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  • 1. Somatoform and Dissociative Disorders Chapter 5
  • 2. Basic definitions• Somatoform disorders – 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• 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
  • 4. Somatoform Disorders• Hypochondriasis – severe anxiety focused on the possibility of having a serious disease – shares age of onset, personality characteristics anf running in families with panic disorder – illness phobia vs. hypochondriasis – 60% of patients with illness phobia develop hypochondriasis – 1% to 14% of medical patients – treatment usually invoves cognitive-behavioral therapy and general stress management treatment (gain retained after 1 year follow-up)
  • 5. Somatoform Disorders• Causes of hypochondriasis
  • 6. Somatoform Disorders• Somatization disorder – Briquet’s syndrome (100 years ago) – patients have a history of many physical complaints that can not be explained by a medical condition, the complaints are not intentionally produced – 20% of patients in primary care setting – develops during adolescence (majority women) – may be connected to Antisocial personality disorder – difficult to treat (reassurance, stress reduction, more adoptive methods of interacting with family are encouraged)
  • 7. Somatoform Disorders• Conversion Disorder – Physical malfunctioning without any physical or organic pathology – Malfunctioning often involves sensory-motor areas – Persons show la belle indifference – Retain most normal functions, but without awareness of this ability – 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
  • 8. 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
  • 9. 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 – Often display ideas of reference for imagined defect – 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
  • 10. 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
  • 11. Dissociative Disorders• Derealization – Loss of sense of the reality of the external world• Depersonalization – Loss of sense of your own reality• 5 types – Depesonalization disorder – Dissociative amnesia – Dissociative fugue – Dissociative trance disorder – Dissociative identity disorder
  • 12. Dissociative Disorders• Depersonalization disorder – Severe feelings of depersonalization dominate the individual’s life and prevent normal functioning – It is chronic – 50% suffer from additional mood and anxiety disorders – Cognitive profile (cognitive deficits in attention, STM, spatial reasoning, perception (3D))
  • 13. Dissociative Disorders• Dissociative Amnesia – Inability to recall personal information, usually of a stressful or traumatic nature – Generalized vs. selective amnesia• 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
  • 14. 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 – Only undesirable trance considered pathological within that culture is characterized as disorder
  • 15. Dissociative Disorders• Dissociative Identity Disorder – Formerly multiple personality disorder – Many personalities (alters) or fragments of personalities coexist 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 – Very high comorbidity – Prevalence about 3%
  • 16. Dissociative Disorders• Dissociative Identity Disorder – Auditory hallucinations (coming from inside their heads) – 97% severe child abuse – Extreme subtype of PTSD – Onset – approximately 9 years – Suggestible people may use dissociation as defense against severe trauma – Real and false memories – Temporal lobe pathology (out of body experiences)
  • 17. Dissociative Disorders• Treatment – Dissociative amnesia and fugue • Get better on their own • Coping mechanisms to prevent future episodes – DID • Reintegration of identities • Neutralization of cues • Confrontation of early trauma • hypnosis