Somatoform and Dissociative Disorders

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Somatoform
and Dissociative Disorders
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The Nature of Somatoform Disorders

• Common Features
• Lots of Physical Complaints
• Appear to be Medical Conditions
• No Identifiable Medical Cause
• Pathological Concern About
• Physical Appearance
• Functioning of Their Bodies

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An Overview of Somatoform Disorders

• Five Somatoform Disorders
• Hypochondriasis
• Somatization Disorder
• Conversion Disorder
• Pain Disorder
• Body Dysmorphic Disorder

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Somatoform Disorders Hypochondriasis

• Clinical Description
• Ancient Roots
• Physical Complaints
• No Known Medical Cause
• Severe Anxiety / Fear About
• Possibly Having a Serious Disease
• Reassurance Doesnt Help

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Somatoform Disorders Hypochondriasis

• Clinical Description
• Essential Problem is Anxiety
• Preoccupied With Bodily Symptoms
• Misinterpretation of Symptoms
• Strong Disease Conviction
• Many Medical Visits and Tests

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Somatoform Disorders Hypochondriasis
Why not Classify Such Persons With an Illness
Phobia?
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Somatoform Disorders Hypochondriasis

• Facts and Statistics
• 1 to 14 Medical Patients
• Equal Rates (Males vs. Females)
• May Occur Any Time
• Strong Disease Conviction
• Many Medical Visits and Tests

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Somatoform Disorders Hypochondriasis

• Causes
• Disorder of Cognition / Perception
• More Disease in Family
• More Illness Concern in Family
• More Attention for Sick Behavior

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Somatoform Disorders Hypochondriasis

• Psychological Treatment
• Modify Illness Perceptions
• Evoke Bodily Sensations
• Provide Appropriate Reassurance
• More Research is Needed!

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An Overview of Somatoform Disorders

• Five Somatoform Disorders
• Hypochondriasis
• Somatization Disorder
• Conversion Disorder
• Pain Disorder
• Body Dysmorphic Disorder

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Somatoform Disorders Somatization
Disorder

• Clinical Description
• Briquets Syndrome
• Many Physical Complaints
• No Known Medical Cause
• Little Concern About Symptoms
• La Belle Indifference
• Life Revolves Around Symptoms

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Somatoform Disorders Somatization
Disorder

• Facts and Statistics
• Extremely Rare
• About 4.4 of Population
• Onset in Adolescence
• Females gt Males
• Often a Chronic Condition

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Somatoform Disorders Somatization
Disorder

• Causes
• Family Link
• Link to Antisocial Personality
• Weak Behavioral Inhibition
• Strong Behavioral Activation
• Short Term Gain

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Somatoform Disorders Somatization
Disorder

• Treatment
• Difficult to Treat
• No Proven Treatments
• Extensive Medical Visits
• Treatment Focuses on
• Reduction of Medical Visits
• Reducing Secondary Gain

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An Overview of Somatoform Disorders

• Five Somatoform Disorders
• Hypochondriasis
• Somatization Disorder
• Conversion Disorder
• Pain Disorder
• Body Dysmorphic Disorder

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Somatoform Disorders Conversion
Disorder

• Clinical Description
• Physical Malfunctioning
• Paralysis, Blindness, Aphonia
• Mutism, Lost Sense of Touch
• No Organic Pathology
• Looks Like Neurological Disease
• Popularized by Freud

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Somatoform Disorders Conversion
Disorder

• Related Conditions
• Malingering or Something Else?
• La Belle Indifference
• Precipitated by Marked Stress
• Can Function Normally
• Factitious Disorders
• Munchausens Syndrome by Proxy

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Somatoform Disorders Conversion
Disorder

• Facts and Statistics
• Relatively Rare
• Females gt Males
• Onset Around Adolescence

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Somatoform Disorders Conversion
Disorder

• Causes
• Experience of Trauma
• Getting Sick is Acceptable
• Symptoms to Escape From the Effects of Trauma
• What Influences Choice of Symptoms?

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Somatoform Disorders Conversion
Disorder

• Treatment
• Address the Traumatic Event
• Remove Sources of Secondary Gain
• No Well Established Treatments

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An Overview of Somatoform Disorders

• Five Somatoform Disorders
• Hypochondriasis
• Somatization Disorder
• Conversion Disorder
• Pain Disorder
• Body Dysmorphic Disorder

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Somatoform Disorders Pain Disorder

• Clinical Description
• Pain is Real
• Pain May Have Organic Cause
• Psychological Factors Maintain Pain
• Can be Debilitating

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An Overview of Somatoform Disorders

• Five Somatoform Disorders
• Hypochondriasis
• Somatization Disorder
• Conversion Disorder
• Pain Disorder
• Body Dysmorphic Disorder

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Somatoform Disorders Body Dysmorphic
Disorder

• Clinical Description
• Preoccupation With Appearance
• Imagined Defect
• Imagined Ugliness
• Mirrors (Fixation or Avoidance)
• Ideas of Reference
• Suicidal Ideation and Tendencies

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Somatoform Disorders Body Dysmorphic
Disorder

• Common Locations of Defects
• Hair
• Nose
• Skin
• Eyes
• Head / Face
• Lips

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Somatoform Disorders Body Dysmorphic
Disorder

• Facts and Statistics
• College Students
• 70 Report Some Disatisfaction
• 28 Meet Diagnostic Criteria
• Many Consult Plastic Surgeons
• Males Females
• Onset Late Adolescence

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Somatoform Disorders Body Dysmorphic
Disorder

• The Plastic Surgery Solution?
• Quite Popular but Expensive
• Most are Disappointed With Results

BEFORE
AFTER
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Somatoform Disorders Body Dysmorphic
Disorder

• Causes and Treatment
• Little is Known
• Co-Occurs With OCD
• Intrusive Thoughts and Checking Compulsions About
  Appearance
• Exposure Response Prevention