DISSOCIATIVE AND

SOMATOFORM DISORDERS

DISSOCIATIVE DISORDERS

Are a fascinating group of disorders in which individual’s identity, memories, and consciousness become separated, or dissociated, from one another.

People with dissociative identity disorders develop multiple separate personalities, which alternate in their control over individual’s behavior. Each personality may be amnesic for the others.

KEY FEATURES OF DISSOCIATIVE DISORDERS

DISORDERDISSOCIATIVE IDENTITY DISORDERS

DISSOCIATIVE FUGUE

KEY FEATURES There are separate, multiple

personalities in the individual. The personalities may be aware of each other or may have amnesia for each other.

The person moves away and assumes a new identity, with amnesia for the previous identity. There is no switching among personalities, as there is dissociative identity disorder

DISSOCIATIVE AMNESIA

DEPERSONALIZATION DISORDERS

The person loses memory of important personal facts, including personal identity with no apparent organic causes.

There are frequent episodes in which the individual feels detached from his or her mental state or body. The person does nor develop new identities or have amnesia for these episodes.

FUGUE A person in the midst of this disorder will suddenly

pick up and move to a new place, assume a new identity, and have no memory for his previous identity. He will behave quiet normally in his new environment, and it will not seem odd to him that he cannot remember anything from his past.

Some , but not all, person who experience fugue episodes do so after traumatic events. It seems to escape from chronic stress in their lives, typically depressed and actually leaves the scene of the trauma.

Fugue states appear to be more common among people who have histories of amnesia, including amnesia due to injuries.

DISSOCIATIVE IDENTITY DISORDERS

formerly known as Multiple Personality Disorder person with DID often engage in self-destructive and

multiple behaviors. The vast majority of diagnosed cases of dissociative

identity disorder are women, and recent cases tend to have histories of childhood sexual or physical abuse.

The alternate personalities, or alters, can be extremely different from one another, with distinct facial expressions, speech characteristics, physiological responses, gestures, interpersonal styles, and attitude

There are some differences between the characteristics of the personalities of males and females with DID.

Males with DID are more aggressive than females. In one study 29 % of male DID patients have been convicted of crimes, compared with 10% female DID patients.

Case reports suggest that females with DID tend to have more somatic complaints than do males and may engage to suicidal behavior.

SYMPTOMS: The cardinal symptoms of DID in the presence

of multiple personalities with distinct qualities, referred to as alters.

Child alters- maybe created during a traumatic experience to become the victim the of trauma, while the “host” personality escapes into the protection of psychological oblivion.

When the child alter is “out” or in control of the individual’s behavior the adult may speak and act in a childlike way.

The second type of alter that is very frequent is the Prosecutor Personality.

these alters inflict pain or punishment on the other personalities by engaging in self-mutilative behaviors, such as self-cutting or burning and suicide attempts.

a prosecutor alter may engage in a dangerous behavior, such as taking an overdose of pills or jumping in front of a truck, and then “go back inside”, leaving the host personality to experience the pain.

a third type of alters is the protector, or helper, personality the function of this personality is to offer advice to other personalities or to perform functions the host personality unable to perform, such as engaging in sexual relations or hiding from abusive parents.

Helpers sometimes control the switching from one personality to another or act as passive observers who can report on the thoughts and intentions of all the other personalities.

people with DID typically claim to have a significant periods of amnesia or blank spells.

They describe being completely amnesic for the periods when the other personalities are in control.

Self-destructive behavior is very common among people with DID and is often the reason they seek or taken for treatment.

this behavior includes self-inflicted burns, or other injuries, wrist slashing, and overdoses.

about three- quarters of patients with DID have a history of suicide attempts, and over 90% report recurrent suicidal thoughts.

Children with DID exhibit lost of behavior and emotional problems. Their performance in school may be erratic, sometimes very good sometimes very poor.

they are prone to antisocial behavior, such as stealing, fire-setting, and aggression. They may engage in sexual relations and abuse alcohol or illicit drugs at an early age.

