Somatoform Disorders

Physical symptoms for which there is no apparent physical cause.

Sick Role Sick Role Have you ever “played sick” in order to get out of something? How did that work out (did you get what you wanted)? Sick  attention (friends, family, medical) = secondary gains Likely link between secondary gains and somatoform disorders Some medical condition may actually exist

Types of Somatoform Disorders Types of Somatoform Disorders 1. Somatization Disorder Known as “Hysteria,” “hypochondriasis,” and “melancholia” until 1800’s Term “somatization disorder” was first used in DSM-III (1980)

Diagnosis Diagnosis DSM-IV criteria History of many physical complaints beginning before age 30 occurring over several years resulting in treatment being sought or significant impairment in functioning.

Additional info Primary relationships are with doctors; personal relationships usually have problems Physical symptoms become part of their identity This disorder is chronic and rarely goes away completely

Causes of Somatization Genetic Genetic influence (30-50%) on somatization symptoms Social learning Parents may reinforce somatic complaints in children  gain attention (sick role) Societal –More acceptance of medical vs. psychological problems

Types of Somatoform Disorders, cont. 2.Conversion Disorder Changing emotional difficulties into a loss of a specific voluntary body function. Loss of function is real, but no physical damage is present. Can be persistent, lasting for years. Examples: paralysis, loss of sight or hearing, loss of speech May free the person from dealing with difficult emotional situations.

Dissociative Disorders

Involve disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment What are some “normal” dissociative experiences that people have sometimes? –You dissociate sometimes when you “space out” while driving, reading, watching t.v., etc.

Dissociative Identity Disorder (DID) Formerly known as multiple personality disorder DSM-IV criteria A. presence of 2 or more distinct identities or personality states B. At least 2 identities/personalities recurrently take control of the person’s behavior

DSM-IV criteria (cont.) C. Inability to recall important personal information (goes beyond ordinary forgetfulness) D. Not due to effects of a substance; in children, symptoms not attributable to imaginary playmates or fantasy play

Additional descriptive info Alter = identity or personality in DID –Many have at least 1 impulsive alter –Alters of the opposite gender are common Switch = transition to another identity

DID (cont.) - more common among women - number of identities varies: - women average about 15 - men average about 8 - dissociation can be spurred by stress

DID (cont.) Causes - almost every DID case has history of severe sexual or physical abuse  dissociation seems to be a defense - may be extreme form of PTSD - biological influences not clear - very few twin studies  suggest environment is more influential than genes

Causes (cont.) Most are highly suggestible; easily hypnotized

DID (cont.) Treatment - similar to treatment of PTSD - exposure to traumatic memories; goal is desensitization and prevention of response (dissociation)

Other Dissociative Disorders Dissociative Amnesia: the inability to recall important personal events or information; is usually associated with stressful events Dissociative Fugue: a person suddenly travels away from home or work and is unable to recall the past

Summary Somatoform disorders involve a focus on physical symptoms that are either not real or are exaggerated Dissociative disorders involve a disturbance in normally integrated functions (memory, identity, etc.) Course is usually chronic Causes for most are unknown