Somatoform and Dissociative DisordersChapter 5

Basic definitionsSomatoform disorderspathological concern of individuals with the appearance or functioning of their bodies when there is no identifiable medical condition causing the physical complaintsDissociative disordersindividuals feel detached from themselves or their surroundings, and reality, experience, and identity may disintegrateHistorically, both somatoform and dissociative disorders used to be categorized as hysterical neurosisin psychoanalytic theory neurotic disorders result from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms

Somatoform DisordersSoma Meaning BodyPreoccupation with health and/or body appearance and functioningNo identifiable medical condition causing the physical complaintsTypes of DSM-IV Somatoform DisordersHypochondriasisSomatization disorderConversion disorderPain disorderBody dysmorphic disorder

Somatoform DisordersHypochondriasissevere anxiety focused on the possibility of having a serious disease shares age of onset, personality characteristics anf running in families with panic disorder illness phobia vs. hypochondriasis60% of patients with illness phobia develop hypochondriasis1% to 14% of medical patientstreatment usually invoves cognitive-behavioral therapy and general stress management treatment (gain retained after 1 year follow-up)

Somatoform DisordersCauses of hypochondriasis

Somatoform DisordersSomatization disorderBriquets syndrome (100 years ago)patients have a history of many physical complaints that can not be explained by a medical condition, the complaints are not intentionally produced20% of patients in primary care settingdevelops during adolescence (majority women)may be connected to Antisocial personality disorderdifficult to treat (reassurance, stress reduction, more adoptive methods of interacting with family are encouraged)

Somatoform DisordersConversion DisorderPhysical malfunctioning without any physical or organic pathologyMalfunctioning often involves sensory-motor areasPersons show la belle indifferenceRetain most normal functions, but without awareness of this abilityStatisticsRare condition, with a chronic intermittent courseSeen primarily in females, with onset usually in adolescenceNot uncommon in some cultural and/or religious groups

Somatoform DisordersConversion disorder (cont.)Freudian psychodynamic view is still popular (anxiety converted into physical symptoms)Emphasis on the role of trauma (stress), conversion, and primary/secondary gainDetachment from the trauma and negative reinforcement seem criticalDifferent from factitious disorder (intentional)TreatmentSimilar to somatization disorderCore strategy is attending to the traumaRemove sources of secondary gainReduce supportive consequences of talk about physical symptoms

Somatoform DisordersBody Dysmorphic Disorder Preoccupation with imagined defect in appearanceEither fixation or avoidance of mirrorsPreviously known as dysmorphophobiaSuicidal ideation and behavior are commonOften display ideas of reference for imagined defectStatisticsMore common than previously thoughtUsually runs a lifelong chronic courseSeen equally in males and females, with onset usually in early 20sMost remain single, and many seek out plastic surgeons

Somatoform DisordersBody Dysmorphic Disorder (cont.)CausesLittle is known Disorder tends to run in familiesShares similarities with obsessive-compulsive disorderTreatmentTreatment parallels that for obsessive compulsive disorderMedications (i.e., SSRIs) that work for OCD provide some reliefExposure and response prevention are also helpfulPlastic surgery is often unhelpful

Dissociative DisordersDerealizationLoss of sense of the reality of the external worldDepersonalizationLoss of sense of your own reality5 typesDepesonalization disorderDissociative amnesiaDissociative fugueDissociative trance disorderDissociative identity disorder

Dissociative DisordersDepersonalization disorderSevere feelings of depersonalization dominate the individuals life and prevent normal functioningIt is chronic50% suffer from additional mood and anxiety disordersCognitive profile (cognitive deficits in attention, STM, spatial reasoning, perception (3D))

Dissociative DisordersDissociative AmnesiaInability to recall personal information, usually of a stressful or traumatic natureGeneralized vs. selective amnesiaDissociative FugueSudden, unexpected travel away from home, along with an inability to recall ones past (new identity)Occur in adulthood and usually end abruptly

Dissociative DisordersDissociative trance disorderAltered state of consciousness in which the person believes firmly that he or she is possessed by spirits; considered a disorder only where there is distress and dysfunctionTrance and possession are a common part of some traditional religious and cultural practices and are not considered abnormal in that contextOnly undesirable trance considered pathological within that culture is characterized as disorder

Dissociative DisordersDissociative Identity DisorderFormerly multiple personality disorderMany personalities (alters) or fragments of personalities coexist within one bodyThe personalities or fragments are dissociatedSwitch (transition form one personality to another, includes physical changes)Can be simulated by malingers are usually eager to demonstrate their symptoms whereas individuals with DID attempt to hide symptomsVery high comorbidityPrevalence about 3%

Dissociative DisordersDissociative Identity DisorderAuditory hallucinations (coming from inside their heads)97% severe child abuseExtreme subtype of PTSDOnset approximately 9 yearsSuggestible people may use dissociation as defense against severe traumaReal and false memoriesTemporal lobe pathology (out of body experiences)

Dissociative DisordersTreatmentDissociative amnesia and fugueGet better on their ownCoping mechanisms to prevent future episodesDIDReintegration of identitiesNeutralization of cuesConfrontation of early traumahypnosis