Somatoform and Dissociative Disorders

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Chapter 7

• Somatoform and Dissociative Disorders

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Somatoform Disorders

• The somatoform disorders are a group of
  conditions
• That involve physical symptoms and complaints
  suggesting the presence of a medical condition
• Without any evidence of physical pathology to
  account for them

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Hypochondriasis

• People with hypochondriasis unrealistically
  interpret bodily symptoms as signs of serious
  illness
• Often their symptoms are merely normal bodily
  changes, such as occasional coughing, sores, or
  sweating
• Although some patients recognize that their
  concerns are excessive, many do not

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Hypochondriasis(contd.)

• starts most often in early adulthood, among men
  and women in equal numbers
• Between 1 and 5 of all people experience the
  disorder
• For most patients, symptoms wax and wane over
  time
• The factor distinguishing Hypochondriasis and
  Somatization Disorder is the focus
• Hypochondriasis worry about illness
• Somatization Disorder the actual physical
  symptoms

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Somatization Disorder

• Somatization disorder
• People with somatization disorder have numerous
  long-lasting physical ailments that have little
  or no organic basis
• Also known as Briquets syndrome
• To receive a diagnosis, a patient must have
  multiple ailments that include four pain
  symptoms, two gastrointestinal symptoms, one
  sexual symptom, and oneneurological symptom
• Patients usually go from doctor to doctor seeking
  relief

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Somatoform Disorders

• Pain disorder is characterized by the experience
  of persistent and severe pain in one or more
  areas of the body
• The symptoms of pain disorder resemble the pain
  symptoms of somatization disorder, but with pain
  disorder, the other symptoms are not present

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Conversion Disorder

• Conversion disorder
• In this disorder, a psychosocial conflict or need
  is converted into dramatic physical symptoms that
  affect motor or sensory functioning
• Symptoms often seem neurological, such as
  paralysis, blindness, or loss of feeling
• Most conversion disorders begin between late
  childhood and young adulthood
• They are diagnosed in women twice as often as in
  men
• They usually appear suddenly and are thought to
  be rare

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Somatoform Disorders

• Conversion disorders is distinct from malingering
  disorder or factitious disorder in which a person
  intentionally produces or grossly exaggerates
  physical symptoms
• Malingering secondary gain
• Factitious disorder assume patient role
• Knowledge of how best to treat conversion
  disorder is extremely limited

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Somatoform Disorders

• The symptoms of conversion disorder fall under
  one of the following four categories
• Sensory symptoms or deficits
• Motor symptoms or 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

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Body dysmorphic disorder (BDD)

• deep and extreme concern over an imagined or
  minor defect in ones appearance
• Foci are most often wrinkles, spots, facial hair,
  or misshapen facial features (nose, jaw, or
  eyebrows)
• Most cases of the disorder begin in adolescence
  but are often not revealed until adulthood
• Up to 2 of people in the U.S. experience BDD,
  and it appears to be equally common among women
  and men

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Dissociative Disorders

• Primarily disorders of memory
• Our recall of the past helps us to react to the
  present and guides us towards the future
• People sometimes experience a major disruption of
  their memory
• They may not remember new information
• They may not remember old information
• No physical cause for the memory disturbance

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Dissociative Disorders

• There are several kinds of dissociative
  disorders, including
• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder (multiple
  personality disorder)
• Depersonalization disorder

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Dissociative Disorders

• In derealization, ones sense of the reality of
  the outside world is temporarily lost
• In depersonalization, ones sense of ones self
  and ones reality is temporarily lost

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Dissociative Amnesia

• unable to recall important information, usually
  of an upsetting nature, about their lives (no
  organic cause)
• Localized most common type loss of all memory
  of events occurring within a limited period of
  time
• Selective loss of memory for some, but not all,
  events occurring within a period of time
• Generalized loss of memory, beginning with an
  event but extending back in time may lose sense
  of identity may fail to recognize family and
  friends
• Continuous forgetting of both old and new
  information and events quite rare in cases of
  dissociative amnesia

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Dissociative Amnesia

• All forms of the disorder are similar in that the
  amnesia interferes primarily with episodic memory
  (ones autobiographical memory of personal
  material)
• Semantic memory memory for abstract or
  encyclopedic information usually remains intact
• It is not known how common dissociative amnesia
  is, but rates increase during times of serious
  threat to health and safety

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Dissociative Fugue

• People with dissociative fugue not only forget
  their personal identities and details of their
  past, but also flee to an entirely different
  location
• For some, the fugue is brief they may travel a
  short distance but do not take on a new identity
• For others, the fugue is more severe they may
  travel thousands of miles, take on a new
  identity, build new relationships, and display
  new personality characteristics
• Fugues tend to end suddenly
• Individuals tend to regain most or all of their
  memories and never have a recurrence

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Dissociative Identity Disorder/ Multiple
Personality Disorder

• two or more distinct personalities
  subpersonalities each with a unique set of
  memories, behaviors, thoughts, and emotions
  usually one appears more often than the others
• Considered to be rare
• Typical onset is before the age of 5
• Result of severe abuse
• Womenmen - 31

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Dissociative Identity Disorder/ Multiple
Personality Disorder

• How do subpersonalities interact?
• Personalities may, or may not, be aware of one
  another
• How do subpersonalities differ?
• Personalities often complement each other
  opposite personality characteristics
  (demanding/compliant)
• Vital statistics
• abilities and preferences
• Physiological responses

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Dissociative Identity Disorder/ Multiple
Personality Disorder

• How do subpersonalities interact?
• Personalities may, or may not, be aware of one
  another
• How do subpersonalities differ?
• Personalities often complement each other
  opposite personality characteristics
  (demanding/compliant)
• Vital statistics
• abilities and preferences
• Physiological responses

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How Do Theorists Explain Dissociative Disorders?

• The psychodynamic view
• Psychodynamic theorists believe that dissociative
  disorders are caused by repression, the most
  basic ego defense mechanism
• People fight off anxiety by unconsciously
  preventing painful memories, thoughts, or
  impulses from reaching awareness
• In this view, dissociative amnesia and fugue are
  single episodes of massive repression
• DID is thought to result from a lifetime of
  excessive repression, motivated by very traumatic
  childhood events