Transcript Dissociative dis

DISSOSIATION
DISORDER
Dissociative and somatoform
disorders

Dissociative disorders
◦ a change/disturbance in function of selfidentity, memory, unconscious that make
personality whole.
◦ There is a disruption/dissociation (splitting
off)
Dissociative identity disorder
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Alternate personalities may require
different eyeglass prescription, display
different allergies, different response to
same medicine, differences in color
blindness. It is as if conflicting internal
impulses cannot coexist or achieve
dominance.
Cont. dissociative identity disorder
◦ Mechanism of dissociation is controlled by
unconscious process.
◦ Individual may report auditory hallucinations
like 2 voices arguing about them, some
complain of being “possessed.”
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they may display wide range abnormal
behavior before being accurately
diagnosed:
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physical complaints without an organic basis
amnesia,
depression/suicide,
anxiety/ panic attacks
depersonalization
derealization (loss of sense of reality: people/objects change
size/shape or in the sense of time)
Dissociative amnesia
Inability to recall important personal
information usually involving traumatic
experiences that cannot be explained by
simple forgetfulness. May last hours/years
 There are 5 types:
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◦ localized a: cannot recall events for a number of hours after
stressful/traumatic incident.
◦ Selective a: forget only disturbing particulars during certain time.
◦ Generalized a: forget entire life but retain habits, tastes, skills.
(rare)
 Continuous a: forget all events that take place after
the problem begins.
 Systematized a: memories relating to specific
categories of information are lost, ie., college
experiences.
 Malingering: attempt to fabricate symptoms/make
false claims of amnesia for personal gain.
Dissociative fugue
Fugue means flight.
 Individual travels suddenly from
home/work, shows loss of memory for
past personal information, becomes
confused about identity or assumes a new
one.
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To differentiate amnesia from fugue:
Amnesia is wandering aimlessly
 Fugue Is acting more purposefully
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◦ Not psychotic
◦ when memory returns can’t remember fugue
state.
◦ Rare
◦ Most likely to occur in wartime/disasters,
◦ Difficult to distinguish from malingering.
Depersonalization disorder
Experience of depersonalization are
persistent/recurrent and cause distress.
 Controversy of including depersonalization
disorder with dissociative because
depersonalization disorder does not affect
memory.
 In other dissociative disorders, it protects
individual from anxiety; depersonalization
generates anxiety.
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Theoretical Perspectives
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Psychodynamic
◦ trauma (abuse, warfare, severe problems,
averting punishment) plays a role.
◦ Dissociating helps to block out troubling
memory.
◦ Use repression.
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Learning:
◦ Individual learns not to think about disturbing
thoughts to avoid guilt/shame.
◦ Negative reinforcement when relieved from
anxiety.
◦ Learned through observational learning.
Treatment
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Psychodynamic:
◦ uncover early childhood traumas
◦ learn to cope.
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Behavioral:
◦ Consider personalities
◦ Reinforcement contingencies.
Somatoform Disorders
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A condition where people have physical
symptoms but no organic abnormalities
can be found to account for them. There
is some reason to believe that the
symptoms reflect psychological factors or
conflict.
Somatoform disorder
Type title here
conversion disorder
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hypochondriasis
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somatization disorder
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Conversion disorder
A major change in or loss of physical
functioning, although there are no medical
findings to support the physical symptoms or
deficits.
 The physical symptoms usually come on
suddenly during a stressful time.
 It is named because it is believed that repressed
sexual/aggressive energy is converted into
physical symptoms.
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Symptom patterns involve
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paralysis
epilepsy
problems in coordination
blindness/tunnel vision
loss of hearing, smell, feeling in a limb
Hypochondriasis
A fear of having a serious illness.
 A fear that their bodily signs or sensations are
due to a serious illness.
 Unlike conversion disorder, hypochondriasis
does not involve the loss or distortion of
physical functioning.
 Unlike conversion disorder, hypochondriacs are
very concerned about their symptoms.
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Hypochondriasis
The disorder is about equally common in
men and women, and most often begins
between 20 and 30.
 They are more likely to report being sick
as children.
 They frequently doctor shop.
