psychological abnormality of human

1. GROUP
6
SOMATIC SYMPTOM
and RELATED DISORDERS
and DISSOCIATIVE
DISORDERS
SOMATIC SYMPTOM
and RELATED DISORDERS
and DISSOCIATIVE
DISORDERS
pRESENT BY:
MOHD. MUSTAFFA BIN MOHD. WARDI
RUZIYANA BINTI MD. SALEH

2. Describe the main features of somatic
symptom and related disorders
Distinguish between somatic symptom
disorder and illness anxiety disorder in
terms of symptoms according to the DSM-5
Discuss how treatment for trauma
addresses the symptoms of
dissociative disorders
QUIZ / GAMES OF MIND
CONTENTS
Differentiate the symptoms of
depersonalization-derealization disorder
and dissociative amnesia from those of
dissociative identity disorder

3. SOMATIC
SYMPTOM
and RELATED
DISORDERS
SOMATIC
SYMPTOM
and RELATED
DISORDERS

4. What is SOMATIC SYMPTOM DISORDER
Somatic symptom disorder is diagnosed when a
person has a significant focus on physical symptoms,
such as pain, weakness or shortness of breath, to a
level that results in major distress and/or problems
functioning. The individual has excessive thoughts,
feelings and behaviors relating to the physical
symptoms.
DSM-5 (2013)

5. Somatic symptom disorder is a condition in which a
person spends excess energy worrying about or acting to
address symptoms that would not typically require this
level of response. It does not matter whether the
symptoms are psychosomatic or medical in origin, only
that the distress they cause is out of proportion with their
actual health impact. Physical symptoms may or may or
may not be explained by a medical condition.
DSM-5, APA (2013)
What is SOMATIC SYMPTOM DISORDER

6. Somatic symptom disorder (SSD) occurs when a
person feels extreme, exaggerated anxiety about
physical symptoms. The person has such intense
thoughts, feelings, and behaviors related to the
symptoms, that they feel they cannot do some of
the activities of daily life.
LEBEL et. al (2020)
TAYLOR & ASMUNDSON (2004, 2009)
WITTHOFT & HILLER (2010)
What is SOMATIC SYMPTOM DISORDER

7. Somatic symptom
disorder is a condition in
which a person spends
excess energy worrying
about or acting to
address symptoms that
would not typically
require this level of
response
1 - SOMATIC SYMPTOM
DISORDERS
Illness anxiety disorder is
similar to somatic symptom
disorder in that it requires a
person to have a high level of
anxiety about physical
symptoms and to take
disproportionate action in
response to them.
A disorder in which the patient
intentionally produces or feigns
physical or psychological
symptoms solely so that he or
she may assume the sick role.
Psychological factors
affecting a medical
condition is the DSM-5
diagnosis for people who
have symptoms with a
known medical cause and
an abnormal or
maladaptive psychological
reaction to them.
5 BASIC SOMATIC SYMPTOM & RELATED DISORDERS
2 - ILLNESS ANXIETY
DISORDER
Occurs when physical symptoms
mimic symptoms of a neurological
disorder even though no neurological
disorder is present. Symptoms may
include paralysis, vision or hearing
loss, or seizures. A conversion
disorder is generally the result of
trauma and impacts a person’s senses
and movement.
3 - PSYCHOLOGICAL FACTORS
AFFECTING MEDICAL
CONDITIONS
5 - FACTITIOUS DISORDERS
4 - CONVERSION DISORDER

8. SYMPTOMS MAY OR MAY
NOT HAVE KNOWN
MEDICAL CAUSES
DIAGNOSIS OF Somatic symptom
EXCESSIVE THOUGHTS,
FEELING OR
BEHAVIORS
SUBSTANTIAL IMPAIRMENT
IN SOCIAL OR OCCUPATIONAL
FUNCTIONING
• relatively rare condition
- onset usually in adolescence
- more likely to effect unmarried, low ses women
• runs a chronic causes

9. SYMPTOMS MAY OR MAY
NOT HAVE KNOWN
MEDICAL CAUSES
DIAGNOSIS OF ilness anxiety disorder
EXCESSIVE THOUGHTS,
FEELING OR
BEHAVIORS
SUBSTANTIAL IMPAIRMENT
IN SOCIAL OR OCCUPATIONAL
FUNCTIONING
• relatively rare condition
- onset usually in adolescence
- more likely to effect unmarried, low ses women
• runs a chronic causes

10. SYMPTOMS MAY OR MAY
NOT HAVE KNOWN
MEDICAL CAUSES
PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITIONS
EXCESSIVE THOUGHTS,
FEELING OR
BEHAVIORS
SUBSTANTIAL IMPAIRMENT
IN SOCIAL OR OCCUPATIONAL
FUNCTIONING
• relatively rare condition
- onset usually in adolescence
- more likely to effect unmarried, low ses women
• runs a chronic causes

11. SYMPTOMS MAY OR MAY
NOT HAVE KNOWN
MEDICAL CAUSES
DIAGNOSIS OF CONVERSION DISORDER
EXCESSIVE THOUGHTS,
FEELING OR
BEHAVIORS
SUBSTANTIAL IMPAIRMENT
IN SOCIAL OR OCCUPATIONAL
FUNCTIONING
• relatively rare condition
- onset usually in adolescence
- more likely to effect unmarried, low ses women
• runs a chronic causes

12. INTEGRATIVE MODEL OF CAUSES OF HYPOCHONDRIASIS
Based on H.M Warwick & P.M.
Salkovskis, 1990, Hypochondriasis. Behavior Research Therapy, 28, 105 - 117.

