Somatoform and dissociative disorders
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Somatoform and Dissociative Disorders. Somatoform Disorders. Concerns with appearance or functioning of body Absence of medical condition Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder. Hypochondriasis.

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Somatoform and Dissociative Disorders

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Somatoform and dissociative disorders

Somatoform and Dissociative Disorders


Somatoform disorders

Somatoform Disorders

  • Concerns with appearance or functioning of body

  • Absence of medical condition

  • Hypochondriasis

  • Somatization Disorder

  • Conversion Disorder

  • Pain Disorder

  • Body Dysmorphic Disorder


Hypochondriasis

Hypochondriasis

  • Anxiety over belief one has a disease, without evident cause

  • Reassurance from doctors no help, in the long-term

  • Misinterpretation of bodily signals as disease

  • Disorder realized after physician visits


Hypochondriasis statistics

Hypochondriasis - Statistics

  • Little information

    • Prevalence estimate 3%

  • Equal in men and women, age groups


Causes of hypochondriasis

Causes of Hypochondriasis

  • Enhanced sensitivity to illness cues

    • Increased awareness and fright

  • Faulty thoughts/interpretation of physical signs(cognition)

  • Context of stressful life events

    • often involving death or illness


Causes of hypochrondriasis

Causes of Hypochrondriasis

Family/genetic influences

  • Might be unspecific anxiety

  • Children report symptoms of parents

  • Disproportionate incidence of disease in family

  • Social influence

    • Attention paid to sick relatives


  • Treatment of hypochrondriasis

    Treatment of Hypochrondriasis

    • Little information regarding treatment

    • Cognitive therapy

      • Exposure to symptoms

      • Decreased reassurance seeking re: symptoms

    • Stress management program


    Somatization disorder

    History of physical complaints, occurring over years

    Result in treatment being sought or impairment

    4 pain symptoms

    2 GI symptoms

    1 sexual symptom

    1 pseudo-neurologic symptom

    Not explained by medical condition

    Complaints not intentionally produced or feigned

    Somatization Disorder


    Somatization disorder statistics

    Somatization Disorder - Statistics

    • Rare

    • Continuum

    • 20% estimated prevalence in primary care settings

    • Adolescent age of onset


    Causes and treatment

    Causes and Treatment

    • History of family illness

    • Few research studies

    • Difficult to treat


    Conversion disorder

    Conversion Disorder

    • Physical malfunctioning, suggesting neurological impairment, with no medical cause

    • E.g., blindness, paralysis

    • Rare

    • Causes - trauma

    • Insight focused treatment, identifying trauma


    Conversion disorder vs malingering

    Conversion Disorder vs. Malingering

    • Conversion patients are indifferent to symptoms

    • Precipitated by stress - 52-93% cases

    • Can function normally, but often unaware of this ability or sensory input

      • E.g., avoiding objects in visual field


    Body dysmorphic disorder

    Body Dysmorphic Disorder

    • Preoccupation with imagined defect in appearance

    • Suicidality common

    • Focused on self and defect (similar to social anxiety)

    • Can significantly disrupt life


    Body dysmorphic disorder statistics

    Body Dysmorphic Disorder - Statistics

    • Difficult to estimate prevalence

    • Chronic course

    • Often seek plastic surgery or other medical attention

      • 2% of plastic surgery patients?

    • Little information on cause


    Dissociative disorders

    Dissociative Disorders


    What is dissociation

    What is Dissociation?

    • Derealization: Losing sense of reality of the external world

    • Common to some degree for everyone (a great example of dimensionality)


    Dissociative disorders1

    Dissociative Disorders

    • Incredibly puzzling category of mental disorder

    • Disruption of normal integration of:

      • Consciousness

      • Memory

      • Perception

    • Separating from identity


    Types of dissociative disorders

    Types of Dissociative Disorders

    • Depersonalization Disorder

    • Dissociative Amnesia

    • Dissociative Fugue

    • Dissociative Trance Disorder

    • Dissociative Identity Disorder


    Dissociative amnesia

    Dissociative Amnesia

    • Loss of autobiographical memory

      • E.g. the loss of one event memory

    • Not due to brain damage

    • Usually in response to trauma (which is forgotten)

    • Spontaneous recovery

    • Prevalence unknown

    • Controversy over existence


    Dissociative fugue

    Dissociative Fugue

    • Amnesia for past + sudden moving

      • Most are not very long-term

    • Confusion re: identity

    • Assumption of a new identity

    • May last: hours to months

    • Prevalence estimated: 1 in 500

    • Usually in response to stressor


    Treating dissociative amnesia and fugue

    Treating Dissociative Amnesia and Fugue

    • Supportive therapy

    • Usually recover on own

    • Fugue often needs couples/family therapy

      • Feelings of abandonment

    • At risk of relapse when stressed

      • Preventive approaches helpful

      • Stress management skills


    Dissociative identity disorder

    Dissociative Identity Disorder

    *Formerly Multiple Personality Disorder

    • Presence of 2+ distinct identities

    • Recurrently control an individual

    • “Alters” & “Host Personality”

    • Alters & Host Personality may/may not be aware of what is going on


    Dissociative identity disorder1

    Dissociative Identity Disorder

    • Alters who are unaware have lapses in memory unaccounted for

    • Own constellation of behavior, voice tone, gestures

    • Different reactions to medications, eyeglass prescriptions

    • May claim to be different in age, gender, race, family history


    Alters awareness of each other

    Alters’ Awareness of Each Other

    • Mutually amnesic

    • Mutually cognizant

    • One-way amnesic


    Dissociative identity disorder2

    Dissociative Identity Disorder

    • Preceded by headaches

    • Rare: 1% of general population

    • Few believe prevalence is that high

    • Higher rates of diagnosis?

