Dissociative and Somatoform Disorders

Dissociative disorders include:

Dissociative Amnesia, Dissociative Fugue, Depersonalization Disorder, Dissociative Identity Disorder

Somatoform disorders include:

Conversion Disorder, Somatization Disorder, Pain Disorder, Hypochondriasis, Body Dysmorphic Disorder

Factitious disorder

Dissociative Disorders

Disorders involve disruptions in the integration of memory, consciousness, or identity

Dissociative Disorders• Dissociative amnesia

– psychologically caused loss of memory

• Dissociative fugue– flight from familiar surroundings accompanied

by memory loss

• Depersonalization disorder– the feeling of being detached from one’s body

• Dissociative identity disorder– multiple personalities in the same person

DSM-IV Criteria for Dissociative Amnesia

• One or more episodes of inability to recall personal information; usually a trauma; too extensive for ordinary forgetfulness

• Disturbance does not occur during another disorder; not directly related to substance abuse, brain injury, or general medical condition

• Symptoms cause clinically significant distress and impairment in social, occupational, other areas of functioning

DSM-IV Criteria for Dissociative Fugue

• Predominant disturbance is sudden; unexpected travel away from home or work; inability to recall one’s past

• Confusion about personal identity or assumption of a new identity

• Is not part of another dissociative disorder, substance abuse, or medical condition

• Causes significant distress, and impairment in functioning

Treatment for Dissociative Amnesia and Fugue

• Psychologists view severe traumatic stress as the cause• Psychoanalysts focus on uncovering repressed trauma• Behaviorists focus on state-dependent learning

– Initial trauma will only be remembered under new forms of extreme stress – ethically psychologists do not create situations to severely stress clients

– Treatment focuses on stress management and prevention of future episodes of amnesia or fugue

Depersonalization Disorder

• “Self” becomes dissociated or separated from rest of personality

• Derealization: feeling the world is not real, one is living in a dream

DSM-IV Criteria for Depersonalization Disorder

• Persistent, recurring feeling detached from one’s mental processes or body; as if an observer

• During depersonalization, reality testing intact• Causes significant distress and impairment in

social, occupational, other functioning• Depersonalization not related to another disorder,

substance abuse, or medical condition

DSM-IV Criteria for Dissociative Identity Disorder

• Shares elements of the other dissociative disorders (amnesia, loss of time or unexpected travel, depersonalization, derealization)

• Symptoms appear more extreme

DSM-IV Criteria for Dissociative Identity Disorder

• Presence of two or more distinct identities or personality states

• At least two identities or personality states recurrently take control of behavior

• Inability to recall personal information; too extensive for forgetfulness

• Disturbance not due to direct physiological effects, substance abuse, or general medical condition

Dissociative Identity Disorder Facts

• Affects more women than men

• Runs in families

• Seems to be increasing

• Linked with childhood sexual abuse

• Prevalence is 3.3 percent in U.S.

Dissociative Identity Disorder Treatment

• In the past, treatment involved picking one personality and focusing on it – this did nothing to prevent new personalities from forming

• Now, treatment focuses on integrating/fusing personalities into one and teaching coping skills for dealing with stress or trauma

• Medications sometimes are used to treat comorbid anxiety or depression

• No controlled tx outcome studies exist

Somatoform Disorders

A category of psychological disorders characterized by unusual physical symptoms that occur in the absence of a known physical pathology

Somatoform Disorders• Conversion disorder

– physical symptoms usually confined to single organ/system and mimic symptoms of neurological condition

• Somatization disorder– multiple, vague, physical complaints

• Hypochondriasis– morbid preoccupation with imagined illness

• Pain disorder– preoccupation with pain

• Body dysmorphic disorder– obsessive concern with presumed defects in appearance

DSM-IV Criteria for Hypochondriasis

• Preoccupation with fears of having disease, misinterpretation of bodily symptoms

• Preoccupation persists despite medical assurances

• Fears of disease not delusional, not restricted to concern about appearance

• Preoccupation causes distress, impairment in social, occupational, other functioning

• Duration is at least 6 months

Hypochondriasis Treatment• Patient’s rarely present for Mental Health

treatment

• Explanations/Treatments vary with theory– Psychoanalysts – repressed conflict

– Family clinicians – family dynamics

– Behaviorists – reinforced learned behavior

– Cognitivists – an attributional bias (attribute everyday experiences to serious illness)

DSM-IV Criteria for Body Dysmorphic Disorder

• Preoccupation with imagined specific defects in appearance, excessiveness over slight anomaly

• Preoccupation causes distress and impairment in social, occupational, other functioning

Body Dysmorphic Disorder Facts

• Usually starts during adolescence

• Females outnumber males 3 to 1

• More common among single and divorced

adults

• Shares many characteristics with OCD

Body Dysmorphic Disorder Treatment

• Difficult to treat because clients avoid

confronting their anxiety

• Behavioral and Cognitive-behavioral

therapy, and medication (SSRI

antidepressant) have shown success.

Factitious Disorder

• Psychological disorder whereby people

feign illness to gain attention

• Munchausen’s syndrome

DSM-IV Criteria for Factitious Disorder

• Intentional production or feigning of

physical, psychological signs, symptoms

• Motivation is to assume sick role

• External incentives are absent