Most children and adults with DID tend to show many symptoms of PTSD (Post Traumatic Stress Disorder) including hyper-vigilance, flashbacks to traumas they have endured, traumatic nightmares, and exaggerated startle response. Their emotions are unstable, alternating among explosive outburst of anger, deep depression and severe anxiety.

DID children and adults report hearing voices inside their heads. Some report being aware that their actions or words are being controlled by other personalities. For example, Rea an 12 year old girl with DID described how “a person inside of me” called B.R. (for Bad Rea) would make her do “bad things.”

TREATMENT OF DISSOCIATIVE IDENTITY DISORDER

The treatment of DID can be extremely challenging. The goal of treatment is the integration of all the alter personalities into coherent personality.

this is done by identifying the functions or roles of each personality confront and work through the traumas that led to the disorder and the concerns each one has or represents, as well as negotiating with the personalities for fusion into one personality who has learned adaptive styles of coping with stress.

Hypnosis is used heavily in the treatment of DID to contacts the alters.

It is often necessary to work with their parents to improve the family life of the patient, and it is necessary to remove the patient from the abusive homes.

SOMATOFORM DISORDERS SOMATOFORM DISORDERS are group of disorders

in which people experience significant physical symptoms for which there is no apparent organic cause.

these symptoms are inconsistent with possible physiological mechanisms, and there is a strong reason to believe that psychological factors are involved..

People with somatoform disorders do not produce or control the symptoms. Instead, they truly experience the symptoms and it only pass when the psychological factors that led to the symptoms are resolved.

one of the great difficulties in diagnosing somatoform disorders is the possibility that an individual has a real physical disorder that is simply difficult to detect or diagnose.

Many of us have friends or relatives who have complained to their physicians for years about specific physical symptoms, which the physician attributed to “nervousness” or “attention seeking” but which later determined to be early symptoms of serious disease.

the diagnosis of somatoform disorder is made easier when psychological factors leading to the development of the symptoms cannot physiological possible.

Example a child who is perfectly healthy on weekends but has terrible stomachaches in the morning just before going to school, it is possible that the stomachaches are due to distress over going to school. A extreme example of a clear somatoform disorder is pseudocyesis, or false pregnancy but physician examination and laboratory test confirm that she is not.

• DISTINCTION BETWEEN SOMATOFORM AND PAIN DISORDERS AND RELATED SYNDROMES

PSYCHOSOMATIC DISORDERS

SOMATOFORM AND PAIN DISORDERS

MALINGERING

have an actual physical illness or defect, such as high blood pressure, that can be documented with medical test that is being worsen by psychological factors.

subjective experience of many physical symptoms, with no organic cause.

deliberate faking of physical symptoms to avoid unpleasant situation (allibi), such as duty or obligation

FACTITIOUS DISORDERSOMATOFORM DISORDERS:

CONVERSION DISORDE

SOMATIZATION DISORDERS

about pain for which no medical attention has been sought but the Deliberate faking of physical illness to gain medical attention.

KEY FEATURES

Loss of functioning in a part of the body for psychological rather than physical reasons example; paralysis, blindness, mutism, seizures, loss of hearing severe loss of coordination and anesthesia in the limb.

Has a long history of complaints about physical symptoms, affecting many different areas of the body, for which medical attention has been sought but that appear to have no physical cause. The most common complaints are headaches, pain in the chest, abdomen, and back.

PAIN DISORDER

HYPOCHONDRIASIS

History of complaints about pain for which medical attention has been sought but that appears to have no physical cause. People who complain only of chronic pain maybe given the diagnosis of pain disorder

Chronic worry that one has a physical disease in the absence of evidence that one does; frequent seeking of medical attention. For example a man may be totally convinced that he has heart disease, even though the most sophisticated medical diagnostic test s have shown no evidence of heart disease.

