Somatoform and Dissociative Disorders

Somatoform Disorders Somatoform Disorders- Conditions involving physical complaints of disabilities that occur without any evidence of physical pathology to account for them. Somatoform Disorders- Conditions involving physical complaints of disabilities that occur without any evidence of physical pathology to account for them. Somatization Disorder Somatization Disorder Hypochondriasis Hypochondriasis Pain Disorder Pain Disorder Conversion Disorder Conversion Disorder

Somatization Disorder Characteristics include Characteristics include Multiple complaints and ailments that extend over a long period beginning before age 30 Multiple complaints and ailments that extend over a long period beginning before age 30 These complaints are not explained by physical illness or injury. These complaints are not explained by physical illness or injury. Must include four levels of symptoms Must include four levels of symptoms Four pain symptoms (different areas of body) Four pain symptoms (different areas of body) Two gastrointestinal symptoms (nausea, bloating) Two gastrointestinal symptoms (nausea, bloating) One sexual symptom (sexual dysfunction / irregularity) One sexual symptom (sexual dysfunction / irregularity) One pseudoneurological symptom (sensory loss) One pseudoneurological symptom (sensory loss)

Somatization Disorder II Up to 10x more common in females Up to 10x more common in females Evidence is linked with some genetic factors. Evidence is linked with some genetic factors. Possibly the underlying etiology is expressed differently in females and males. These being somatization and antisocial behavior respectively. Possibly the underlying etiology is expressed differently in females and males. These being somatization and antisocial behavior respectively. Evidence is linked to family disoganization such as abuse Evidence is linked to family disoganization such as abuse

Hypochandriasis Differentiation from Somatization Disorder Differentiation from Somatization Disorder Onset may be after age 30 Onset may be after age 30 Focus on having a disease rather than symptoms Focus on having a disease rather than symptoms Unrealistic fears of disease Unrealistic fears of disease Difficulty in describing exact symptoms (general) Difficulty in describing exact symptoms (general) Mental orientation of alertness for new symptoms Mental orientation of alertness for new symptoms Focus on remedies and studying different diseases. Focus on remedies and studying different diseases. Lack of intense fear normally associated with having their feared disease Lack of intense fear normally associated with having their feared disease Has a 4-9% prevalence in medical practices Has a 4-9% prevalence in medical practices Malingering- consciously faking symptoms to achieve a nonmedical goal. Malingering- consciously faking symptoms to achieve a nonmedical goal.

Hypochandriasis Theories Theories Interpersonal Interpersonal I deserve more attention I deserve more attention Don’t expect as much from me as a person Don’t expect as much from me as a person Maintanence by physicians rejection Maintanence by physicians rejection Abuse and Trauma as children Abuse and Trauma as children

Pain Disorder A somatoform Disorder characterized by reported pain of sufficient duration and severity to cause significant life disruption and the absence of medical pathology that would explain the experienced pain. A somatoform Disorder characterized by reported pain of sufficient duration and severity to cause significant life disruption and the absence of medical pathology that would explain the experienced pain. Subjectivity of Pain Subjectivity of Pain

Conversion Disorder A somatoform disorder in which symptoms of some physical malfunction or loss of control appear without any underlying organic pathology; originally called hysteria. A somatoform disorder in which symptoms of some physical malfunction or loss of control appear without any underlying organic pathology; originally called hysteria. Secondary gain or excuse enabling escape or avoidance of an intolerably stressful situation. Secondary gain or excuse enabling escape or avoidance of an intolerably stressful situation.

Treatment of Somatoform Disorders Caution against medication Caution against medication Support, reassurance, explanations etc.. Support, reassurance, explanations etc.. Prognosis generally poor Prognosis generally poor

Dissociative Disorders Dissociative Amnesia Dissociative Amnesia Memory loss following a stressful experience Memory loss following a stressful experience Dissociative Fugue Dissociative Fugue Memory loss accompanied by leaving home and establishing a new identity Memory loss accompanied by leaving home and establishing a new identity Depersonalization Disorder Depersonalization Disorder Experience of the self is altered Experience of the self is altered Dissociative Identity Disorder Dissociative Identity Disorder At least two distinct ego states At least two distinct ego states

