Somatoform and Dissociative Disorders Chapter five

Somatoform Disorders Overly preoccupied with health and or body appearance Usually no identifiable medical condition causing the physical complaints

Somatoform Disorders Hypochondriasis Somatization disorder Conversion disorder Pain disorder Body dysmorphic disorder

Hypochondriasis Physical complaints without a clear medical cause and severe anxiety focused on the possibility of having a serious illness Medical reassurance does not seem to help Comorbidity with anxiety and mood disorders

Hypochondriasis Anxiety and features of panic disorder Expression of anxiety is different –Preoccupation with physical symptoms Reassurance seems to have temporary impact at best Disease Conviction: core diagnostic feature

Hypochondriasis Differs from illness phobia: fear of getting a disease Hypochondriasis: fear they already have a disease Chronic course

Hypochondriasis Distortions in cognition, perception and emotion Interpret minor pain as threatening Self focusing creates anxiety which leads to more symptoms View of health as being completely symptom-free

Hypochondriasis Treatment? CBT with focused reassurance

Somatization Disorder Extended history of physical complaints starting before age 30 and substantial impairment in social or occupational functioning Multitude of symptoms –4 pain –3 gastrointestinal –1 sexual –1 neurological

Somatization Disorder Focus on symptoms instead of what they might mean Often show little urgency to do anything about symptoms Symptoms become major part of indentity Most are unmarried women, lower SES chronic

Somatization Disorder Family studies: link to antisocial personality disorder Males more likely to show aggression Females more likely to display dependence No known effective treatment Physician as “gatekeeper”

Conversion Disorder Physical malfunctioning without apparent physical cause Often resemble neurological diseases Usually apathy towards symptoms Usually stressful precipitator Extremely rare

Pain Disorder Psychological factors play a role in the persistence of pain Pain is real

Body Dysmorphic Disorder Preoccupation with imagined defect Fixated on mirrors, engage in suicidal behavior, display ideas of reference and avoidance Severe disruption of daily functioning CBT and SSRI’s Big business for plastic surgeons

Dissociative Disorders Depersonalization –Distortion in perception –Sense or reality is lost –Person dissociates from reality Derealization –Losing sense of external world Both can be panic and acute stress disorder

Dissociative Disorders Alterations or detachments in consciousness or identity involving either dissociation or depersonalization Extreme variants on normal phenomena

Depersonalization Disorder Severe and frightening feelings of detachment and unreality Very rare Cognitive deficits –Attention, short-term memory, spatial reasoning –Reports of tunnel vision and mind emptiness

Dissociative Amnesia Psychogenic memory loss Usually in females Generalized –Unable to recall anything including identity Selective (localized) –Selective forgetting related to trauma

Dissociative Fugue Leaves and may set up another identity in another place Very rare Inability to recall why or how they got there and little memory of the past

Dissociative Trance Disorder Attributed to spirit posession

Dissociative Identity Disorder (DID) Adoption of new identities Often display unique behaviors, voice and posture As many as 100 “Alters” Host: identity that seeks treatment Switch Mostly female Severe, chronic sexual abuse

Dissociative Identity Disorder (DID) Natural tendency to dissociate from negative affect related to abuse Survival mechanism Lack of social support while abuse is going on Thought to be extreme subtype of PTSD