Dissociative and Somatoform Disorders

1. 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

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

3. 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

4. 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

5. 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

6. 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

7. Depersonalization Disorder • “Self” becomes dissociated or separated from rest of personality • Derealization: feeling the world is not real, one is living in a dream

8. 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

9. 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

10. 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

11. 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.

12. 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

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

14. 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

15. 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

16. 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)

17. 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

18. 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

19. 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.

20. Factitious Disorder • Psychological disorder whereby people feign illness to gain attention • Munchausen’s syndrome

21. 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