Schizophrenia Diagnosis Two or more symptoms for most of the time during 1 month period (less if treated successfully) Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms Social/occupation dysfunction Continuous signs of disturbance for at least 6 months:1 month of symptoms plus 5 months of prodromal or residual periods (usually negative sx) Prodromal – gradual decline prior to active phase

Somatoform & Dissociative Disorders Chapter 6

An Overview of Somatoform Disorders Extreme Body Concerns Appearance or functioning of body No known medical condition Types of DSM-IV Somatoform Disorders Hypochondriasis Somatization disorder Conversion disorder Pain Disorder Body Dysmorphic Disorder

Hypochondriasis Preoccupation with fear that have serious disease or physical condition Preoccupied persists despite medical reassurance Misinterpretation of bodily cues and function Little data, but occurs 1-3% with #men=#women Onset in adolescence, age 40-50, and after 60

Somatization Disorder Multiple physical complaints and symptoms Before age 30 multiple physical complaints, impaired functioning, medical treatment sought, but no medical basis Multiple symptoms: 4 pain sx + 2 gastrointestinal sx + 1 sexual sx + 1 pseudoneurological sx (double vision) Preoccupied with physical condition Little data – very rare, typically starts in adolescence, more common in women

Conversion Disorder Voluntary motor or sensory function suggests neurological or medical condition, but no medical condition exists Stress and other conflicts precede onset Distress or impairment Paralysis, blindness, seizures Rare, but often occurs with somatization disorder Onset in adolescence or early adulthood, more common in women

Conversion Disorder Related Disorders Malingering – faking to gain something (disability payments) Factitious disorders – voluntary control of symptoms, only purpose appears to be gaining attention, fill illness role Factitious or Munchausen by proxy – fake/cause illness in another while take on the caretaker role

Pain Disorder Serious pain in 1 or more areas Psychological factors play role in onset, severity, exacerbation, maintenance of pain Not faking pain Often follows actual medical condition that causes pain; when healed, pain persists

Body Dysmorphic Disorder Preoccupied with imagined defect in appearance or serious exaggeration of minor physical anomaly Significant distress, impaired functioning Distinct from distorted body image in eating disorders Little data on prevalence, but appears to be a lifelong problem with severe impairment, distress, and possible negative consequences (multiple surgeries, attempts to correct themselves)

Causes Biological – runs in families, but not clear whether inherit personality or other traits, limited data Psychological Stress or traumatic event usually precedes Overly sensitive to bodily cues – may be modeled Misinterpretation of physical sensations – bias in perceiving threat/danger Unconscious processes and anxiety/trauma (Freud) Cultural differences – distinguish cultural practices from disorders

Treatment Little data on treatment effectiveness, most with hypochondriasis, somatization & conversion disorder Cognitive Behavior Therapy Identify and challenge misinterpretation of cues Learn to produce own physical symptoms (control) Coach to seek less reassurance May add general stress management techniques Scheduled visits to medical facilities Address traumatic event Reduce/remove secondary gain (attention, disability

Treatment cont’d Body dysmorphic disorder – SSRIs and exposure & response prevention

Dissociative Disorders Depersonalization Disorder Feeling detached from own body or mind (in a dream) Dissociative Amnesia Generalized amnesia – lose all memory, including own identity Localized, selective amnesia – lose memory of specific events (usually traumatic) during particular period of time Dissociative Fugue Unexpected travel associated with loss of memory Lose memory of own past, may assume new identity Dissociative Trance Disorder Trance or possession with undesirable state; in nonWestern cultures

Dissociative Identity Disorder Multiple personalities, identities or “alters” At least 2 distinct identities with own pattern take control of person’s behavior Unable to recall important information Onset usually in childhood, average 15 personalities Prevalence.5 to 1% Characteristic that are highly suggestible

Causes Biological vulnerability? Twin studies do not support genetic vulnerability to DID Psychological factors Trauma is precipitating event; repeated trauma or extreme trauma for DID Suggestibility or ability to autohypnotize False memories

Treatment Amnesia & Fugue Usually get better on their own May help recall events or present information and help integrate into conscious experience Hypnosis and benzodiazepines to aid in recall of events DID No controlled studies of treatment, limited success Exposure treatment using PTSD model, extinguish cues triggering anxiety and dissociation May use hypnosis to bring memories into conscious awareness