Chapter 5 Somatoform and Dissociative Disorders

Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning –No identifiable medical condition causing the physical complaints

Somatoform Disorders (continued) Types of DSM-IV Somatoform Disorders –Hypochondriasis –Somatization disorder –Conversion disorder –Pain disorder –Body dysmorphic disorder

Hypochondriasis Clinical Description –Physical complaints without a clear cause –Severe anxiety about the possibility of having a serious disease –Strong disease conviction –Medical reassurance does not seem to help

Hypochondriasis (continued) Statistics –Good prevalence data are lacking –Onset at any age –Runs a chronic course

Hypochondriasis: Causes and Treatment Causes –Cognitive perceptual distortions –Familial history of illness Treatment –Challenge illness-related misinterpretations –Provide more substantial and sensitive reassurance –Stress management and coping strategies

Fig. 5.1, p. 176

Somatization Disorder Clinical Description –Extended history of physical complaints before age 30 –Substantial impairment in social or occupational functioning –Concern about the symptoms, not what they might mean –Symptoms become the person’s identity

Somatization Disorder (continued) Statistics –Rare condition –Onset usually in adolescence –Mostly affects unmarried, low SES women –Runs a chronic course

Somatization Disorder: Causes and Treatment Causes –Familial history of illness –Relation with antisocial personality disorder –Weak behavioral inhibition system Treatment –No treatment exists with demonstrated effectiveness –Reduce the tendency to visit numerous medical specialists

Somatization Disorder: Causes and Treatment (continued) –Assign “gatekeeper” physician –Reduce supportive consequences of talk about physical symptoms

Conversion Disorder Clinical Description –Physical malfunctioning –Lack physical or organic pathology –Malfunctioning often involves sensory- motor areas –Persons show “la belle indifference” –Retain most normal functions, but lack awareness

Conversion Disorder (continued) Statistics –Rare condition, with a chronic intermittent course –Seen primarily in females –Onset usually in adolescence –Common in some cultural and/or religious groups

Conversion Disorder: Causes Causes –Freudian psychodynamic view is still popular –Emphasis on the role of past trauma and conversion Detachment from the trauma and negative reinforcement –Address primary/secondary gain

Conversion Disorder: Treatment Treatment –Similar to somatization disorder –Core strategy is attending to the trauma –Remove sources of secondary gain –Reduce supportive consequences of talk about physical symptoms

Body Dysmorphic Disorder Clinical Description –Previously known as dysmorphophobia –Preoccupation with imagined defect in appearance –Often display ideas of reference for imagined defect –Suicidal ideation and behavior are common

Body Dysmorphic Disorder (continued) Statistics –More common than previously thought –Seen equally in males and females –Onset usually in early 20s –Most remain single, and many seek out plastic surgeons –Usually runs a lifelong chronic course

Body Dysmorphic Disorder: Causes Causes –Little is known – Disorder tends to run in families –Shares similarities with obsessive- compulsive disorder

Body Dysmorphic Disorder: Treatment Treatment –Treatment parallels that for obsessive compulsive disorder –Medications (i.e., SSRIs) that work for OCD provide some relief –Exposure and response prevention is also helpful –Plastic surgery is often unhelpful

An Overview of Dissociative Disorders Overview –Involve severe alterations or detachments –Affects identity, memory, or consciousness –Depersonalization – Distortion is perception of reality –Derealization – Losing a sense of the external world

An Overview of Dissociative Disorders (continued) Types of DSM-IV Dissociative Disorders –Depersonalization Disorder –Dissociative Amnesia –Dissociative Fugue –Dissociative Trance Disorder –Dissociative Identity Disorder

Depersonalization Disorder: An Overview Overview and Defining Features –Severe and frightening feelings of unreality and detachment –Feelings dominate and interfere with life functioning –Primary problem involves depersonalization and derealization

Depersonalization Disorder: An Overview (continued) Facts and Statistics –High comorbidity with anxiety and mood disorders –Onset is typically around age 16 –Usually runs a lifelong chronic course

Depersonalization Disorder: Causes and Treatment Causes –Cognitive deficits in –Attention, short-term memory, spatial reasoning –Deficits related to tunnel vision and mind emptiness –Such persons are easily distracted Treatment –Little is known

Dissociative Amnesia: An Overview Dissociative Amnesia –Includes several forms of psychogenic memory loss –Generalized vs. localized or selective type

Dissociative Fugue: An Overview Dissociative Fugue –Related to dissociative amnesia –Take off and find themselves in a new place –Unable to remember the past –Unable to remember how they arrived at new location –Often assume a new identity

Dissociative Amnesia and Fugue: Causes Statistics –Usually begin in adulthood –Show rapid onset and dissipation –Occur most often in females Causes –Little is known –Trauma and stress can serve as triggers

Dissociative Amnesia and Fugue: Causes and Treatment Treatment –Most get better without treatment –Most remember what they have forgotten

Dissociative Trance Disorder: An Overview Clinical Description –Symptoms resemble other dissociative disorders –Dissociative symptoms and sudden changes in personality –Changes often attributed to possession by a spirit –Presentation varies across cultures

Dissociative Trance Disorder: Causes, and Treatment Facts and Statistics –More common in females than males Causes –Often attributable to a life stressor or trauma Treatment –Little is known

Dissociative Identity Disorder (DID): An Overview Clinical Description –Formerly known as multiple personality disorder –Defining feature is dissociation of personality –Adoption of several new identities (as many as 100) –Identities display unique behaviors, voice, and posture

Dissociative Identity Disorder (DID): An Overview (continued) Unique Aspects of DID –Alters – Different identities or personalities –Host – The identity that keeps other identities together –Switch – Quick transition from one personality to another

Dissociative Identity Disorder (DID): An Overview (continued) Statistics –Average number of identities is close to 15 –Ratio of females to males is high (9:1) –Onset is almost always in childhood –High comorbidity rates & lifelong, chronic course

Dissociative Identity Disorder (DID): Causes Causes –Histories of horrible, unspeakable, child abuse –Closely related to PTSD –Mechanism to escape from the impact of trauma

Dissociative Identity Disorder (DID): Treatment Treatment –Focus is on reintegration of identities –Identify and neutralize cues/triggers that provoke memories of trauma/dissociation

Diagnostic Considerations in Somatoform and Dissociative Disorders Separating Real Problems from Faking –Malingering – Deliberately faking symptoms False Memories and Recovered Memory Syndrome Related Conditions – Factitious Disorder –Factitious Disorder by Proxy

Summary of Somatoform and Dissociative Disorders Features of Somatoform Disorders –Physical problems without on organic cause Features of Dissociative Disorders –Extreme distortions in perception and memory Well Established Treatments Are Generally Lacking