1. CHAPTER 7 SOMATIC & DISSOCIATIVE DISORDERS 1

2. SOMATIC SYMPTOM & RELATED DISORDERS Relating to the body Factitious d/o – aka Munchausen’s syndrome Munchausen was a famous liar & fake hero Pts present themselves as physically ill – take chemicals or do things to themselves -Want tx > more involved, the better, chemo, operations -Experts on dz & medicine 2

3. FACTITIOUS D/O Go doctor shopping Begins in late teens – more common in women – prevalence unknown Factors Some were ill as children Angry at medical field Work in medical field Few friends, not close to families 3

4. FACTITIOUS D/O Tend to be emotionally needy Depression Unpleasant pts, but in trouble Munchausen’s by proxy – do this to children, others – caregiver hero 4

5. CONVERSION D/O Odd sx – can’t be explained by medicine Sudden blindness, paralysis, muteness “glove paralysis” Factitious d/o pts > consciously producing their sx Conversion d/o pts > unconscious activity Conversion d/o Rare 5/1000 5

6. CONVERSION D/O More women than men Early teens Begins after trauma or stress > sudden 6

7. SOMATIC SYMPTOM DISORDER Worry about their bodies & sx Chronic Sx might have a reason, but still too extreme Somatization pattern Predominant pain pattern  Sx change – all over the place – wide-ranging – multiple systems  Wax & wane  Women – see this in families - teens 7

8. CAUSES OF CONVERSION & SOMATIC SX D/O Old psychoanalysts called both hysteria > feminine, wildly emotional  Some made subject develop sx in experiments  Suggestible, easy to hypnotize Freud – conflict “converted” into pain, sx Females fixated at the Phallic Stage > Electra Complex [Oedipal Complex for girls] > sexually attracted to father Girls might be punished Controversial view 8

9. CAUSES Modern Psychodynamic view Primary gain for pt – direct Secondary gain for pt – indirect but helpful Behavioral POV Similar to above > rewards Cognitive POV Pts really don’t understand emotions  Focus on sx > sx are the bad feelings > pt c/o something is wrong > research unsupportive 9

10. CAUSES Multicultural Issues Somatization is common in some cultures – Chinese, Hispanic Americans tend to see this as weakness Biology Explain the placebo Role of the mind 10

11. TREATMENT OF SOMATIC D/O These pts resent “mental health care” – not CRAZY Drug & talk therapy often needed Therapy – find the basic fear – teach pts to deal with their issues Some therapist focus on sx – reinforce being healthy Research not conclusive 11

12. ILLNESS ANXIETY D/O Hypochondriasis No sx, but they still worry Afraid of normal issues 3% pop Equally men & women Teens Causes Behaviorists > another learned beh – rewarded Tx – antidepressants & therapy (response prevention) 12

13. BODY DYSMORPHIC D/O Aka Dysmorphobia > unhappy about their bodies DSM-5 regards this as Obsessive-compulsive-related d/o Not just about faces, height, & weight Body odor Some teens are like this > just continues ½ go for plastic surgery or cosmetic dermatology 1/3 are reclusive ¼ may try suicide Men & women = 13

14. BODY DYSMORPHIC D/O Type of anxiety d/o Theories the same Meds, esp antidepressants Cognitive-Behavioral therapy > response prevention 14

15. NO ! YYY 15 Yesssss !

16. DISSOCIATIVE DISORDERS Break with own identity Rare !! Memory usually altered or erased Sx extreme Not from anything organic (illness, accident, chemical) Known from popular media, rather than science Dissociative Amnesia Dissociative Identity d/o Depersonalization-derealization d/o 16

17. DISSOCIATIVE AMNESIA Psychogenic - Often from a psychological trauma > 1 event Localized amnesia – most common – time-frame around event Selective amnesia – have some memory around time-frame Generalized amnesia – loss of past, more global Continuous amnesia – loss of all memory Most psychogenic amnesia affects personal material Impairment varies - Generally know “stuff” & how to do things Trauma – disaster – health scare – sexual abuse in childhood – guilt Repressed/recovered memory controversy – revealed in therapy 17

18. DISSOCIATIVE FUGUE Dissoc. Amnesia + relocation & taking up new lives Tend to have new personalities (livelier), new spouses, etc Fugue may be long or short-term Far less than 1% of US pop When the return or are found, may forget the fugue Therapy > must ground the pt in who he/she is 18

19. DISSOCIATIVE IDENTITY D/O Aka Multiple Personality d/o Core person (often weak), sometimes called primary of host personality + alternative personalities (alters) Known & documented for centuries Often linked to severe childhood abuse, esp sexual alters may or may not know each other Three Faces of Eve Sybil Alters can be very different – gender, knowledge, experience, what they like, temperature, BP, etc 19

20. DISSOCIATIVE IDENTITY D/O Much media attn Rare Years of controversy about dx Easy to mistake this for something else Psychodynamic POV Classic repression taken over life – most primitive defense Dis amnesia – 1 event Dis Identity – larger block of time 20

21. DISSOCIATIVE IDENTITY & AMNESIA Psychodynamic POV Abuse leads to fear > fantasy thinking about heroes /being something else Unable to cope w/ bad thoughts – repress them Escapist (Unconsious) Behavioral POV Operant conditioning > relief from unpleasant environment, memories > letting mind focus on something else  Escapist (consciously know what they are doing)  Hard to understand the dramatic consequences of this, or why so rare 21

22. STATE-DEPENDENT LEARNING, ETC State-dependent Learning Explains why drunk or high witnesses remember better when they drink or take drugs Research supports this Emotional states, too Hypnosis & Self-hypnosis – like a trance 22

23. TREATMENT OF THESE D/O Psychodynamic therapy – uncover the Unc & confront issue Meds – truth serums (sodium amobarbital, sodium pentobarbital) Hypnosis Dissociative amnesia pts often go in remission w/o tx Provider needs to know the DSM, recognize this Get alters to support host 23

24. DEPERSONALIZATION-DEREALIZATION D/O Often after trauma Pt reports being in dream, floating above, watching from the side Detached (deper) from self & environment (dereal) Psychotic flavor Linked to PTSD > guide dx & tx 24