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Somatization Disorder
Formerly known as Briquet’s syndrome.
 Multiple, recurrent somatic complaints that
began prior to the age of 30, usually begins in
late adolescence. Complaints usually involve
different organ systems.
 The groups of symptoms are categorized as
pain involving multiple sites.
 10 times more likely to be found in women; 4
times more likely among Afr-Americans.
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Theoretical Perspectives
Hippocrates believed the strange bodily
symptoms were caused by a wandering uterus
which created internal chaos.
 Freud believed that hysteria was rooted in
psychological rather than physical causes.
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Cont. theoretical
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Hysterical symptoms are functional. They allow
the patients to achieve primary(keeping internal
conflicts repressed) and secondary gains
(avoiding burdensome responsibilities)
◦ Example of primary - hand paralysis to
prevent masturbation or murder
◦ secondary - hand paralysis to keep from firing
a gun in battle thus being removed from the
front line.
Cont. Theoretical
Psychodynamic and learning concur that
the symptoms reduce anxiety.
 Learning theory - the symptoms carry the
benefits or reinforcing properties of the
“sick role” though it is not conscious.
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◦ Distinguish from malingering which is
conscious.
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Cognitive ◦ Hypochondriasis may represent a type of selfhandicapping.
◦ May also be a cognitive bias to misinterpret
changes in bodily cues or sensations.
Treatment
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Psychodynamic
◦ Uncover unconscious conflicts.
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Behavioral
◦ Remove the secondary gains.
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Biological
◦ Use anti-depressants
Münchausen Syndrome
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Patients who tell tall tales to their doctors.
A type of factitious disorder. Münchausen
syndrome is a term for psychiatric
disorders known as factitious disorders
wherein those affected feign disease, , illness,
or psychological trauma in order to draw
attention or sympathy to themselves. It is
also sometimes known as hospital
addiction syndrome or hospital hopper
syndrome.
Medical professionals suspecting Münchausen's
in a patient should first rule out the
possibility that the patient does indeed have
a disease state, but it is in an early stage and
not yet clinically detectable.
take a careful patient history, and seek
medical records,
to look for early deprivation, childhood abuse,
mental illness.
If a patient is at risk to himself or herself,
inpatient psychiatric hospitalization. should
be initiated.
Medical providers should consider
working with mental health specialists to
help treat the underlying mood or
disorder as well as to avoid
countertransference.
 Therapeutic and medical treatment
should center on the underlying
psychiatric disorder: a mood disorder, an
anxiety disorder, or borderline personality
disorder.
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The patient's prognosis depends upon the
category under which the underlying
disorder falls; depression and anxiety, for
example, generally respond well to
medication and/or cognitive behavioral
therapy, whereas borderline personality
disorder, like all personality disorders, is
presumed to be pervasive and more
stable over time,thus offers the worst
prognosis.
Ganser’s Syndrome
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Ganser syndrome is a rare dissociative
disorder previously classified as a
factitious disorder.. It is characterized by
nonsensical or wrong answers to
questions or doing things incorrectly,
other dissociative symptoms such as
fugue, amnesia or conversion disorder,
often with visual pseudohallucinations and
a decreased state of consciousness.
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Ganser is an extremely rare variation of dissociative disorder.
It is a reaction to extreme stress and the patient thereby
suffers from approximation or giving absurd answers to
simple questions.
Symptoms
clouding of consciousness, somatic conversion symptoms,
confusion, stress, loss of personal identity, echolalia, and
echopraxia.
Individuals also give approximate answers to simple
questions. For example, "How many legs are on a cat?", to
which the subject may respond '3?'.
The syndrome may occur in persons with other mental
disorders such as schizophrenia, depressive disorders, toxic
states, paresis, alcohol use disorders and factitious disorders.
EEG data does not suggest any specific organic cause.
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It is also sometimes called nonsense
syndrome, syndrome of approximate
answers, pseudodementia, hysterical
pseudodementia or prison psychosis.
This last name, prison psychosis, is
sometimes used because the syndrome
occurs most frequently in prison inmates,
where it may represent an attempt to gain
leniency from prison or court officials.