Transcript Day 20: Somatoform & Dissociative Disorders

Schizophrenia Diagnosis
 Two or more symptoms for most of the time during 1
month period (less if treated successfully)
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Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
 Social/occupation dysfunction
 Continuous signs of disturbance for at least 6
months:1 month of symptoms plus 5 months of
prodromal or residual periods (usually negative sx)
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Prodromal – gradual decline prior to active phase
Somatoform & Dissociative
Disorders
Chapter 6
An Overview of Somatoform Disorders
 Extreme Body Concerns
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Appearance or functioning of body
No known medical condition
 Types of DSM-IV Somatoform Disorders
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Hypochondriasis
Somatization disorder
Conversion disorder
Pain Disorder
Body Dysmorphic Disorder
Hypochondriasis
 Preoccupation with fear that have serious disease or
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physical condition
Preoccupied persists despite medical reassurance
Misinterpretation of bodily cues and function
Little data, but occurs 1-3% with #men=#women
Onset in adolescence, age 40-50, and after 60
Somatization Disorder
 Multiple physical complaints and symptoms
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Before age 30 multiple physical complaints, impaired
functioning, medical treatment sought, but no medical
basis
Multiple symptoms: 4 pain sx + 2 gastrointestinal sx + 1
sexual sx + 1 pseudoneurological sx (double vision)
 Preoccupied with physical condition
 Little data – very rare, typically starts in
adolescence, more common in women
Conversion Disorder
 Voluntary motor or sensory function suggests
neurological or medical condition, but no medical
condition exists
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Stress and other conflicts precede onset
Distress or impairment
 Paralysis, blindness, seizures
 Rare, but often occurs with somatization disorder
 Onset in adolescence or early adulthood, more
common in women
Conversion Disorder
 Related Disorders
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Malingering – faking to gain something (disability payments)
Factitious disorders – voluntary control of symptoms, only
purpose appears to be gaining attention, fill illness role
Factitious or Munchausen by proxy – fake/cause illness in
another while take on the caretaker role
Pain Disorder
 Serious pain in 1 or more areas
 Psychological factors play role in onset, severity,
exacerbation, maintenance of pain
 Not faking pain
 Often follows actual medical condition that causes
pain; when healed, pain persists
Body Dysmorphic Disorder
 Preoccupied with imagined defect in appearance or
serious exaggeration of minor physical anomaly
 Significant distress, impaired functioning
 Distinct from distorted body image in eating
disorders
 Little data on prevalence, but appears to be a
lifelong problem with severe impairment, distress,
and possible negative consequences (multiple
surgeries, attempts to correct themselves)
Causes
 Biological – runs in families, but not clear whether
inherit personality or other traits, limited data
 Psychological
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Stress or traumatic event usually precedes
Overly sensitive to bodily cues – may be modeled
Misinterpretation of physical sensations – bias in perceiving
threat/danger
Unconscious processes and anxiety/trauma (Freud)
 Cultural differences – distinguish cultural practices
from disorders
Treatment
 Little data on treatment effectiveness, most with
hypochondriasis, somatization & conversion disorder
 Cognitive Behavior Therapy
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Identify and challenge misinterpretation of cues
Learn to produce own physical symptoms (control)
Coach to seek less reassurance
May add general stress management techniques
 Scheduled visits to medical facilities
 Address traumatic event
 Reduce/remove secondary gain (attention, disability
Treatment cont’d
 Body dysmorphic disorder – SSRIs and exposure &
response prevention
Dissociative Disorders
 Depersonalization Disorder
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Feeling detached from own body or mind (in a dream)
 Dissociative Amnesia
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Generalized amnesia – lose all memory, including own
identity
Localized, selective amnesia – lose memory of specific
events (usually traumatic) during particular period of time
 Dissociative Fugue
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Unexpected travel associated with loss of memory
Lose memory of own past, may assume new identity
 Dissociative Trance Disorder
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Trance or possession with undesirable state; in nonWestern
cultures
Dissociative Identity Disorder
 Multiple personalities, identities or “alters”
 At least 2 distinct identities with own pattern take
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control of person’s behavior
Unable to recall important information
Onset usually in childhood, average 15 personalities
Prevalence .5 to 1%
Characteristic that are highly suggestible
Causes
 Biological vulnerability?
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Twin studies do not support genetic vulnerability to DID
 Psychological factors
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Trauma is precipitating event; repeated trauma or extreme
trauma for DID
Suggestibility or ability to autohypnotize
False memories
Treatment
 Amnesia & Fugue
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Usually get better on their own
May help recall events or present information and help
integrate into conscious experience
Hypnosis and benzodiazepines to aid in recall of events
 DID
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No controlled studies of treatment, limited success
Exposure treatment using PTSD model, extinguish cues
triggering anxiety and dissociation
May use hypnosis to bring memories into conscious
awareness