Transcript Somatoform & Dissociative Disorders

Somatoform Disorders &
Dissociative Disorders
Kimberley Clow
[email protected]
http://instruct.uwo.ca/psychology/155b/
Outline
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Somatoform Disorders
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Somatization Disorder
Pain Disorder
Hypochondriasis
Conversion Disorder
Body Dysmorphic Disorder
Dissociative Disorders
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Dissociative Amnesia
Dissociative Fugue
Depersonalization Disorder
Dissociative Identity Disorder
Somatoform Disorders
 Bodily
symptoms that suggest
a physical defect or dysfunction
BUT no physiological basis can be
found
 Emotions  Physical Symptoms
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 Different
from
Malingering
 Factitious Disorder
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Somatization Disorder
Causes & Treatment
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Contributors
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Behaviour rewarded
Excessive illness growing up
Association with Antisocial Personality
Disorder
Runs in families
Treatment
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Focus on stress
Reduce help-seeking behaviour
Eliminate reinforcers
Pain Disorder
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Predominant complain is pain and
psychological factors have an
important role in the onset, severity,
exacerbation, or maintenance of the
pain
Types
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Acute
Chronic
Causes
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Psychodynamic
Behavioural
Hypochondriasis
Causes & Treatment
Conversion Disorder
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Freud
Motor or sensory
symptoms suggesting a
neurological impairment
when there is none
Conversion refers to
unconscious conflicts
being converted into
physical symptoms
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Discharging anxiety without
experiencing it
Causes & Treatment
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Contributors
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Triggered by a stressful
/ traumatic event
 Primary
Gain
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Treatment
Need to address initial
stressful event
 Remove reinforcers
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Glove Anesthesia
& Secondary
Body Dysmorphic Disorder
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70
60
50
%
40
30
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20
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10
Penis
Breasts
Stomach
Eyes
Skin
Nose
Hair
0
Dysfunctional
preoccupation
about imagined
physical defects
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Ideas of reference
Successive changes
& surgeries
With insight
Without insight
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Delusional Disorder
Causes & Treatment
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Contributors
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Societal beauty images
High comorbidity with OCD
Treatment
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Drugs
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Same ones for OCD
Behavioural Therapy
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Exposure and Response
Prevention
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Same therapy as for OCD
General Considerations
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Psychodynamic
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Neurosis
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Primary gain
Secondary gain
Cognitive
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Sick role
Modeling
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Stress & Trauma
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High incidences
of child abuse
History of illness
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Faulty
interpretations
Biological
Behavioural
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History of illness
Sensitivity to
bodily sensations
Cultural Factors
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More prevalent in
cultures that
stigmatize mental
disorders
Dissociative Disorders
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Disruptions of consciousness,
memory, and identity
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Missing time
 No
memory for a period
 Weren’t conscious when it happened
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Don’t know who you are
 Lost
memories
 Don’t identify with self
 Multiple identities
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Don’t feel real
Dissociative Experiences Scale
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Able to ignore pain
Missing part of a conversation
Usually difficult things can be done with
ease and spontaneity
Not sure whether you have done
something or only thought about it
Absorption in TV program or movie
Remembering past so vividly you seem to
be reliving it
Staring into space
Talking out loud to yourself when alone
Finding evidence of having done things you
can’t remember doing
10.
11.
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14.
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18.
Not sure if remembered event happened or
was a dream
Being approached by people you doesn’t know
who call you by a different name
Feeling as though you were two different
people
So involved in fantasy that it seems real
Driving a car and realizing you don’t
remember part of the trip
Not remembering important events in your life
Being in a familiar place but finding it
unfamiliar
Being accused of lying when you are telling the
truth
Finding notes or drawings that you must have
done but don’t remember doing
19.
20.
21.
22.
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25.
26.
27.
28.
Seeing yourself as if looking at another
person
Hearing voices inside your head
Not recognizing friends or family members
Other people and objects do not seem real
Looking at the world through a fog
Finding unfamiliar things among your
belongings
Feeling as though your body is not your
own
Finding yourself in a place but unaware of
how you got there
Finding yourself dressed in clothes that you
don’t remember putting on
Not recognizing your own reflection in a
mirror
Dissociative Amnesia
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Person is unable to
recall important
personal information
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24
Usually related to a
traumatic or stressful
event
Variations
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Generalized
Localized
Selective
Dissociative Fugue
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Person suddenly
leaves home and
work and assumes
a new identity
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Usually triggered by
stress or trauma
Depersonalization Disorder
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Person’s perception
or experience of the
self is disconcertingly
and disruptively
altered
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Frequent episodes
Reality does remain
intact during episodes
No amnesia or new
identities
Causes & Treatment
Dissociative Identity Disorder (DID)
Causes & Treatment
Is DID A Real Disorder?
 Yes
It Is
Many symptoms
of PTSD are
similar to those of
DID
 Alters show
several
physiological and /
or behavioural
differences
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 No
It Isn’t
The use of hypnosis
may be a source of
therapist
contamination
 Physiological
changes are also
seen in subjects
asked to fake DID
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