Somatoform and dissociative disorder


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Somatoform and dissociative disorder

  1. 1. qwertyuiopasdfghjklzxcvbnmqw ertyuiopasdfghjklzxcvbnmqwert yuiopasdfghjklzxcvbnmqwertyui SOMATOFORM AND DISSOCIATIVE opasdfghjklzxcvbnmqwertyuiopa DISORDER sdfghjklzxcvbnmqwertyuiopasdf A Report on Abnormal Psychology ghjklzxcvbnmqwertyuiopasdfghj klzxcvbnmqwertyuiopasdfghjklz xcvbnmqwertyuiopasdfghjklzxcv bnmqwertyuiopasdfghjklzxcvbn mqwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvbnmqwe rtyuiopasdfghjklzxcvbnmqwerty uiopasdfghjklzxcvbnmqwertyuio pasdfghjklzxcvbnmqwertyuiopas dfghjklzxcvbnmqwertyuiopasdfg hjklzxcvbnmqwertyuiopasdfghjk Roa, Francis Carlo Rosales, Jonel Joshua Pascua, Abby Grace Rivera, RianneClarizze
  2. 2. Somatoform and Dissociative Disorders Somatoform Disorders • Physical symptoms that mimic medical conditions with no physiological basis. • Symptoms are not under voluntary or conscious control • Somatoform disorders: • Somatization Disorder • Conversion Disorder • Pain Disorder • Hypochondriasis • Body DysmorphicDisorder • Comorbid disorders: Mood, personality, and substance use disorders. • Differentiated from malingering or factitious disorders. • Cultural differences: Psychosomatic versus somatopsychic perspectives Somatoform Disorders Somatization Disorder • Chronic complaints of many bodily symptoms with no physical basis. • Complaints include at least four pain symptoms in different sites (DSM-IV-TR): • Two gastrointestinal • One sexual • One pseudoneurological • Undifferentiated Somatoform Disorder • Relatively rare diagnosis world-wide • • • • • • a. Conversion Disorder Conversion Disorder: Complaints of physical problems or impairments of sensory or motor functions controlled by voluntary nervous system, suggesting neurological disorder, with no underlying physical cause. Often related to stress Most common conversion symptoms: • Psychogenic pain • Disturbances of stance and gait • Sensory symptoms • Dizziness • Psychogenic seizures Some symptoms are easily diagnosed as conversion disorders, while others require extensive neurological and physical examination. b. Pain Disorder Pain Disorder: Reports of severe pain, but: • No physiological or neurological basis (vague descriptions) • Pain is greatly in excess of that expected with an existing condition, OR • Pain lingers long after a physical injury has healed Frequent visits to doctors with numerous physical complaints; potential for drug or medication abuse.
  3. 3. • • • • • • • • • • • • • c. Hypochondriasis Hypochondriasis: Persistent preoccupation with one’s health and physical condition, despite physical evaluations that reveal no organic problems. Prevalence: 2-7% of general medical population Somatoform Disorders Hypochondriasis Predisposing factors: • History of physical illness • Parental attention to somatic symptoms • Low pain threshold • Greater sensitivity to somatic cues • Anxiety/stress-arousing event, plus perception of somatic symptoms, plus fear that sensations reflect disease = greater attention to somatic cues. d. Body Dysmorphic Disorder Body Dysmorphic Disorder: Preoccupation with imagined physical defect in a normal-appearing person, or excessive concern with slight physical defect. May be underdiagnosed due to embarrassment to discuss the problem Comorbid: Functional impairment, mood disorders, social phobia, low self-esteem; may be suicidal Possibly related to obsessive-compulsive disorder Etiology of Somatoform Disorders Diathesis-stress models: • Predisposition may be learned or “hard-wired” • Predisposition involves hypervigilance or exaggerated focus on bodily sensations, increased sensitivity to weak bodily sensations, and disposition to react to somatic sensations with alarm. • Predisposition becomes fully developed disorder when person can’t deal with trauma or stress. Psychodynamic perspective: Somatic symptoms defend against awareness of unconscious emotional issues. • Freud: Hysterical reactions result from repression of conflict (usually sexual) • Two mechanisms produce and sustain symptoms: • Primary gain (protection from anxiety) • Secondary gain (dependency needs fulfilled) Behavioral perspective: • Reinforcement • Modeling • Cognitive styles • Combination of all three Sociocultural perspective: • Societal restrictions on women Biological perspective: • There may be innate physical bases • Hypochondriacs are more sensitive to bodily sensations
