Somatoform and Dissociative Disorders

1
Somatoform and Dissociative Disorders

• Somatoform Disorders
• Hypochondriasis
• Somatization Disorder
• Pain Disorder
• Conversion Disorder
• Body Dysmorphic Disorder
• Dissociative Disorders
• Dissociative Amnesia
• Dissociative Fugue
• Dissociative Identity Disorder

2
Somatoform Disorder

• Somatoform disorders are a group of
• conditions
• That involve physical symptoms and complaints
  suggesting the presence of a medical condition.
• No evidence of physical pathology.

3
Hypochondriasis

• Preoccupied with fears of
• getting a serious disease or
• the idea that they have one.
• Cognitive-behavioral views
• most widely accepted.
• Cognitive-behavioral therapy most effective.

4
Somatization Disorder

• Many different complaints of physical ailments
  with the following characteristics
• Lasting several years.
• Beginning before age 30.
• Not adequately explained by independent findings
  of physical illness or injury.
• Leading to medical treatment or to significant
  life impairment.

5
Somatization Disorder

• DSM-IV-TR lists four additional symptom criteria
  needed for a diagnosis of somatization disorder
• 4 pain symptoms
• 2 gastrointestinal symptoms
• 1 sexual symptom
• 1 pseudo neurological symptom

6
Somatization Disorder

• Features
• Usually begins in adolescence.
• Is 3 to 10 times more common in women than in
  men.
• Often occurs with major depression/panic disorder
• There may be a genetic predisposition.
• Contributory Factors
• Personality
• Cognitive
• Learning variables

7
Somatization Disorder

• Extremely difficult to treat.
• Cognitive-behavioral therapy.

8
Pain Disorder

• Persistent/Severe pain in one or moare areas in
  the body.
• Symptoms of pain disorder resemble the pain
  symptoms of somatization disorder.
• With pain disorder, the other symptoms are not
  present.

9
Pain Disorder

• DSM-IV-TR specifies two subtypes of PD
• Associated with psychological factors.
• Associated with both psychological/General
  Medical Condition.
• Treatment
• Cognitive-behavioral techniques.

10
Conversion disorder

• Deficits affecting sensory or voluntary motor
  functions lead one to think a patient has a
  medical condition.
• The patient looses a sensory function.
• Sight
• Taste
• Tactile (limbs)
• Smell
• Hearing

11
Conversion disorder

• Primary gain
• Escape or avoidance of a stressful situation.
• Secondary gain
• Attention and financial compensation.
• Conversion disorders are no longer as prevalent
  as they once were.

12
Conversion disorder

• Symptoms of conversion disorder fall under one of
  the following four categories
• Sensory symptoms/deficits
• Motor symptoms/deficits
• Seizures
• Mixed presentation from the first three
  categories
• It is crucial that patients receive a thorough
  medical and neurological examination to rule out
  organic illness.

13
Conversion disorder

• Conversion disorders are considered distinct
  from (Intentionality)
• Malingering Disorder
• Factitious Disorder
• Knowledge of how best to treat conversion
  disorder is extremely limited.

14
Body Dysmorphic Disorder

• Obsessed with some perceived or imagined flaws in
  appearance.
• 12 suffer from the disorder.
• People with the disorder commonly have a
  depressive diagnosis.
• Many researchers believe BDD is closely related
• OCD
• Eating disorders

15
Somatoform Disorders

• Treatments
• Antidepressant medications
• Cognitive-behavioral treatment focused on
  exposure and response prevention.

16
Dissociative Disorders

• Defined Group of conditions involving
  disruptions in a persons normally integrated
  functions
• Consciousness
• Memory
• Identity
• Perception
• Derealization
• Sense of the reality of the outside world is
  temporarily lost.
• Depersonalization
• Sense of ones self and ones reality is
  temporarily lost.

17
Dissociative Amnesia

• Failure to recall previously stored personal
  information.
• Cant be explained by basic forgetting.
• Dissociative fugue
• Person also departs from home surroundings

18
Dissociative Identity Disorder

• Patient manifests two or more distinct identities
  or personality states.
• Must alternate in taking control of behavior.
• Alters are not personalities.
• Rare.
• Starts in childhood.

19
Dissociative Identity Disorder

• Controversy
• Is the disorder real or faked?
• How does it develop?
• Are recovered memories of abuse in the disorder
  real or false?
• If abuse has occurred, did it play a causal
  role?

20
Dissociative Identity Disorder

• No systematic controlled research has been
  conducted.
• Possible treatments include
• Hypnosis
• Integration of separate alters