Somatoform and dissociative disorders
1 / 42

Somatoform and Dissociative Disorders - PowerPoint PPT Presentation

  • Uploaded on

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.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Somatoform and Dissociative Disorders' - sahara

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

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


  • 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

    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


    • 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








    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”