Somatoform and Dissociative Disorders

1. Somatoform and Dissociative Disorders

2. Somatoform Disorders • Somatoform disorders – Psychological problems appearing in the form of bodily symptoms or physical complaints • Conversion disorder – Somatoform disorder marked by paralysis, weakness, or loss of sensation, but with no discernable physical cause

3. Somatoform Disorders • Glove Anesthesia

4. Somatoform Disorders • Hypochondriasis – Somatoform disorder involving excessive concern about health and disease

5. Dissociative Disorders • Dissociative disorders – Group of pathologies involving “fragmentation” of the personality Dissociative amnesia Dissociativefugue Depersonalization disorder Dissociative identity disorder

6. Dissociative Disorders Dissociative amnesia • A psychologically induced loss of memory for personal information Dissociative fugue Depersonalization disorder Dissociative identity disorder

7. Dissociative amnesia • A 29-year-old female experienced the onset of dissociative amnesia during an academic trip to China.[2] She was found in a hotel bathroom unconscious, with no signs of structural or neurologic abnormalities or alcohol or chemical consumption. The woman was sent home but could not remember her name, address, family, or any facts about her home life. The amnesia persisted for nearly 10 months, until the feeling of blood on the woman's fingers triggered the recollection of events from the night of onset of dissociative amnesia, and, subsequently, other facts and events. The woman finally remembered having witnessed a murder that night in China. She recalled being unable to help the victim out of fear for her own safety. She came to remember other aspects of her life; however, some memories remain unretrievable.

8. Dissociative Disorders Dissociative amnesia • Dissociative amnesia with the addition of “flight” from one’s home, family, and job Dissociative fugue Depersonalization disorder Dissociative identity disorder

9. Dissociative fugue • Commonly, individuals who experience the onset of dissociative fugue are found wandering in a dazed or confused state, unable to recall their own identity or recognize their own relatives or daily surroundings. Often, they have suffered from some post-traumatic stress, as in the case of a 35-year-old businessman who disappeared more than 2 years after narrowly escaping from the World Trade Center attack in 2001, leaving behind his wife and children. The man was missing for more than 6 months when an anonymous tip helped police in Virginia identify him.

10. Dissociative Disorders Dissociative amnesia • Abnormality involving the sensation of mind and body having separated Dissociative Fugue Depersonalization disorder Dissociative identity disorder

11. Depersonalization disorder • Depersonalization disorder generally leads to observable distress in the affected individual. It often occurs in individuals who are also affected by some other psychological nondissociative disorder, as in the case of a 19-year-old college student who was suffering from sleep deprivation at the onset of depersonalization disorder. The young man experienced increased anxiety as he struggled to meet his responsibilities as a scholarship-dependent student athlete. Teammates expressed concern about his apparent distress to their coach who arranged for the young man to speak with a therapist. The young man described feeling as though he were observing the interactions of others as if it were a film. The young man's anxiety was determined to contribute to severe sleep deprivation, which triggered episodes of depersonalization.

12. Dissociative Disorders Dissociative amnesia • Condition in which the individual displays multiple identities Dissociative Fugue Depersonalization disorder Dissociative identity disorder

13. Dissociative identity disorder • In a case of dissociative identity disorder, a woman who had been physically and sexually abused by her father throughout her childhood and adolescence exhibited at least 4 personalities as an adult. Each personality was of a different age, representing the phases of the woman's experience – a fearful child, a rebellious teenager, a protective adult, and the woman's primary personality. Only one of the personalities, the protective adult, was consciously aware of the others, and during therapy sessions was realized to have been developed to protect the woman during the abusive experiences. When one of the secondary personalities took over, it often led to episodic dissociative amnesia, during which the woman acted out according to the nature of the dominating personality. During intensive therapy sessions, each personality was called upon as necessary to facilitate their integration.