13. DISSOCIATIVE
DISORDERS
DISSOCIATIVE
DISORDERS

14. What is DISSOCIATIVE DISORDERS
Dissociative disorders are mental disorders that involve
experiencing a disconnection and lack of continuity between
thoughts, memories, surroundings, actions and identity. People
with dissociative disorders escape reality in ways that are
involuntary and unhealthy and cause problems with functioning
in everyday life. Dissociative disorders involve problems with
memory, identity, emotion, perception, behavior and sense of self.
Dissociative symptoms can potentially disrupt every area of
mental functioning.
DSM-5 (2013)

15. • Dissociation
- Some aspect of cognition or experience
becomes inaccessible to consciousness
ü Avoidance response
- Some types of dissociation are harmless and
common (e.g., losing track of time)
• Sudden disruption in the continuity of:
ü Consciousness
ü Emotions
ü Motivation
ü Memory
ü Identity

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Triggered by stress or
traumatic event
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and briefly explain your point of view.
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and briefly explain your point of view.
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Depersonalization/Derealization Disorder
No disturbance in
memory
No psychosis or loss of
memory
Typical onset in
adolescence
Often comorbid with
anxiety, depression
Chronic course

17. ü Limbs feel
deformed or
enlarged
ü Voice sounds
different or
distant
A
Feelings of
detachment or
disconnection
B
Or experiences of
derealization
C
Symptoms are not
explained by
substances
E
ü Watching self from
outside
ü Floating above one’s
body
• World has become unreal
ü World appears strange,
peculiar, foreign, dream-like
ü Objects appear at times
strangely diminished in size,
at times flat
ü Incapable of experiencing
emotions
ü Feeling as if they were dead,
lifeless
• Experiences of unreality of
surroundings
DSM-5 CRITERIA:
Depersonalization/Derealization Disorder
Experiences of depersonalization or detachment from one’s mental
processes as if one is in a dream
Unusual sensory
experiences
Symptoms are
persistent or
recurrent
D

18. • Inability to remember important personal information,
usually of a traumatic or stressful nature, that is too
extensive to be ordinary forgetfulness
• The amnesia is not explained by substances, or by other
medical or psychological conditions
üNeed to rule out other possible causes of memory loss
• Specify dissociative fugue subtype if the amnesia is
associated with bewildered or apparently purposeful
wandering
DSM-5 CRITERIA:
Dissociative Amnesia

19. • Inability to remember important personal information, usually of
a traumatic or stressful nature, that is too extensive to be
ordinary forgetfulness
• The amnesia is not explained by substances, or by other medical
or psychological conditions
• Specify dissociative fugue subtype if:
• the amnesia includes inability to recall one’s past, confusion
about identity, or assumption of a new identity, and
• sudden, unexpected travel away from home or work
DSM-5 CRITERIA:
Dissociative Amnesia

20. • Amnesia and flight and new identity
ü Latin fugere, “to flee”
• Sudden, unexpected travel with inability
to recall one’s past
ü Assume new identity
• May involve new name, job,
personality characteristics
ü More often of brief duration
ü Remits spontaneously
Dissociative Amnesia:
Dissociative Fugue Subtype

21. • Two or more distinct and fully developed personalities (alters)
üEach has unique modes of being, thinking, feeling, acting, memories,
and relationships
üPrimary alter may be unaware of existence of other alters
• Most severe of dissociative disorders
üRecovery may be less complete
• Typical onset in childhood
üRarely diagnosed until adulthood
• More common in women than men
Dissociative Identity Disorder (DID)

22. • Disruption of identity characterized by two or more distinct personality states
(alters) or an experience of possession, as evidenced by discontinuities in sense of
self as reflected in altered cognition, behavior, affect, perceptions, consciousness,
memories, or sensory-motor functioning. This disruption may be observed by
others or reported by the patient
• Recurrent gaps in recalling events or important personal information that are
beyond ordinary forgetting
• Symptoms are not part of a broadly accepted cultural or religious practice
• Symptoms are not due to drugs or a medical condition
• In children, symptoms are not better explained by an imaginary playmate or by
fantasy play
DSM-5 Criteria for Dissociative Identity
Disorder (DID)

23. Dissociative Identity
Disorder (DID):
• Appearance of DID in popular culture
üThe Three Faces of Eve

24. Etiology of
Dissociative Identity Disorder (DID):
Major Theories
• Posttraumatic Model
üDID results from severe psychological
and/or sexual abuse in childhood

25. TREATMENT of
Dissociative Identity Disorder (DID):
• Most treatments involve:
üEmpathic and supportive therapist
üPsycho therapy in spiritual approach such as by forgiving, be
patient, grateful
üImprovement of coping skills

26. American Psychiatric Association. Somatic symptom disorder.
Diagnostic and Statistical Manual of Mental Disorders. 5th ed.
Arlington, VA: American Psychiatric Publishing; 2013:311-315.
Anxiety.org. “Two disorders introduced for better diagnoses.”
October 8, 2014. Accessed March 31, 2019.
REFERENCES
Gerstenblith TA, Kontos N. Somatic symptom disorders. In:
Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds.
Massachusetts General Hospital Comprehensive Clinical
Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016

27. THANK YOU
FOR LISTENING
RECOVERY IS ABOUT
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