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chapter five


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chapter five

  1. 1. Somatoform and Dissociative Disorders Chapter five
  2. 2. Somatoform Disorders <ul><li>Overly preoccupied with health and or body appearance </li></ul><ul><li>Usually no identifiable medical condition causing the physical complaints </li></ul>
  3. 3. Somatoform Disorders <ul><li>Hypochondriasis </li></ul><ul><li>Somatization disorder </li></ul><ul><li>Conversion disorder </li></ul><ul><li>Pain disorder </li></ul><ul><li>Body dysmorphic disorder </li></ul>
  4. 4. Hypochondriasis <ul><li>Physical complaints without a clear medical cause and severe anxiety focused on the possibility of having a serious illness </li></ul><ul><li>Medical reassurance does not seem to help </li></ul><ul><li>Comorbidity with anxiety and mood disorders </li></ul>
  5. 5. Hypochondriasis <ul><li>Anxiety and features of panic disorder </li></ul><ul><li>Expression of anxiety is different </li></ul><ul><ul><li>Preoccupation with physical symptoms </li></ul></ul><ul><li>Reassurance seems to have temporary impact at best </li></ul><ul><li>Disease Conviction: core diagnostic feature </li></ul>
  6. 6. Hypochondriasis <ul><li>Differs from illness phobia: fear of getting a disease </li></ul><ul><li>Hypochondriasis: fear they already have a disease </li></ul><ul><li>Chronic course </li></ul>
  7. 7. Hypochondriasis <ul><li>Distortions in cognition, perception and emotion </li></ul><ul><li>Interpret minor pain as threatening </li></ul><ul><li>Self focusing creates anxiety which leads to more symptoms </li></ul><ul><li>View of health as being completely symptom-free </li></ul>
  8. 8. Hypochondriasis <ul><li>Treatment? </li></ul><ul><li>CBT with focused reassurance </li></ul>
  9. 9. Somatization Disorder <ul><li>Extended history of physical complaints starting before age 30 and substantial impairment in social or occupational functioning </li></ul><ul><li>Multitude of symptoms </li></ul><ul><ul><li>4 pain </li></ul></ul><ul><ul><li>3 gastrointestinal </li></ul></ul><ul><ul><li>1 sexual </li></ul></ul><ul><ul><li>1 neurological </li></ul></ul>
  10. 10. Somatization Disorder <ul><li>Focus on symptoms instead of what they might mean </li></ul><ul><li>Often show little urgency to do anything about symptoms </li></ul><ul><li>Symptoms become major part of indentity </li></ul><ul><li>Most are unmarried women, lower SES </li></ul><ul><li>chronic </li></ul>
  11. 11. Somatization Disorder <ul><li>Family studies: link to antisocial personality disorder </li></ul><ul><li>Males more likely to show aggression </li></ul><ul><li>Females more likely to display dependence </li></ul><ul><li>No known effective treatment </li></ul><ul><li>Physician as “gatekeeper” </li></ul>
  12. 12. Conversion Disorder <ul><li>Physical malfunctioning without apparent physical cause </li></ul><ul><li>Often resemble neurological diseases </li></ul><ul><li>Usually apathy towards symptoms </li></ul><ul><li>Usually stressful precipitator </li></ul><ul><li>Extremely rare </li></ul>
  13. 13. Pain Disorder <ul><li>Psychological factors play a role in the persistence of pain </li></ul><ul><li>Pain is real </li></ul>
  14. 14. Body Dysmorphic Disorder <ul><li>Preoccupation with imagined defect </li></ul><ul><li>Fixated on mirrors, engage in suicidal behavior, display ideas of reference and avoidance </li></ul><ul><li>Severe disruption of daily functioning </li></ul><ul><li>CBT and SSRI’s </li></ul><ul><li>Big business for plastic surgeons </li></ul>
  15. 15. Dissociative Disorders <ul><li>Depersonalization </li></ul><ul><ul><li>Distortion in perception </li></ul></ul><ul><ul><li>Sense or reality is lost </li></ul></ul><ul><ul><li>Person dissociates from reality </li></ul></ul><ul><li>Derealization </li></ul><ul><ul><li>Losing sense of external world </li></ul></ul><ul><li>Both can be panic and acute stress disorder </li></ul>
  16. 16. Dissociative Disorders <ul><li>Alterations or detachments in consciousness or identity involving either dissociation or depersonalization </li></ul><ul><li>Extreme variants on normal phenomena </li></ul>
  17. 17. Depersonalization Disorder <ul><li>Severe and frightening feelings of detachment and unreality </li></ul><ul><li>Very rare </li></ul><ul><li>Cognitive deficits </li></ul><ul><ul><li>Attention, short-term memory, spatial reasoning </li></ul></ul><ul><ul><li>Reports of tunnel vision and mind emptiness </li></ul></ul>
  18. 18. Dissociative Amnesia <ul><li>Psychogenic memory loss </li></ul><ul><li>Usually in females </li></ul><ul><li>Generalized </li></ul><ul><ul><li>Unable to recall anything including identity </li></ul></ul><ul><li>Selective (localized) </li></ul><ul><ul><li>Selective forgetting related to trauma </li></ul></ul>
  19. 19. Dissociative Fugue <ul><li>Leaves and may set up another identity in another place </li></ul><ul><li>Very rare </li></ul><ul><li>Inability to recall why or how they got there and little memory of the past </li></ul>
  20. 20. Dissociative Trance Disorder <ul><li>Attributed to spirit posession </li></ul>
  21. 21. Dissociative Identity Disorder (DID) <ul><li>Adoption of new identities </li></ul><ul><li>Often display unique behaviors, voice and posture </li></ul><ul><li>As many as 100 “Alters” </li></ul><ul><li>Host: identity that seeks treatment </li></ul><ul><li>Switch </li></ul><ul><li>Mostly female </li></ul><ul><li>Severe, chronic sexual abuse </li></ul>
  22. 22. Dissociative Identity Disorder (DID) <ul><li>Natural tendency to dissociate from negative affect related to abuse </li></ul><ul><li>Survival mechanism </li></ul><ul><li>Lack of social support while abuse is going on </li></ul><ul><li>Thought to be extreme subtype of PTSD </li></ul>