Transcript Dissociative & Somatic Symptom and Related Disorders

Dissociative & Somatic Symptom
and Related Disorders
Dissociative Disorders
I. Dissociative Identity Disorder (DID): a
dissociative disorder in which a person has two
or more distinct (alternate) personalities each
with a unique set of memories, behaviors,
thoughts, and emotions (a.k.a. Multiple
Personality Disorder).
At any given time, one of the alternate personalities dominates the
person’s functioning.
Usually one of these alternate personalities – called the primary, or host,
personality – appears more often than the others.
Most cases are first diagnosed in late adolescence or early adulthood.
Symptoms generally begin in childhood after episodes of abuse.
Women receive the diagnosis three times as often as men.
A. Mutually Amnesic Relationships: the alternate
personalities have no awareness of one another.
B. Mutually Cognizant Patterns: each alternate personality is
well aware of the rest.
C. One-way Amnesic Relationships: most common pattern;
some personalities are aware of others, but the awareness is
not mutual.
Note that the real person is NOT one of the personalities. The real person
has been divided up into the distinct personalities.
However, there is a main host personality through which the other
alternate personalities typically must transfer through before another
alternate personality can surface.
Studies suggest that the average number of alternate personalities is 15
for women and 8 for men.
D. The Controversy
Only a handful of cases worldwide were reported from 1920 to 1970, but
since then the number of reported cases has skyrocketed into the
thousands.
It’s almost exclusively found in North America.
Many DID clients have been in therapy for years before the different
personalities emerge.
It has been noted that people with DID are often very suggestible,
imaginative, and easily hypnotized.
1) Self-Fulfilling Prophecy: the case whereby people have
an expectation about what another person is like, which
influences how they act toward that person, which causes
that person to behave consistently with people’s original
expectations, making the expectations come true.
2) Self-Monitoring: being aware of how one is presenting
oneself in a social context and being able to adjust that
image in different social contexts to create favorable
impressions.
E. Documented DID Characteristics of different
personalities that would be difficult (if not impossible) to
fabricate...
1) handedness
2) presence/absence of visible allergic reactions
3) differences in blood pressure levels
4) EEG brain-response pattern variations
F. Documented DID Characteristics of different personalities
that would be easier to fabricate...
1) different ages
2) different sexes / sexual orientations
3) different eyeglass prescriptions
4) presence/absence of psychotic features (hallucinations,
paranoia, disorganized thinking)
5) different skills (playing musical instruments, other artistic
abilities)
6) understanding foreign languages
7) different styles of handwriting
8) different food preferences
9) different recreational interests
10) differences in social behavior (e.g. introversion vs extraversion)
11) differences in emotional responses (reserved/timid vs
aggressive/confident)
G. The role of childhood abuse
H. Posttraumatic Theory: DID starts from the child’s attempt to
cope with an overwhelming sense of hopelessness and
powerlessness in the face of repeated traumatic abuse.
Lacking other resources or routes of escape, the child may
dissociate or escape into fantasy, becoming someone else.
Severe childhood
sexual and/or
physical abuse
An unusually
imaginative and
suggestible
disposition
Coping via the unintentional
development of multiple personalities
that serve as an escape from reality
I. Sociocognitive Theory: DID develops when a highly
suggestible person learns to adopt the roles of multiple identities
mostly because clinicians have inadvertently suggested,
legitimized, and reinforced them and because these different
identities are geared to the individual’s own personal goals.
An unusually
imaginative and
suggestible
disposition
Severe childhood
sexual and/or
physical abuse
Exposure to
a self-focused &
individualistic
culture
High
self-monitoring
tendencies
Exposure to
those who promote
a self-fulfilling
prophecy
Coping via the unintentional
development of multiple personalities
that serve as an escape from reality
II. Dissociative Amnesia: a condition in which
people are unable to recall important
information, usually of an upsetting nature,
about their lives.
A. Types of Dissociative Amnesia
1) Localized: most common type; loss of all memory of events occurring
within a limited period.
2) Selective: loss of memory for some, but not all, events occurring
within a period.
3) Generalized: loss of memory beginning with an event, but extending
back in time; may lose sense of identity; may fail to recognize family and
friends.
4) Continuous: forgetting from a certain point in time that continues into
the future; quite rare in cases of dissociative amnesia.
