Somatoform & dissociative disorders

Somatoform & Dissociative Disorders

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Somatoform Disorders

Characterized by a pathological concern with physical functioning or appearance

Soma means “body”, and problem preoccupying an individual seem, initially to be physical orders

DSM-5 Proposal: to change to “Somatic Symptom Disorders” to include other psychologcial disorders affecting medical conditions


characterized by anxiety or fear that one has a serious disease

Ancient root (Greeks): it has something to do

with hypochondria, a region below the

ribs wherein organs that can be found in

this region can affect mental state

1. Hypochondriasis

Somatoform DisordersHypochondriasis

- Severe anxiety over physical problems that are medically undetectable

- Affects men and women equally- May emerge at any age- Comorbid w/ Anxiety & Mood disorders- Course: Chronic- Evident in diverse cultures


CULTURE-SPECIFIC SYNDROMES THAT FIT WITH HYPOCHONDRIASIS

• Koro: belief, accompanied by severe anxiety and sometimes panic, that the genitals are retracting into the abdomen [mostly Chinese males]

• Dhat: associated w/ vague mix of physical symptoms, including dizziness, weakness and fatigue that are not so specific


Faulty interpretation of

physical sensations

Intensified focus on symptoms

Increased anxiety

Additional physical

symptoms

CAUSES


Explanatory therapy

Cognitive-behavioral treatment to challenge illness perception

Counseling and/or support groups to provide reassurance

TREATMENT


Formerly known as Briquet’s syndrome [for more than 100 yrs] and was changed in 1980 to somatization disorder

2. Somatization disorder

- Reports of multiple physical symptoms without medical basis

- Runs in families (probable heritable basis)- Rare (most prevalent among unmarried

women low in socioeconomic groups)- Onset usually in adolescence; often

persists into old age

Somatoform DisordersSomatization Disorder

Continual development

of new symptoms

Immediate sympathy and

attention

Eventual social isolation

CAUSES

Somatoform DisordersSomatization Disorder

Hard to treat!

Cognitive-behavioral therapy to provide reassurace, reduce stress, and minimize help-seeking behaviors

Therapy to broaden basis for relating to others

TREATMENT


Refers to pain in one or more sites in the body that is associated with significant distress or impairment

3. Pain disorder

There may have been physical reasons for pain but psychological

factors play a major role in maintaining it.


Generally have to do with physical malfunctioning, such as paralysis, blindness or difficulty speaking, without any physical or organic pathology to account for malfunctionDSM-5 Proposal: Functional Neurological Disorder

4. Conversion disorder

The term was used by Freud who believed that anxiety resulting from unconscious conflicts

somehow was “converted” into physical

symptoms to find expression

Somatoform DisordersConversion disorder

- Comorbid with: Anxiety & Mood disorders

- Coincide with somatization disorders

- Affected people are genuinely unaware that they can function normally

- Most prevalent in low socio-economic groups, primarily in women and also in men under extreme stress


Life stresses or psychological

conflict

Reduced by incapacitating

symptoms

Social influences (symptoms learned from observing real

illness or injury)

CAUSES


Same as for somatization disorder, with emphasis on resolving life stress or conflict and reducing help-seeking behaviors

CBT & Catharsis

TREATMENT


Features a disruptive preoccupation with some imagined defect in appearance (imagined ugliness) by someone who actually looks reasonably normal. This was previously known as dysmorphobia.

5. Body Dysmorphic Disorder

- Prevalence is not known- Affects men and women equally- Associated with obsessive-compulsive

disorder

Somatoform DisordersBody Dysmorphic Disorder

Intrusive, anxiety-provoking idea that

individual has a physical defect apparent to

everyone

Intensified focus on imagined defects accompanied by

extreme self-consciousness

Increased anxiety

Pathological attempts to “fix” the problem that

prevents a more reality-based appraisal of the

defect

CAUSES

Somatoform DisordersBody Dysmorphic Disorder

CBT Treatments seem most effective

Drug treatments can provide relief for some sufferers

Without treatment, BDD lasts a lifetime

TREATMENT

Dissociative Disorders

Disorder in which individuals feel detached from themselves (depersonalization) or their surroundings and reality (derealization), experience and identity may disintegrate

Influence of social and cultural factors is strong in dissociative disorders


1. Depersonalization disorder- Severe and frightening feelings of

detachment dominate the person’s life- Causes significant distress or impairment in

functioning, especially emotional expression and deficits in perception

- Some symptoms are similar to those of panic disorder

- Rare; onset usually in adolescence


Psychological treatments similar to those for panic disorder may help

Stresses associated with onset or disorder should be addressed

Tends to be lifelong

TREATMENT

DepersonalizationDisorder


2. Dissociative AmnesiaFeatures the inability to recall personal information, usually of a stressful and traumatic nature; adult onset

*Generalized amnesia

-inability to remember anything including identity, comparatively rare

(lifelong or may extend from a

period in the more recent past)

*Localized or selective amnesia-failure to recall specific events,

usually traumatic, that occur a specific period; frequently

occurs in war (more common than

general amnesia)


Usually self-correcting when current life stress is resolved

If needed, therapy focuses on retrieving lost information

TREATMENT

Dissociative Amnesia


3. Dissociative FugueFeatures sudden, unexpected travel away from home, along with an inability to recall the past

-sometimes with assumption of a new identity or confusion about an old identity-fugue states usually end abruptly-typically adult onset and may continue in old age


Usually self-correcting when current life stress is resolved

If needed, therapy focuses on retrieving lost information

TREATMENT

Dissociative Fugue


4. Dissociative Trance Disorder (DTD)

Features altered state of consciousness in which

people firmly believe they are possessed by spirits;

considered only a disorder when there is distress and

dysfunctionDSM-5 Proposal: Diagnose DTD as a subtype of DID


- Sudden changes in personality accompany a trance or possession

- Causes significant distress and/or impairment in functioning

- Often associated with stress or trauma

- Prevalent worldwide, usually in a religious context; rare in western cultures

- More common in women than in men

Dissociative Trance Disorder


5. Dissociative Identity Disorder (DID)

Formerly known as multiple personality disorder; a disorder

in which as many as 100 personalities or fragments of

personalities coexist within one body and mind


- Affected person adopts new identities, or alters that coexist simultaneously

- Average no. of alters is 15 (*alters: diff. identities)

- Childhood onset; affects more women than men

- Rare outside of western culture- Patients often suffer from other

psychological disorders simultaneously

Dissociative Identity Disorder

Dissociative DisordersDissociative Identity Disorder Severe abuse during

childhood*Fantasy life is only

“escape”*Practice becomes automatic and then

involuntary

High suggestibility a possible trait

Biological vulnerability likely

Similar etiology to posttraumatic stress disorder

CAUSES

Dissociative DisordersDissociative Identity Disorder

Long-term psychotherapy may reintegrate separate personalities in 25% patients

Treatment of associated trauma similar to posttraumatic stress disorder

Lifelong condition without treatment

TREATMENT

Health & Medicine

Somatoform & dissociative disorders