Dissociative and Somatoform Disorders 022505

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Dissociative and Somatoform Disorders02-25-05
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Dissociative Disorders

• Dissociative Disorders involve some sort of
  dissociation (separation) of, or changes in, a
  part of the persons sense of identity,
  consciousness, or memory
• Often linked to trauma and anxiety

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Dissociative Amnesia

• Partial or total memory loss for important
  personal information, usually occurring after a
  stressful experience
• Localized amnesia (most common) all events
  during a limited period of time
• Selective amnesia selected events during a
  limited period of time or specific incident
• Generalized amnesia total no memory of previous
  life

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Dissociative Fugue

• Confusion and/or amnesia about personal identity
  accompanied by leaving home
• Typically occurs after a severe stress
• Usually characterized by limited, but apparently
  purposeful, travel
• In some cases, a person may assume a new identity
  and build a new life

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Depersonalization Disorder

• Feelings of unreality concerning the self and the
  environment
• Involves no disturbance of memory
• Often triggered by stress
• Unusual sensory experiences persons limbs may
  seem drastically changed in size voice may sound
  strange may feel as if outside body may feel
  mechanical (like a robot)

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Dissociative Identity Disorder

• Formerly Multiple Personality Disorder
• At least two distinct personalities (different
  modes of being and feeling and acting) that
  exist independently of each other and that are in
  control at different times
• Gaps in memory are common because personalities
  may have no contact with the others

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Dissociative Identity Disorder

• Personalities may each have independent behavior
  patterns, memories, and relationships may even
  have different handedness, eyeglass
  prescriptions, allergies
• Usually begins in childhood often associated
  with childhood abuse more common in women than
  men
• Often comorbid with other disorders such as
  depression, borderline personality disorder

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Etiology of Dissociative Disorders

• Psychodynamic view Repression is used to block
  stressful/traumatic experiences and memories from
  consciousness
• Pathological dissociation may result from an
  interaction between a persons tendency toward
  self-hypnosis and acute stress

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Psychodynamic Model of DID
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Etiology of Dissociative Disorders

• Behavioral view Dissociation is an avoidance
  response that protects the person from stressful
  events and memories
• Iatrogenic view Dissociative symptoms may be
  produced or maintained through selective
  attention, suggestion, reinforcement, and /or
  expectations of the therapist
• Feigning/faking must also be considered

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Treatment/Courseof Dissociative Disorders

• Psychoeducational, cognitive-behavioral, and/or
  supportive therapy typically address primary as
  well as comorbid symptoms (e.g., depression,
  anxiety)
• Dissociative Amnesia Fugue typically remit
  spontaneously
• Hypnosis may be utilized in the treatment of
  Dissociative Identity Disorder

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Somatoform Disorders
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Somatoform Disorders

• Experience of somatic (bodily) symptoms for which
  no physiological basis can be found
• Symptoms are not considered under voluntary
  control individual believes the symptoms are
  real. Thus, somatic disorders are NOT
  malingering (faking a disorder to achieve some
  gain) or Factitious Disorders (deliberately
  inducing physical symptoms with no apparent
  incentive)

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Somatization Disorder

• Complaints of multiple physical symptoms (e.g.,
  pain, gastrointestinal, sexual, neurological)
  that have no apparent physical basis
• Typically characterized by persistent seeking of
  medical care and doctor-shopping

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Conversion Disorder

• Complaints of physical problems or impairments of
  sensory or motor functions controlled by the
  voluntary nervous system, all suggesting a
  neurological disorder but with no underlying
  cause
• Example symptoms partial/complete paralysis,
  seizures, coordination disturbances, anesthesias,
  visual impairment
• Symptoms may be physiologically impossible (e.g.,
  glove anesthesia)

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Pain Disorder

• Complaints of severe pain that has no
  physiological or neurological basis, is greatly
  in excess of that expected with an existing
  condition, or lingers long after a physical
  injury has healed
• Complaints of pain may be vague, not localized

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Hypochondriasis

• Persistent preoccupation with fears of having a
  serious disease, even in the face of physical
  evaluations that reveal no organic problems
• Patients appear to be oversensitive to physical
  sensations and make more catastrophic
  interpretations of symptoms
• Often co-occurs with anxiety and mood disorders

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Body Dysmorphic Disorder

• Preoccupation with an imagined physical defect in
  a normal-appearing person, or an excessive
  concern with a slight physical defect
• Common concerns hair, nose, face, eyes differ
  by gender
• Frequent checking in mirror consultation with
  plastic surgeons activity limitations

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Etiology of Somatoform Disorders

• Psychodynamic view Defense against the awareness
  of unconscious emotional issues
• Behavioral view Reinforcement of the sick
  role avoidance of unpleasant situations or
  responsibilities
• Diathesis-Stress Model

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Treatment of Somatoform Disorders

• Psychodynamic treatment psychoanalysis and
  hypnotherapy
• Cognitive-behavioral treatments (exposure and
  response prevention systematic desensitization
  cognitive therapies)
• Family systems therapy
• Biological treatment SSRIs

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Culture and Somatization

• People from non-Western cultures tend to express
  distress somatically (e.g., depression, anxiety
  headaches, abdominal distress, body pains, sleep
  disturbance, appetite change, fatigue,
  restlessness, etc. )
• Stigma of psychological/mental disorders
• Examples Neurasthenia among Chinese, Chawaj
  among Maya