Dissociative Amnesia Unable to recall important information usually of a traumatic or stressful nature Unable to recall important information usually of a traumatic or stressful nature Amnestic episode- forgotten period Amnestic episode- forgotten period Dissociative amnesia may be: Dissociative amnesia may be: localized –losses all memory within a period of time (most common) localized –losses all memory within a period of time (most common) selective- remember some but not all selective- remember some but not all generalized- may forget identity generalized- may forget identity Continuous- unlike others there is not an end Continuous- unlike others there is not an end

Dissociative Amnesia (Cont) Interference is primarily with episodic memory (ones autobiographical memory) while semantic memory (facts) remains intact Interference is primarily with episodic memory (ones autobiographical memory) while semantic memory (facts) remains intact

Dissociative Fugue Forget personal details, identity, and flee to an entirely new location Forget personal details, identity, and flee to an entirely new location Tend to end abruptly Tend to end abruptly Majority regain most of memories without a recurrence Majority regain most of memories without a recurrence Must face consequences of their fugue Must face consequences of their fugue Illegal or violent activity etc… Illegal or violent activity etc…

Dissociative Identity Disorder Develop two or more distinct personalities (subpersonalities or alternate personalities) Develop two or more distinct personalities (subpersonalities or alternate personalities) Switching- transition from one subpersonality to another Switching- transition from one subpersonality to another Primary or Host Personality- that personality which appears most often Primary or Host Personality- that personality which appears most often 97% of cases are thought to have experienced abuse 97% of cases are thought to have experienced abuse

Women are diagnosed 3 times as often as men Women are diagnosed 3 times as often as men Subpersonality Interaction Subpersonality Interaction Mutual Amnesia- no awareness of alters Mutual Amnesia- no awareness of alters Cognizant- each alter is aware of the other (hear each others voices and talk among themselves) Cognizant- each alter is aware of the other (hear each others voices and talk among themselves) One-way Amnesic- some are aware of others without them being aware of them (most common) One-way Amnesic- some are aware of others without them being aware of them (most common) Co-conscious- quiet observers with no interaction Co-conscious- quiet observers with no interaction

How do subpersonalities differ How do subpersonalities differ Vital statistics (age, sex, family history, race) Vital statistics (age, sex, family history, race) Abilities and Preferences Abilities and Preferences Evidence suggests different physiological responses Evidence suggests different physiological responses Iatrogenic- unintentionally produced by practitioners Iatrogenic- unintentionally produced by practitioners 100 cases in 1973 and now thousands 100 cases in 1973 and now thousands Increase due to 1) belief that it exists and 2) diagnostic procedures tend to be more accurate Increase due to 1) belief that it exists and 2) diagnostic procedures tend to be more accurate

Etiology / Explanations Psychodynamic Psychodynamic Caused by excessive memory repression Caused by excessive memory repression Behavioral Behavioral Operant conditioning in which forgetting is reinforced by drop in anxiety Operant conditioning in which forgetting is reinforced by drop in anxiety State-Dependent Learning State-Dependent Learning Extremely rigid state-to-memory links Extremely rigid state-to-memory links Self-Hypnosis Self-Hypnosis Self induced hypnotic amnesia Self induced hypnotic amnesia

Treatments for Dissociative Amnesia and Fugues Psychodynamic therapy Psychodynamic therapy Hypnotic therapy Hypnotic therapy Drug therapy Drug therapy Sodium pentobarbital (“truth serums”). Medication decreases inhibitions making recall more likely but may forget again upon awake. Sodium pentobarbital (“truth serums”). Medication decreases inhibitions making recall more likely but may forget again upon awake. All focus on uncovering memories All focus on uncovering memories

Treatment Dissociative Dissociative Disorder Three Major Goals Three Major Goals 1) Help recognize fully the nature of their disorder 1) Help recognize fully the nature of their disorder 2) Recover gaps in their memory 2) Recover gaps in their memory 3) Integrate their personalities into one functioning personality 3) Integrate their personalities into one functioning personality Fusion- final merging of 2 or more alters Fusion- final merging of 2 or more alters

Goal is integration Goal is integration Help each alter to understand they are part of one person Help each alter to understand they are part of one person Use alters names for convenience not to confirm existence of separate autonomy Use alters names for convenience not to confirm existence of separate autonomy All alters should be treated with fairness All alters should be treated with fairness Encourage empathy amongst the alters Encourage empathy amongst the alters Gentleness and supportiveness are needed in consideration of childhood traumas Gentleness and supportiveness are needed in consideration of childhood traumas