Chapter 5 Somatoform and Dissociative Disorders

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Chapter 5 Somatoform and Dissociative Disorders
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Somatoform Disorders

• Soma Meaning Body
• Preoccupation with health and/or body appearance
  and functioning
• No identifiable medical condition causing the
  physical complaints

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Somatoform Disorders (continued)

• Types of DSM-IV Somatoform Disorders
• Hypochondriasis
• Somatization disorder
• Conversion disorder
• Pain disorder
• Body dysmorphic disorder

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Hypochondriasis

• Clinical Description
• Physical complaints without a clear cause
• Severe anxiety about the possibility of having a
  serious disease
• Strong disease conviction
• Medical reassurance does not seem to help

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Hypochondriasis (continued)

• Statistics
• Good prevalence data are lacking
• Onset at any age
• Runs a chronic course

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Hypochondriasis Causes and Treatment

• Causes
• Cognitive perceptual distortions
• Familial history of illness
• Treatment
• Challenge illness-related misinterpretations
• Provide more substantial and sensitive
  reassurance
• Stress management and coping strategies

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Fig. 5.1, p. 176
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Somatization Disorder

• Clinical Description
• Extended history of physical complaints before
  age 30
• Substantial impairment in social or occupational
  functioning
• Concern about the symptoms, not what they might
  mean
• Symptoms become the persons identity

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Somatization Disorder (continued)

• Statistics
• Rare condition
• Onset usually in adolescence
• Mostly affects unmarried, low SES women
• Runs a chronic course

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Somatization Disorder Causes and Treatment

• Causes
• Familial history of illness
• Relation with antisocial personality disorder
• Weak behavioral inhibition system
• Treatment
• No treatment exists with demonstrated
  effectiveness
• Reduce the tendency to visit numerous medical
  specialists

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Somatization Disorder Causes and Treatment
(continued)

• Assign gatekeeper physician
• Reduce supportive consequences of talk about
  physical symptoms

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Conversion Disorder

• Clinical Description
• Physical malfunctioning
• Lack physical or organic pathology
• Malfunctioning often involves sensory-motor areas
• Persons show la belle indifference
• Retain most normal functions, but lack awareness

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Conversion Disorder (continued)

• Statistics
• Rare condition, with a chronic intermittent
  course
• Seen primarily in females
• Onset usually in adolescence
• Common in some cultural and/or religious groups

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Conversion Disorder Causes

• Causes
• Freudian psychodynamic view is still popular
• Emphasis on the role of past trauma and
  conversion
• Detachment from the trauma and negative
  reinforcement
• Address primary/secondary gain

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Conversion Disorder Treatment

• Treatment
• Similar to somatization disorder
• Core strategy is attending to the trauma
• Remove sources of secondary gain
• Reduce supportive consequences of talk about
  physical symptoms

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Body Dysmorphic Disorder

• Clinical Description
• Previously known as dysmorphophobia
• Preoccupation with imagined defect in appearance
• Often display ideas of reference for imagined
  defect
• Suicidal ideation and behavior are common

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Body Dysmorphic Disorder (continued)

• Statistics
• More common than previously thought
• Seen equally in males and females
• Onset usually in early 20s
• Most remain single, and many seek out plastic
  surgeons
• Usually runs a lifelong chronic course

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Body Dysmorphic Disorder Causes

• Causes
• Little is known Disorder tends to run in
  families
• Shares similarities with obsessive-compulsive
  disorder

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Body Dysmorphic Disorder Treatment

• Treatment
• Treatment parallels that for obsessive compulsive
  disorder
• Medications (i.e., SSRIs) that work for OCD
  provide some relief
• Exposure and response prevention is also helpful
• Plastic surgery is often unhelpful

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An Overview of Dissociative Disorders

• Overview
• Involve severe alterations or detachments
• Affects identity, memory, or consciousness
• Depersonalization Distortion is perception of
  reality
• Derealization Losing a sense of the external
  world

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An Overview of Dissociative Disorders (continued)

• Types of DSM-IV Dissociative Disorders
• Depersonalization Disorder
• Dissociative Amnesia
• Dissociative Fugue
• Dissociative Trance Disorder
• Dissociative Identity Disorder

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Depersonalization Disorder An Overview

• Overview and Defining Features
• Severe and frightening feelings of unreality and
  detachment
• Feelings dominate and interfere with life
  functioning
• Primary problem involves depersonalization and
  derealization

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Depersonalization Disorder An Overview
(continued)

• Facts and Statistics
• High comorbidity with anxiety and mood disorders
• Onset is typically around age 16
• Usually runs a lifelong chronic course

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Depersonalization Disorder Causes and Treatment

• Causes
• Cognitive deficits in
• Attention, short-term memory, spatial reasoning
• Deficits related to tunnel vision and mind
  emptiness
• Such persons are easily distracted
• Treatment
• Little is known

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Dissociative Amnesia An Overview

• Dissociative Amnesia
• Includes several forms of psychogenic memory loss
• Generalized vs. localized or selective type

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Dissociative Fugue An Overview

• Dissociative Fugue
• Related to dissociative amnesia
• Take off and find themselves in a new place
• Unable to remember the past
• Unable to remember how they arrived at new
  location
• Often assume a new identity

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Dissociative Amnesia and Fugue Causes

• Statistics
• Usually begin in adulthood
• Show rapid onset and dissipation
• Occur most often in females
• Causes
• Little is known
• Trauma and stress can serve as triggers

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Dissociative Amnesia and Fugue Causes and
Treatment

• Treatment
• Most get better without treatment
• Most remember what they have forgotten

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Dissociative Trance Disorder An Overview

• Clinical Description
• Symptoms resemble other dissociative disorders
• Dissociative symptoms and sudden changes in
  personality
• Changes often attributed to possession by a
  spirit
• Presentation varies across cultures

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Dissociative Trance Disorder Causes, and
Treatment

• Facts and Statistics
• More common in females than males
• Causes
• Often attributable to a life stressor or trauma
• Treatment
• Little is known

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Dissociative Identity Disorder (DID) An Overview

• Clinical Description
• Formerly known as multiple personality disorder
• Defining feature is dissociation of personality
• Adoption of several new identities (as many as
  100)
• Identities display unique behaviors, voice, and
  posture

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Dissociative Identity Disorder (DID) An
Overview (continued)

• Unique Aspects of DID
• Alters Different identities or personalities
• Host The identity that keeps other identities
  together
• Switch Quick transition from one personality to
  another

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Dissociative Identity Disorder (DID) An
Overview (continued)

• Statistics
• Average number of identities is close to 15
• Ratio of females to males is high (91)
• Onset is almost always in childhood
• High comorbidity rates lifelong, chronic course

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Dissociative Identity Disorder (DID) Causes

• Causes
• Histories of horrible, unspeakable, child abuse
• Closely related to PTSD
• Mechanism to escape from the impact of trauma

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Dissociative Identity Disorder (DID) Treatment

• Treatment
• Focus is on reintegration of identities
• Identify and neutralize cues/triggers that
  provoke memories of trauma/dissociation

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Diagnostic Considerations in Somatoform and
Dissociative Disorders

• Separating Real Problems from Faking
• Malingering Deliberately faking symptoms
• False Memories and Recovered Memory Syndrome
• Related Conditions Factitious Disorder
• Factitious Disorder by Proxy

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Summary of Somatoform and Dissociative Disorders

• Features of Somatoform Disorders
• Physical problems without on organic cause
• Features of Dissociative Disorders
• Extreme distortions in perception and memory
• Well Established Treatments Are Generally Lacking