Somatoform &dissociative Disorder

1. Somatoform &dissociative Disorder Prepered by :Prof.Dr. Elham Fayad Alya AlGhamdi

2. Basic definitions • Somatoform disorders(somatic symptom disorder) • pathological concern of individuals with the appearance or functioning of their bodies when there is no identifiable medical condition causing the physical complaints • Dissociative disorders • individuals feel detached from themselves or their surroundings, and reality, experience, and identity may disintegrate • Historically, both somatoform and dissociative disorders used to be categorized as hysterical neurosis • in psychoanalytic theory neurotic disorders result from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms

3. *Somatoform disorders(somatic symptom disorder)

4. Somatoform disorders(somatic symptom disorder in DSM-V) -The DSM-IV term somatoform disorders is replaced by somatic symptom and related disorders in DSM-V. -In DSM-IV there was a great deal of overlap across the somatoform disorders and a lack of clarity about the boundaries of diagnoses. - Non psychiatric physicians found the DSM-IV somatoform diagnoses difficult to understand and use. The current DSM-5 classification recognizes this overlap by reducing the total number of disorders as well as their subcategories.

5. Diagnostic Criteria of(Somatic symptom disorder) A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy lost in these symptoms or health concerns. symptomatic is persistent (typically more than 6 months).

6. Somatoform Disorders • Soma – Meaning Body • Preoccupation with health and/or body appearance and functioning • No identifiable medical condition causing the physical complaints • Types of DSM-IV Somatoform Disorders • Hypochondriasis • Somatization disorder • Conversion disorder • Pain disorder • Body dysmorphic disorder

7. Somatoform Disorders • Hypochondriasis • severe anxiety focused on the possibility of having a serious disease • Client is preoccupied with fear that he/she has or will get a serious disease • History of seeing many doctors • Misinterpretation of bodily sensations or functions despite medical evaluations and reassurance • Preoccupation with symptoms is not as intense or distorted as in delusional disorder • Significant distress/impairment in function • Dependent behaviors/desires,demands attention • Treatment: usually involves cognitive-behavioral therapy and general stress management treatment)

8. Somatoform Disorders -C/b multiple recurrent physical complaints over many years -No organic etiology for these complaints -Begins by age 30 -Pain, GI, sexual, pseudoneurologic symptoms: impaired coordination or balance,paralysis or localized weakness,difficulty swallowing, aphonia, urinary retention, hallucinations, loss of touch or pain sensation,double vision,amnesia,sensory losses,loss of consciousness (APA 2000 DSM IV-TR) Somatization disorder

9. Somatoform Disorders • Somatization disorder • may be connected to Antisocial personality disorder • difficult to treat (reassurance, stress reduction, more adoptive methods of interacting with family are encouraged) • Focus on anxiety reduction, not physical symptoms • Minimize secondary gain(I.e. increased attention and decreased responsibilities)

10. Somatoform Disorders • Conversion Disorder • Physical malfunctioning without any physical or organic pathology • Malfunctioning often involves sensory-motor areas suggesting neurologic origin Mainly example losing function in limbs • Statistics • Rare condition, with a chronic intermittent course • Seen primarily in females, with onset usually in adolescence • Not uncommon in some cultural and/or religious groups

11. Somatoform Disorders • Conversion disorder (cont.) • Freudian psychodynamic view is still popular (anxiety converted into physical symptoms) • Emphasis on the role of trauma (stress), conversion, and primary/secondary gain • Detachment from the trauma and negative reinforcement seem critical • Different from factitious disorder (intentional) • Treatment • Similar to somatization disorder • Core strategy is attending to the trauma • Remove sources of secondary gain • Reduce supportive consequences of talk about physical symptoms

12. Pain Disorder Somatoform Disorders • C/b physical symptom of pain-one or more anatomic sites • May occur with a General medical condition • Pain –not relieved by analgesics • Onset,severity, exacerbation and maintenance affected by psychological stressors

13. Pain d/o interventions Somatoform Disorders • Pain management • Encourage participation in activities • Provide distractions

14. Somatoform Disorders • Body Dysmorphic Disorder • Preoccupation with imagined defect in appearance • Either fixation or avoidance of mirrors • Previously known as dysmorphophobia • Suicidal ideation and behavior are common • Statistics • More common than previously thought • Usually runs a lifelong chronic course • Seen equally in males and females, with onset usually in early 20s • Most remain single, and many seek out plastic surgeons

15. Somatoform Disorders • Body Dysmorphic Disorder (cont.) • Causes • Little is known – Disorder tends to run in families • Shares similarities with obsessive-compulsive disorder • Treatment • Treatment parallels that for obsessive compulsive disorder • Medications (i.e., SSRIs) that work for OCD provide some relief • Exposure and response prevention are also helpful • Plastic surgery is often unhelpful

16. Dissociative Disorders

17. Dissociative Disorders • 5 types • Depersonalization & Derealization disorder. • Dissociative amnesia*. • Dissociative fugue*. • Dissociative trance disorder. • Dissociative identity disorder*.

18. Dissociative Disorders • Depersonalization&Derealization disorder: • Derealization • Loss of sense of the reality of the External surrounding world • Depersonalization • Loss of sense of your own reality or identity.

19. Dissociative Disorders • Depersonalization & Derealization disorder • Severe feelings of depersonalization& Derealization dominate the individual’s life and prevent normal functioning • It is chronic • 50% suffer from additional mood and anxiety disorders

20. Dissociative Disorders • Dissociative Amnesia • Inability to recall personal information, usually of a stressful or traumatic nature • Not due to effects of substance abuse. • Dissociative Fugue • Sudden, unexpected travel away from home, along with an inability to recall one’s past (new identity) • Occur in adulthood and usually end abruptly

21. Dissociative Disorders • Dissociative trance disorder • Altered state of consciousness in which the person believes firmly that he or she is possessed by spirits; considered a disorder only where there is distress and dysfunction • Trance and possession are a common part of some traditional religious and cultural practices and are not considered abnormal in that context

22. Dissociative Disorders • Dissociative Identity Disorder • Formerly multiple personality disorder • At least two of these personality states take control of the individuals behavior • Many personalities (alters) or fragments of personalities within one body • The personalities or fragments are dissociated • Switch (transition form one personality to another, includes physical changes) • Can be simulated by malingers are usually eager to demonstrate their symptoms whereas individuals with DID attempt to hide symptoms • Prevalence about 3%

23. Dissociative Disorders • Dissociative Identity Disorder • Auditory hallucinations (coming from inside their heads) • 97% severe child abuse • Extreme subtype of PTSD • Suggestible people may use dissociation as defense against severe trauma • Real and false memories

24. Dissociative Disorders • Treatment • Dissociative amnesia and fugue • Get better on their own • Coping mechanisms to prevent future episodes • DID • Reintegration of identities • Confrontation of early trauma • hypnosis

25. Intervention of somataform and dissosicative disorder. Be aware of own responses Minimize secondary gain(I.e. increased attention and decreased responsibilities Focus on anxiety reduction, not physical symptoms Use matter-of-fact approach Encourage client to discuss conflict Provide diversionary activities Encourage expression of feelings