BODY DYSMORPHIC DISORDER

Excessive preoccupation with a part of the body the persons believe is defective. Men and women with BDD tend to obsess about different parts of their bodies. Women seem to be more concerned with their breast, legs, hips, and weight, whereas men tend to be preoccupied with a small body build, their genitals, excessive bod hair, and hair thinning. People with this disorder will spend hours looking at their “deformed” body parts, perhaps in a mirror, and will perform elaborate rituals to try to improve the parts to hide them. For example, they may spend hours styling their hair to hide their defects.

SOMATIZATION AND PAIN DISORDERS

To receive a diagnosis of somatization disorder a person has to complain of pain in at least four areas of the body including two gastrointestinal symptoms (such as nausea and diarrhea), a sexual symptoms (such as mentrual difficulties and painful intercourse), and an apparent neurological symptoms (such as double vision or paralysis). A person with somatization disorder often goes from physician to physician, looking for attention and sympathy and for the test that will prove that he or she really sick.

These complaints are usually presented in vague, dramatic, or exaggerated ways and the individual may have insisted on medical procedures, even surgeries, that clearly not necessary. As with conversion disorder, people with somatization or pain disorder may be prone to anxiety and depression that they cannot express or or cope with adaptively, and they either somatize their distress or mask the distress in alcohol

abuse or antisocial behavior.

THEORIES OF SOMATIZATION AND PAIN DISORDERS A cognitive theory of somatization and pain

disorder suggest that persons with these disorders tend to experience bodily sensation more intensely than other people, they pay more attention than others to physical symptoms, and they tend to catastrophize these symptoms.

Parents who are somatizers are also more likely to neglect their children, and the children may learn that the only way to receive care and attention is to be ill.

In general, the children of parents who are somatizers have increased vulnerability to a wide range of psychological problems, to suicide attempts, and to frequent hospitalizations.

TREATMENT OF SOMATIZATION AND PAIN DISORDERS Psychological treatment, teaches them to

express negative feelings or memories and to understand the relationship between their emotions and their physical symptoms.

Psychodynamic therapies focus on providing this insight about the connections between emotions and physical symptoms by helping people recall events and memories that may have triggered the symptoms.

Cognitive therapies help people learn to interpret their physical symptoms appropriately and to avoid catastrophizing physical symptoms.

HYPOCHONDRIASIS this is quite similar to somatization, the

primary distinction between the two disorders is that people with somatization disorder actually experience physical symptoms and seek help for them, whereas hypochondriasis worry that they have a serious disease but do not always experience severe physical symptoms.

Hypochondriasis may go through many medical procedures and float from physician to physician, sure that they have a dread disease. Often, their fear focus on a particular organ system.

People with hypochondriasis are prone to chronic depression and anxiety and have family histories of these disorders. As is the case with people who have somatization disorder, suggestions that their problems are caused by psychological factors and thus tend not to seek psychological treatment.

Treatment focuses on helping them understand the association between their symptoms and emotional distress and on helping them find more adaptive ways of coping with their distress.

BODY DYSMORPHIC DISORDER

People with this disorder are excessively preoccupied with a part of their bodies that they believe is defective.

Case studies of some people with this disorder indicate that their perceptions of deformation can be so severe and bizarre as to be considered out of touch with reality.

Body dysmorphic disorder tends to begin in the teenage years and to become chronic if untreated.

Theorist point out commonalities between body dysmorphic disorder and eating disorder, particularly of overvaluing of appearance.

TREATMENTS: Psychoanalytically oriented therapy for body

dysmorphic disorder focuses on helping clients gain insight into the real concerns behind their obsessions with a body part.

Cognitive-behavioral therapies on challenging clients’ maladaptive cognitions about the body, exposing them to feared situations concerning their body parts, and preventing compulsive responses to those body parts.

the eventual goal in therapy would be for the client’s concern about the body part to diminish totally not to affect her behavior or functioning.

Studies suggest that selective serotonin reuptake inhibitors can be effective in some cases in reducing obsessional thought and compulsive behavior in persons with disorder.

Thank you!!

Gilda Almelor Singular

MAED- Student, Guidance and Counseling