DISSOSIATION DISORDER

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DISSOSIATION DISORDER
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Dissociative and somatoform disorders

• Dissociative disorders
• a change/disturbance in function of
  self-identity, memory, unconscious that make
  personality whole.
• There is a disruption/dissociation (splitting
  off)

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Dissociative identity disorder

• Alternate personalities may require different
  eyeglass prescription, display different
  allergies, different response to same medicine,
  differences in color blindness. It is as if
  conflicting internal impulses cannot coexist or
  achieve dominance.

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Cont. dissociative identity disorder

• Mechanism of dissociation is controlled by
  unconscious process.
• Individual may report auditory hallucinations
  like 2 voices arguing about them, some complain
  of being possessed.

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• they may display wide range abnormal behavior
  before being accurately diagnosed
• physical complaints without an organic basis
• amnesia,
• depression/suicide,
• anxiety/ panic attacks
• depersonalization
• derealization (loss of sense of reality
  people/objects change size/shape or in the sense
  of time)

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Dissociative amnesia

• Inability to recall important personal
  information usually involving traumatic
  experiences that cannot be explained by simple
  forgetfulness. May last hours/years
• There are 5 types
• localized a cannot recall events for a number of
  hours after stressful/traumatic incident.
• Selective a forget only disturbing particulars
  during certain time.
• Generalized a forget entire life but retain
  habits, tastes, skills. (rare)

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• Continuous a forget all events that take place
  after the problem begins.
• Systematized a memories relating to specific
  categories of information are lost, ie., college
  experiences.
• Malingering attempt to fabricate symptoms/make
  false claims of amnesia for personal gain.

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Dissociative fugue

• Fugue means flight.
• Individual travels suddenly from home/work, shows
  loss of memory for past personal information,
  becomes confused about identity or assumes a new
  one.

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To differentiate amnesia from fugue

• Amnesia is wandering aimlessly
• Fugue Is acting more purposefully
• Not psychotic
• when memory returns cant remember fugue state.
• Rare
• Most likely to occur in wartime/disasters,
• Difficult to distinguish from malingering.

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Depersonalization disorder

• Experience of depersonalization are
  persistent/recurrent and cause distress.
• Controversy of including depersonalization
  disorder with dissociative because
  depersonalization disorder does not affect
  memory.
• In other dissociative disorders, it protects
  individual from anxiety depersonalization
  generates anxiety.

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Theoretical Perspectives

• Psychodynamic
• trauma (abuse, warfare, severe problems, averting
  punishment) plays a role.
• Dissociating helps to block out troubling memory.
• Use repression.

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• Learning
• Individual learns not to think about disturbing
  thoughts to avoid guilt/shame.
• Negative reinforcement when relieved from
  anxiety.
• Learned through observational learning.

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Treatment

• Psychodynamic
• uncover early childhood traumas
• learn to cope.
• Behavioral
• Consider personalities
• Reinforcement contingencies.

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Somatoform Disorders

• A condition where people have physical symptoms
  but no organic abnormalities can be found to
  account for them. There is some reason to
  believe that the symptoms reflect psychological
  factors or conflict.

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Conversion disorder

• A major change in or loss of physical
  functioning, although there are no medical
  findings to support the physical symptoms or
  deficits.
• The physical symptoms usually come on suddenly
  during a stressful time.
• It is named because it is believed that repressed
  sexual/aggressive energy is converted into
  physical symptoms.

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• Symptom patterns involve
• paralysis
• epilepsy
• problems in coordination
• blindness/tunnel vision
• loss of hearing, smell, feeling in a limb

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Hypochondriasis

• A fear of having a serious illness.
• A fear that their bodily signs or sensations are
  due to a serious illness.
• Unlike conversion disorder, hypochondriasis does
  not involve the loss or distortion of physical
  functioning.
• Unlike conversion disorder, hypochondriacs are
  very concerned about their symptoms.

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Hypochondriasis

• The disorder is about equally common in men and
  women, and most often begins between 20 and 30.
• They are more likely to report being sick as
  children.
• They frequently doctor shop.

