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Somatoform & Dissociative Disorders
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Common Features Lots of Physical Complaints Appear to be Medical Conditions No Identifiable Medical Cause Pathological Concern About
– Physical Appearance– Functioning of Their Bodies
Common Features Lots of Physical Complaints Appear to be Medical Conditions No Identifiable Medical Cause Pathological Concern About
– Physical Appearance– Functioning of Their Bodies
Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Clinical Description Ancient Roots Physical Complaints No Known Medical Cause Severe Anxiety / Fear About
Possibly Having a Serious Disease Reassurance Doesn’t Help
Clinical Description Ancient Roots Physical Complaints No Known Medical Cause Severe Anxiety / Fear About
Possibly Having a Serious Disease Reassurance Doesn’t Help
Clinical Description Essential Problem is Anxiety Preoccupied With Bodily Symptoms Misinterpretation of Symptoms Strong Disease Conviction Many Medical Visits and Tests
Clinical Description Essential Problem is Anxiety Preoccupied With Bodily Symptoms Misinterpretation of Symptoms Strong Disease Conviction Many Medical Visits and Tests
Why not Classify Such Persons With an Illness Phobia?
Why not Classify Such Persons With an Illness Phobia?
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
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
Causes Disorder of Cognition / Perception More Disease in Family More Illness Concern in Family More Attention for Sick Behavior
Causes Disorder of Cognition / Perception More Disease in Family More Illness Concern in Family More Attention for Sick Behavior
Psychological Treatment Modify Illness Perceptions Evoke Bodily Sensations Provide “Appropriate” Reassurance More Research is Needed!
Psychological Treatment Modify Illness Perceptions Evoke Bodily Sensations Provide “Appropriate” Reassurance More Research is Needed!
Five Somatoform Disorders Hypochondriasis
Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Five Somatoform Disorders Hypochondriasis
Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Clinical Description Briquet’s Syndrome Many Physical Complaints No Known Medical Cause Little Concern About Symptoms
La Belle Indifference Life Revolves Around Symptoms
Clinical Description Briquet’s Syndrome Many Physical Complaints No Known Medical Cause Little Concern About Symptoms
La Belle Indifference Life Revolves Around Symptoms
Facts and Statistics Extremely Rare About 4.4% of Population Onset in Adolescence Females > Males Often a Chronic Condition
Facts and Statistics Extremely Rare About 4.4% of Population Onset in Adolescence Females > Males Often a Chronic Condition
Causes Family Link Link to Antisocial Personality
– Weak Behavioral Inhibition– Strong Behavioral Activation– Short Term Gain
Causes Family Link Link to Antisocial Personality
– Weak Behavioral Inhibition– Strong Behavioral Activation– Short Term Gain
Treatment Difficult to Treat No Proven Treatments Extensive Medical Visits Treatment Focuses on
– Reduction of Medical Visits– Reducing Secondary Gain
Treatment Difficult to Treat No Proven Treatments Extensive Medical Visits Treatment Focuses on
– Reduction of Medical Visits– Reducing Secondary Gain
Five Somatoform Disorders Hypochondriasis Somatization Disorder
Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Five Somatoform Disorders Hypochondriasis Somatization Disorder
Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Clinical Description Physical Malfunctioning
– Paralysis, Blindness, Aphonia– Mutism, Lost Sense of Touch
No Organic Pathology Looks Like Neurological Disease Popularized by Freud
Clinical Description Physical Malfunctioning
– Paralysis, Blindness, Aphonia– Mutism, Lost Sense of Touch
No Organic Pathology Looks Like Neurological Disease Popularized by Freud
Related Conditions Malingering or Something Else?
– La Belle Indifference– Precipitated by Marked Stress– Can Function Normally
Factitious Disorders– Munchausen’s Syndrome by Proxy
Related Conditions Malingering or Something Else?
– La Belle Indifference– Precipitated by Marked Stress– Can Function Normally
Factitious Disorders– Munchausen’s Syndrome by Proxy
Facts and Statistics Relatively Rare Females > Males Onset Around Adolescence
Facts and Statistics Relatively Rare Females > Males Onset Around Adolescence
Causes Experience of Trauma Getting Sick is Acceptable Symptoms to Escape From the
Effects of Trauma What Influences Choice of
Symptoms?
Causes Experience of Trauma Getting Sick is Acceptable Symptoms to Escape From the
Effects of Trauma What Influences Choice of
Symptoms?
Treatment Address the Traumatic Event Remove Sources of Secondary Gain No Well Established Treatments
Treatment Address the Traumatic Event Remove Sources of Secondary Gain No Well Established Treatments
Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder
Pain Disorder Body Dysmorphic Disorder
Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder
Pain Disorder Body Dysmorphic Disorder
Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Maintain Pain Can be Debilitating
Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Maintain Pain Can be Debilitating
Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder
Clinical Description Preoccupation With Appearance
– Imagined Defect “Imagined” Ugliness Mirrors (Fixation or Avoidance) Ideas of Reference Suicidal Ideation and Tendencies
Clinical Description Preoccupation With Appearance
– Imagined Defect “Imagined” Ugliness Mirrors (Fixation or Avoidance) Ideas of Reference Suicidal Ideation and Tendencies
Common Locations of Defects Hair Nose Skin Eyes Head / Face Lips
Common Locations of Defects Hair Nose Skin Eyes Head / Face Lips
Facts and Statistics College Students
– 70% Report Some Disatisfaction– 28% Meet Diagnostic Criteria
Many Consult Plastic Surgeons Males = Females Onset Late Adolescence
Facts and Statistics College Students
– 70% Report Some Disatisfaction– 28% Meet Diagnostic Criteria
Many Consult Plastic Surgeons Males = Females Onset Late Adolescence
The Plastic Surgery Solution? Quite Popular but Expensive Most are Disappointed With Results
The Plastic Surgery Solution? Quite Popular but Expensive Most are Disappointed With Results
BEFOREBEFORE AFTERAFTER
Causes and Treatment Little is Known Co-Occurs With OCD
– Intrusive Thoughts and Checking Compulsions About Appearance
Exposure + Response Prevention
Causes and Treatment Little is Known Co-Occurs With OCD
– Intrusive Thoughts and Checking Compulsions About Appearance
Exposure + Response Prevention
Depersonalization– Altered Perception of Self
Depersonalization– Altered Perception of Self
Derealization– Altered Perception of World
Derealization– Altered Perception of World
Dissociative Phenomena Dissociative Phenomena
Common Experience Common Experience
Some people have the experience of driving a car and suddenly realizing that
they don’t remember what happened during all or part of the trip.
