it is not appropriate to diagnose
individuals with a mental disorder solely because a medical cause
cannot be demonstrated. Furthermore, whether or not the somatic
symptoms are medically explained, the individual would still
have to meet the rest of the criteria in order to receive a diagnosis
of SSD.