  4. 4. • • • • • • Treatment of Somatoform Disorders Psychodynamic: Psychoanalysis and hypnosis to help person relive feelings associated with repressed trauma. • Determining the validity of memories dating from an early age is very difficult. Behavioral: Many strategies, including exposure and response prevention (extinction and nonreinforcement of complaints); systematic desensitization. Cognitive-behavioral: Correct cognitive distortions and reattribution training Treatment of Somatoform Disorders Biological: Antidepressant medications, increased physical activity, SSRIs Family systems treatment: Place identified patient’s disorder in perspective, teach family adaptive ways of support, prepare family members to deal with problems. Dissociative Disorders: Mental disorders in which a person’s identity, memory, or consciousness is altered or disrupted: • Dissociative Amnesia • Dissociative Fugue • Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder or MPD) • Depersonalization Disorder Dissociative Amnesia • Dissociative Amnesia: Partial or total loss of important personal information, may occur suddenly after stressful/traumatic event. • Localized: Failure to recall all the events that happened during a specific period. • Selective: Inability to remember certain details of an incident. • Generalized: Inability to remember anything about one’s past life. • Systematized: Loss of memory for selected types of information. • Continuous: Inability to recall events occurring between specific time in the past and the present. • Possibly due to repression (or closely related process) of a traumatic event: • Posthypnotic Amnesia: Individual cannot recall events occurring during hypnosis with hypnotist suggesting what is to be forgotten. • Dissociative Amnesia: Both the source and content of the amnesia are unknown (not caused by physical injury). • In posthypnotic and dissociative amnesia, lost material can sometimes be retrieved with professional help. Dissociative Fugue • Dissociative Fugue: Confusion over personal identity, together with unexpected travel away from home. • Also called “fugue state” • Usually involves only short periods of time with incomplete change of identity. Depersonalization Disorder • Depersonalization Disorder: A dissociative disorder in which feelings of unreality concerning the self or the environment cause major impairment in social or occupational functioning. • Depersonalization is the most common dissociative disorder. • Precipitated by physical or psychological stress; evidence that it may be related to emotional abuse, especially by parents. • Dissociative Disorders Dissociative Identity Disorder (DID)
  5. 5. • • Formerly called Multiple Personality Disorder Dissociative Identity Disorder: Dissociative disorder in which two or more relatively independent personalities appear to exist in one person, with only one evident at a time. • Tone of voice, mannerisms, and other personality characteristics change. Dissociative Identity Disorder (DID) • Originates in childhood: Reports of extreme physical or sexual abuse • Comorbid with conversion symptoms, depression, and anxiety • Diagnostic controversy • Number of personalities has increased. • Much higher in highly suggestible patients. • Often “discovered” in hypnosis. Etiology of Dissociative Disorders • Psychodynamic perspective: Repression blocks unpleasant/traumatic events from consciousness. • Amnesia and fugue: Part of personal identity blocked • DID: Conflicts in personality structure; opposing personality components disable ego’s ability to control incompatible elements • Behavioral perspective: Indirect avoidance of stress. • Sociocognitive model: Rule-governed/goal-directed experiences and displays created, legitimized, and maintained by social reinforcement. • Learn behaviors from observing what works for others. • Reinforced by the removal of unpleasant memories. • Iatrogenic: Created by the therapeutic situation (hypnotic suggestibility). • Treatment of Dissociative Disorders • No specific medication, but medications can treat accompanying anxiety or depression. • Survivors of childhood sexual abuse who have dissociated are often treated with psychoeducation, use of group resources, and cognitive/social skills training. • Amnesia and fugue (usually spontaneously remit): • Supportive counseling • Treat depression and stress • Depersonalization disorder (slower spontaneous remission) • Alleviate feelings of anxiety, depression, fear of going insane. • Occasionally behavioral therapy (reinforcement of appropriate responses) • Dissociative identity disorder (DID): • Controversial treatments, not always successful • Psychotherapy and hypnosis • Personalities introduce selves to patient (in hypnosis) and recall traumatic experiences/memories which developed them • Therapist suggests personalities served a purpose but now alternative coping strategies will be more effective • Integrate personalities