Transcript Somatic Symptom & Related Disorders and

Chapter 6
Somatic Symptom & Related
Disorders & Dissociative
Disorders
Somatic Symptom &
Related Disorders
 Soma – Meaning Body
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Preoccupation with physical disorders
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Excessive or maladaptive response to or
associated health concerns
Includes the following 5 disorders:
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Somatic symptom disorder
Illness anxiety disorder
Psychological Factors affecting medical
condition
Conversion disorder
Factitious disorder
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Somatic Symptom Disorder
Illness Anxiety Disorder
 Formerly called “hypochondriasis”
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Physical symptoms are not presently
experienced or are mild
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Severe anxiety about the possibility of
having a serious disease
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Strong disease conviction
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Medical reassurance does
not seem to help
Illness Anxiety Disorder
1% to 5%
 6.7% median rate of medical patients
 Causes
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Cognitive perceptual distortions
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Familial history of illness
 Treatment
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Challenge illness-related misinterpretations
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Provide more substantial and sensitive
reassurance
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Stress management and coping strategies
Conversion Disorder
(Functional Neurological Symptom Disorder)
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Physical malfunctioning
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Lack physical or organic pathology
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Malfunctioning often involves sensorymotor areas
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Retain most normal functions,
but lack awareness
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Freudian explanation
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Emphasis on the role of past trauma
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Not same as malingering (faking)
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
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Involve severe alterations or detachments
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Affects identity, memory, or consciousness
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Depersonalization – Distortion is perception of
one’s own reality
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Derealization – Losing a sense of the external
world
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Severe and frightening feelings of unreality and
detachment
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Feelings dominate and interfere with life
functioning
Depersonalization-Derealization
Disorder
 Facts and Statistics
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High comorbidity with anxiety and mood disorders
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Onset is typically around age 16
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Usually runs a lifelong chronic course
 Causes
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Cognitive deficits in attention, short-term memory,
spatial reasoning
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Such persons are easily distracted
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May begin with no trigger or stress/trauma
 Treatment
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Little is known
Dissociative Amnesia
 Dissociative Amnesia
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Includes several forms of psychogenic
memory loss
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Most common dissociative disorder
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Generalized vs. localized or selective type
 Dissociative Fugue (sub-type of dissociative
amnesia)
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Take off and find themselves in a new place
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Unable to remember the past
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Unable to remember how they arrived at new
location
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Often assume a new identity
Dissociative Amnesia
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Usually begin in adulthood
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Show rapid onset and dissipation
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Occur most often in females
 Causes
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Little is known
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Trauma and stress can serve as triggers
 Treatment
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Most get better without treatment
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Most remember what they have forgotten
Dissociative Identity Disorder
(DID)
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Has at least 2 or more distinct identities
(personality states)
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Identities display unique behaviors, voice, and
posture
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Alters – Different identities or personalities
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Host – The identity that keeps other identities
together
Can it be faked?
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Hillside strangler case
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Controversial diagnosis
Dissociative Identity Disorder
(DID)
Average number of identities is close to 15
(as many as 100)
 Ratio of females to males is high (9:1)
 Onset is almost always in childhood
 High comorbidity rates & lifelong, chronic
course
 Considered rare
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Dissociative Identity Disorder
(DID)
 Causes
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Histories of horrible, unspeakable, child abuse or
other trauma
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Closely related to PTSD
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Mechanism to escape from the impact of trauma
 Treatment
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Focus is on reintegration of identities
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Identify and neutralize cues/triggers that provoke
memories of trauma/dissociation