Chapter 5 Somatoform and Dissociative Disorders

1. Chapter 5 Somatoform and Dissociative Disorders

2. Somatoform Disorders • Soma – Meaning Body • Preoccupation with health and/or body appearance and functioning • No identifiable medical condition causing the physical complaints

3. Somatoform Disorders (continued) • Types of DSM-IV Somatoform Disorders • Hypochondriasis • Somatization disorder • Conversion disorder • Pain disorder • Body dysmorphic disorder

4. Hypochondriasis • Clinical Description • Physical complaints without a clear cause • Severe anxiety about the possibility of having a serious disease • Strong disease conviction • Medical reassurance does not seem to help

5. Hypochondriasis (continued) • Statistics • Good prevalence data are lacking • Onset at any age • Runs a chronic course

6. Hypochondriasis: Causes and Treatment • Causes • Cognitive perceptual distortions • Familial history of illness • Treatment • Challenge illness-related misinterpretations • Provide more substantial and sensitive reassurance • Stress management and coping strategies

7. Fig. 5.1, p. 176

8. Somatization Disorder • Clinical Description • Extended history of physical complaints before age 30 • Substantial impairment in social or occupational functioning • Concern about the symptoms, not what they might mean • Symptoms become the person’s identity

9. Somatization Disorder (continued) • Statistics • Rare condition • Onset usually in adolescence • Mostly affects unmarried, low SES women • Runs a chronic course

10. Somatization Disorder: Causes and Treatment • Causes • Familial history of illness • Relation with antisocial personality disorder • Weak behavioral inhibition system • Treatment • No treatment exists with demonstrated effectiveness • Reduce the tendency to visit numerous medical specialists

11. Somatization Disorder: Causes and Treatment (continued) • Assign “gatekeeper” physician • Reduce supportive consequences of talk about physical symptoms

12. Conversion Disorder • Clinical Description • Physical malfunctioning • Lack physical or organic pathology • Malfunctioning often involves sensory-motor areas • Persons show “la belle indifference” • Retain most normal functions, but lack awareness

13. Conversion Disorder (continued) • Statistics • Rare condition, with a chronic intermittent course • Seen primarily in females • Onset usually in adolescence • Common in some cultural and/or religious groups

14. Conversion Disorder: Causes • Causes • Freudian psychodynamic view is still popular • Emphasis on the role of past trauma and conversion • Detachment from the trauma and negative reinforcement • Address primary/secondary gain

15. Conversion Disorder: Treatment • 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

16. Body Dysmorphic Disorder • Clinical Description • Previously known as dysmorphophobia • Preoccupation with imagined defect in appearance • Often display ideas of reference for imagined defect • Suicidal ideation and behavior are common

17. Body Dysmorphic Disorder (continued) • Statistics • More common than previously thought • Seen equally in males and females • Onset usually in early 20s • Most remain single, and many seek out plastic surgeons • Usually runs a lifelong chronic course

18. Body Dysmorphic Disorder: Causes • Causes • Little is known – Disorder tends to run in families • Shares similarities with obsessive-compulsive disorder

19. Body Dysmorphic Disorder: Treatment • Treatment • Treatment parallels that for obsessive compulsive disorder • Medications (i.e., SSRIs) that work for OCD provide some relief • Exposure and response prevention is also helpful • Plastic surgery is often unhelpful

20. An Overview of Dissociative Disorders • Overview • Involve severe alterations or detachments • Affects identity, memory, or consciousness • Depersonalization – Distortion is perception of reality • Derealization – Losing a sense of the external world

21. An Overview of Dissociative Disorders (continued) • Types of DSM-IV Dissociative Disorders • Depersonalization Disorder • Dissociative Amnesia • Dissociative Fugue • Dissociative Trance Disorder • Dissociative Identity Disorder

22. Depersonalization Disorder: An Overview • Overview and Defining Features • Severe and frightening feelings of unreality and detachment • Feelings dominate and interfere with life functioning • Primary problem involves depersonalization and derealization

23. Depersonalization Disorder: An Overview (continued) • Facts and Statistics • High comorbidity with anxiety and mood disorders • Onset is typically around age 16 • Usually runs a lifelong chronic course

24. Depersonalization Disorder: Causes and Treatment • Causes • Cognitive deficits in • Attention, short-term memory, spatial reasoning • Deficits related to tunnel vision and mind emptiness • Such persons are easily distracted • Treatment • Little is known

25. Dissociative Amnesia: An Overview • Dissociative Amnesia • Includes several forms of psychogenic memory loss • Generalized vs. localized or selective type

26. Dissociative Fugue: An Overview • Dissociative Fugue • Related to dissociative amnesia • Take off and find themselves in a new place • Unable to remember the past • Unable to remember how they arrived at new location • Often assume a new identity

27. Dissociative Amnesia and Fugue: Causes • Statistics • Usually begin in adulthood • Show rapid onset and dissipation • Occur most often in females • Causes • Little is known • Trauma and stress can serve as triggers

28. Dissociative Amnesia and Fugue: Causes and Treatment • Treatment • Most get better without treatment • Most remember what they have forgotten

29. Dissociative Trance Disorder: An Overview • Clinical Description • Symptoms resemble other dissociative disorders • Dissociative symptoms and sudden changes in personality • Changes often attributed to possession by a spirit • Presentation varies across cultures

30. Dissociative Trance Disorder: Causes, and Treatment • Facts and Statistics • More common in females than males • Causes • Often attributable to a life stressor or trauma • Treatment • Little is known

31. Dissociative Identity Disorder (DID): An Overview • Clinical Description • Formerly known as multiple personality disorder • Defining feature is dissociation of personality • Adoption of several new identities (as many as 100) • Identities display unique behaviors, voice, and posture

32. Dissociative Identity Disorder (DID): An Overview (continued) • Unique Aspects of DID • Alters – Different identities or personalities • Host – The identity that keeps other identities together • Switch – Quick transition from one personality to another

33. Dissociative Identity Disorder (DID): An Overview (continued) • Statistics • Average number of identities is close to 15 • Ratio of females to males is high (9:1) • Onset is almost always in childhood • High comorbidity rates & lifelong, chronic course

34. Dissociative Identity Disorder (DID): Causes • Causes • Histories of horrible, unspeakable, child abuse • Closely related to PTSD • Mechanism to escape from the impact of trauma

35. Dissociative Identity Disorder (DID): Treatment • Treatment • Focus is on reintegration of identities • Identify and neutralize cues/triggers that provoke memories of trauma/dissociation

36. Diagnostic Considerations in Somatoform and Dissociative Disorders • Separating Real Problems from Faking • Malingering – Deliberately faking symptoms • False Memories and Recovered Memory Syndrome • Related Conditions – Factitious Disorder • Factitious Disorder by Proxy

37. Summary of Somatoform and Dissociative Disorders • Features of Somatoform Disorders • Physical problems without on organic cause • Features of Dissociative Disorders • Extreme distortions in perception and memory • Well Established Treatments Are Generally Lacking