5) Systemized: memory loss of a particular category of information such
as family members or coworkers.
B. Dissociative Fugue: a condition in which people not only
forget their personal identities and details of their past, but also
flee to an entirely different location.
People may travel far from home, take a new name and establish new
relationships, and even a new line of work; some display new
personality characteristics.
It usually follows a severely stressful event.
Fugues tend to end abruptly.
Interestingly, when the fugue ends on its own, the person is flooded
with memories of their original identity AND typically forgets all of the
events and circumstances surrounding their new identity.
III. Depersonalization / Derealization
Disorder: characterized by persistent or
recurrent episodes of depersonalization (a
temporary change in their usual sense of reality
in which people feel detached from themselves
and their surroundings) and/or derealization (a
sense of unreality about the external world
involving odd changes in the perception of one’s
surroundings or in the passage of time).
IV. Theories and Treatment of Dissociative
Disorders
A. Psychodynamic Theory
B. Psychodynamic Treatment
1) How do therapists help individuals with Dissociative Amnesia?
People with dissociative amnesia often recover on their own.
Therapists guide patients to search their unconscious and bring forgotten
experiences into consciousness.
2) How do therapists help individuals with DID?
Therapists try to help patients recover missing memories.
Therapists usually try to help the client by integrating the personalities.
Integration is a continuous process; fusion is the final merging.
Somatic Symptom and Related
Disorders
I. Somatic Symptom Disorder: excessive
distress, concern, and anxiety about bodily
symptoms that one is experiencing.
A sufferer’s ailments often include pain symptoms, gastrointestinal
symptoms, sexual symptoms, and neurological symptoms.
Patients with this pattern often describe their symptoms in dramatic and
exaggerated terms.
As high as 2% of all women in the U.S. experience Somatic Symptom
Disorder in any given year (compared with less than 0.2% of men).
A. Hypochondriasis: when one has a belief or fear that one
has a serious disease when one is only experiencing normal
bodily reactions.
II. Illness Anxiety Disorder: the experience of
chronic anxiety about one’s health and concern
that one is developing a serious medical illness,
despite the absence of somatic symptoms.
Sometimes they have physiological symptoms, but they’re remarkable
mild.
Often their symptoms are merely normal bodily changes, such as
occasional coughing, sores, or sweating.
This disorder starts most often in early adulthood, among men and
women in equal numbers.
Between 1% and 5% of all people experience the disorder.
III. Functional Neurological Symptom
Disorder: characterized by symptoms or
deficits that affect the ability to control voluntary
movements or that impair sensory functions,
such as an inability to see, hear, or feel tactile
stimulation (a.k.a. Conversion Disorder).
Individuals experience neurological-like symptoms – blindness,
paralysis, or loss of feeling – that have no neurological basis.
Symptoms may only persist for minutes, but often continue for hours or
days.
It is diagnosed in women twice as often as in men occurring in 0.5% of
the U.S. population.
IV. Factitious Disorder: (popularly referred to
as Münchausen Syndrome) characterized by
intentional fabrication of psychological or
physical symptoms for no clear tangible gain.
Perhaps motivated by the experience of care and sympathy that they
receive in settings such as a hospital.
Overall, the pattern appears to be more common in women than men
and the disorder usually begins during early adulthood.
A. Factitious Disorder Imposed on Another: parents make up
or produce physical illnesses in their children.
It appears that parents who do this to their children, for example, are
trying to gain external sympathy for their supposedly sick children and
themselves as well.
They seem to take great pleasure in the experience of taking care of
sick people and will sometimes make their children sick just so that
they can care for them.
V. Theories of Somatic Symptom and Related
Disorders
A. Psychodynamic Theory
Psychodynamic theorists propose that two mechanisms are at work
in hysterical disorders:
1) Primary gain: bodily symptoms keep internal conflicts out of
conscious awareness.
2) Secondary gain: bodily symptoms allow the individual to avoid
burdensome responsibilities and to gain the support, rather than
condemnation, of those around them.
B. Behavior / Learning Theory
From this perspective, the symptoms in conversion and related disorders
may also carry the benefits, or reinforcing properties, of the “sick role.”
Hypochondriasis is often linked to obsessive–compulsive disorder.
VI. Treatment of Somatic Symptom and
Related Disorders
A. Psychodynamic Treatment
B. Behavioral Treatment
C. Biological Treatment