Some people have the experience of driving a car and suddenly realizing that
they don’t remember what happened during all or part of the trip.
0% 100%0% 100%0% 100%0% 100%
0% 100%0% 100%0% 100%0% 100%
Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear
part or all of what was just said.
Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear
part or all of what was just said.
0% 100%0% 100%0% 100%0% 100%
Some people find that they have no memory for some important events in their lives
(e.g. a wedding or graduation).
Some people find that they have no memory for some important events in their lives
(e.g. a wedding or graduation).
0% 100%0% 100%0% 100%0% 100%
Some people have the experience of finding themselves dressed in clothes that
they don’t remember putting on.
Some people have the experience of finding themselves dressed in clothes that
they don’t remember putting on.
0% 100%0% 100%0% 100%0% 100%
Some people sometimes have the experience of feeling that other people, objects, and the world
around them are not real.
Some people sometimes have the experience of feeling that other people, objects, and the world
around them are not real.
Nor
mal
Dis
soci
atio
nN
orm
alD
isso
ciat
ion
AmnesiaAmnesia
FugueFugue
PartialDID
PartialDID
ComplexDID
ComplexDID
Poly-F
ragmented
DID
Poly-F
ragmented
DID
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Primary Features– Depersonalization– Derealization
Primary Features– Depersonalization– Derealization
Impairs Functioning Causes Significant Distress Runs a Chronic Course
Impairs Functioning Causes Significant Distress Runs a Chronic Course
Clinical Description Clinical Description
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Clinical Description Clinical Description
Localized or Selective– Failure to Recall Specific Events
Localized or Selective– Failure to Recall Specific Events
Several Patterns Generalized
– Unable to Remember Anything
Several Patterns Generalized
– Unable to Remember Anything
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Clinical Description Clinical Description
Go to Another Location– Unaware “How They Arrived”
Go to Another Location– Unaware “How They Arrived”
Memory Loss – Specific Incident
Memory Loss – Specific Incident
May Assume New Identity May Assume New Identity Fugue Usually Ends Abruptly Fugue Usually Ends Abruptly
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Clinical Description Clinical Description Differ Across Cultures
– Sudden Changes in Personality– Possession by Spirits
Differ Across Cultures – Sudden Changes in Personality– Possession by Spirits
Females > Males Females > Males Often Related to Trauma Often Related to Trauma
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder
Clinical Description Clinical Description Formally
– Multiple Personality Disorder
Formally – Multiple Personality Disorder
Person’s Identity is Dissociated Person’s Identity is Dissociated
May Adopt 100 Identities – “Alters”– The Nature of Alters
May Adopt 100 Identities – “Alters”– The Nature of Alters
Central Features Central Features Host Identity
– One Who Asks for Treatment– Attempt to Hold Alters Together
Host Identity – One Who Asks for Treatment– Attempt to Hold Alters Together
A Switch – Abrupt Change in Personalities– Usually Instantaneous
A Switch – Abrupt Change in Personalities– Usually Instantaneous
Facts and Statistics Facts and Statistics Average Number of Alters?
– 15
Average Number of Alters? – 15
Females > Males (9:1) Females > Males (9:1) Onset in Childhood
– Linked to Extreme Abuse
Onset in Childhood– Linked to Extreme Abuse
Runs a Chronic Course Runs a Chronic Course
Causes Causes Unspeakable Childhood Abuse
– 97% of Cases – Escape Into Fantasy World– Become Someone Else– Do What It Takes to Survive
Unspeakable Childhood Abuse– 97% of Cases – Escape Into Fantasy World– Become Someone Else– Do What It Takes to Survive
DID as a Means of Coping? DID as a Means of Coping?
Other Related Features Other Related Features Suggestibility Hypnotizability
– Similar to Dissociation
Suggestibility Hypnotizability
– Similar to Dissociation Are These Related to DID? Are These Related to DID?
Abuse: Controversial Issues Abuse: Controversial Issues False vs. Real Memories Do Therapists Plant Memories? Can False Memories be Created?
– Elizabeth Loftus– Other Related Research
False vs. Real Memories Do Therapists Plant Memories? Can False Memories be Created?
– Elizabeth Loftus– Other Related Research
Consequences of the Debate? Consequences of the Debate?
Treatment Treatment Dissociative Amnesia & Fugue
– Usually Improve on Their Own– Stress Reduction and Coping
Dissociative Amnesia & Fugue– Usually Improve on Their Own– Stress Reduction and Coping
Dissociative Identity Disoder– No Controlled Research– Treatments are Similar to PTSD
Dissociative Identity Disoder– No Controlled Research– Treatments are Similar to PTSD
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