      • Better identification?

      • Overused?

      • Iatrogenic?


    Dissociative identity disorder3

    Dissociative Identity Disorder

    • Course is unpredictable and varies

    • May be long time b/w treatment & diagnosis (e.g. 6-7 years)

    • Little insight


    What causes dissociative disorders

    What Causes Dissociative Disorders?

    • Trauma (child abuse, etc)

    • Child abuse as first onset -> coping in children

      • Massive repression

    • Commonly report child abuse

      • 90% of patients report child abuse


    Problems with trauma dissociation

    Problems with Trauma & Dissociation

    • Reports are

      • Self-report

      • Retrospective

    • 1/3 report abuse prior to age 3

    • Autobiographical memory rarely accurate before 5

    • Why no evidence of alters during childhood?


    Causes of dissociative disorders

    Causes of Dissociative Disorders

    • Suggestibility

      • How are people who develop dissociative disorders different from those who develop PTSD?

      • Those who develop are better @ dissociating

    • Suggestibility = personality trait re: ease of accepting ideas proposed by others


    Suggestibility

    Suggestibility

    • Highly suggestible people:

      • Have more detailed fantasy lives

      • Respond more dramatically to hypnosis

    • The Autohypnotic Model of DID

      • Select people use self-hypnosis as defense against emotional trauma

      • Retreat into a trance during trauma that is protective and provides amnesia


    Autohypnotic model of did

    Autohypnotic Model of DID

    Trauma

    (Repeated)

    Self-hypnosis

    Alters

    Form

    Suggestible

    Personality


    Flaws in the autohypnotic model

    Flaws in the Autohypnotic Model

    • Why develop only with abuse?

      • Not war related. Not in bullying

      • Involves a betrayal of trust?

    • How exactly do alters develop from hypnotic state?

    • May be little/no evidence of alters until adulthood


    Neurobiology did

    Neurobiology & DID

    • Neurobiology seems to support multiple, distinct states of awareness in one brain

    • Changes in skin conductance, heartbeat

    • Allergies

    • Endocrine function


    Trauma narratives did simone reinders university of groningen

    Trauma Narratives & DID (Simone Reinders, University of Groningen)

    • 11 DID patients - story from life (traumatic vs. nontraumatic)

    • Recording of subjective & biological reactions


    Somatoform and dissociative disorders

    Neutral Personality

    Reacted as if neutral memory

    Claimed not to remember

    Trauma Personality

    Subjective and cardiovascular reaction

    Different brain activation pattern

    Reported memory of event


    Neurobiological differences waldvogel ullrich strasburger munich germany

    Neurobiological Differences (Waldvogel, Ullrich, Strasburger, Munich Germany)

    • Case study of dissociated patient with 15-years of blind male alter

    • Sighted personality = EEG reaction to checkerboard pattern

    • Reduced visual activity in “blind” personality

    • Neurobiological summary: DID is a lack of integration, cohesiveness?


    Treating did

    Treating DID

    • No controlled treatment studies

    • Agree: People cannot function well with alters

    • Disagree: How to integrate alters

    • Identify & map alters, then integrate

    • Mapping alters may create more?

    • Others argue - ignore, and will go away


    Treating did1

    Treating DID

    • Important to establish trust

      • Usually unsuccessful treatment history

      • Secretive about symptoms

      • Skepticism from other providers


    Culture and did

    Culture and DID

    • Rare until late 1980s

      • 1st case 1817, by 1960s lit review = 77 cases

      • 1970s = 300 cases, doubled in 1980s

      • Why the rapid increase? Is it real?

    • Increase is largely North American

      • Rare in France, where theorists played a big role


    Controversies surrounding did

    Controversies Surrounding DID

    • Could Therapists Shape DID?

    • Sociocognitive model of DID (Spanos)

      • Symptoms shaped by available info & therapist responses

      • To avoid responsibility?

      • Interest due to rarity

      • Normal social reinforcement

      • Ignore to treat


    Controversies surrounding did1

    Controversies Surrounding DID

    • Recovered Memories

    • Use recovered memory techniques to assess

    • People repress painful memories of abuse

    • Therapists encourage recovery of memory


    Evidence against recovered memories

    Evidence Against Recovered Memories

    • Little scientific evidence for repressed memories

    • Can implant false memories in children/adults

    • Techniques used to implant same as therapists use to “recover”


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