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Somatization Disorder

• Formerly known as Briquets syndrome.
• Multiple, recurrent somatic complaints that began
  prior to the age of 30, usually begins in late
  adolescence. Complaints usually involve different
  organ systems.
• The groups of symptoms are categorized as pain
  involving multiple sites.
• 10 times more likely to be found in women 4
  times more likely among Afr-Americans.

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Theoretical Perspectives

• Hippocrates believed the strange bodily symptoms
  were caused by a wandering uterus which created
  internal chaos.
• Freud believed that hysteria was rooted in
  psychological rather than physical causes.

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Cont. theoretical

• Hysterical symptoms are functional. They allow
  the patients to achieve primary(keeping internal
  conflicts repressed) and secondary gains
  (avoiding burdensome responsibilities)
• Example of primary - hand paralysis to prevent
  masturbation or murder
• secondary - hand paralysis to keep from firing a
  gun in battle thus being removed from the front
  line.

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Cont. Theoretical

• Psychodynamic and learning concur that the
  symptoms reduce anxiety.
• Learning theory - the symptoms carry the benefits
  or reinforcing properties of the sick role
  though it is not conscious.
• Distinguish from malingering which is conscious.

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• Cognitive -
• Hypochondriasis may represent a type of
  self-handicapping.
• May also be a cognitive bias to misinterpret
  changes in bodily cues or sensations.

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Treatment

• Psychodynamic
• Uncover unconscious conflicts.
• Behavioral
• Remove the secondary gains.
• Biological
• Use anti-depressants

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Münchausen Syndrome

• Patients who tell tall tales to their doctors.
• A type of factitious disorder. Münchausen
  syndrome is a term for psychiatric disorders
  known as factitious disorders wherein those
  affected feign disease, , illness, or
  psychological trauma in order to draw attention
  or sympathy to themselves. It is also sometimes
  known as hospital addiction syndrome or hospital
  hopper syndrome.

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• Medical professionals suspecting Münchausen's in
  a patient should first rule out the possibility
  that the patient does indeed have a disease
  state, but it is in an early stage and not yet
  clinically detectable.
• take a careful patient history, and seek medical
  records,
• to look for early deprivation, childhood abuse,
  mental illness.
• If a patient is at risk to himself or herself,
  inpatient psychiatric hospitalization. should be
  initiated.

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• Medical providers should consider working with
  mental health specialists to help treat the
  underlying mood or disorder as well as to avoid
  countertransference.
• Therapeutic and medical treatment should center
  on the underlying psychiatric disorder a mood
  disorder, an anxiety disorder, or borderline
  personality disorder.

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• The patient's prognosis depends upon the category
  under which the underlying disorder falls
  depression and anxiety, for example, generally
  respond well to medication and/or cognitive
  behavioral therapy, whereas borderline
  personality disorder, like all personality
  disorders, is presumed to be pervasive and more
  stable over time,thus offers the worst prognosis.

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Gansers Syndrome

• Ganser syndrome is a rare dissociative disorder
  previously classified as a factitious disorder..
  It is characterized by nonsensical or wrong
  answers to questions or doing things incorrectly,
  other dissociative symptoms such as fugue,
  amnesia or conversion disorder, often with visual
  pseudohallucinations and a decreased state of
  consciousness.

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• Ganser is an extremely rare variation of
  dissociative disorder. It is a reaction to
  extreme stress and the patient thereby suffers
  from approximation or giving absurd answers to
  simple questions.
• Symptoms
• clouding of consciousness, somatic conversion
  symptoms, confusion, stress, loss of personal
  identity, echolalia, and echopraxia.
• Individuals also give approximate answers to
  simple questions. For example, "How many legs are
  on a cat?", to which the subject may respond
  '3?'.
• The syndrome may occur in persons with other
  mental disorders such as schizophrenia,
  depressive disorders, toxic states, paresis,
  alcohol use disorders and factitious disorders.
  EEG data does not suggest any specific organic
  cause.

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• It is also sometimes called nonsense syndrome,
  syndrome of approximate answers, pseudodementia,
  hysterical pseudodementia or prison psychosis.
  This last name, prison psychosis, is sometimes
  used because the syndrome occurs most frequently
  in prison inmates, where it may represent an
  attempt to gain leniency from prison or court
  officials.

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