1. Dissociative Disorders & Somatic Symptom and Related Disorders
Chapter 10 & 11
Dissociative Disorders & Somatic Symptom and Related Disorders
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2. The Nature of Dissociation
Normally integrated elements of consciousness, memory, and personal identity become splintered
May impair memory of important personal experiences
Potential identity confusion
Feeling that surroundings or objects are not real
Emotional detachment
Types of Dissociative Disorders
Dissociative Identity Disorder (DID)
Dissociative Amnesia
Depersonalization/Derealization Disorder
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3. Dissociative Identity Disorder (DID)
Formerly known as multiple personality disorder or dual personality
Shattering of a unified identity into at least two separate but coexisting personalities with different memories, behaviors, patterns, and emotions
Alters – Internal; Different identities or personalities
Host – Primary identity; often has the person’s given name
Controversial diagnosis
More common in women than men
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4. Dissociative Amnesia
Sudden loss of memory for personally important information (not caused by a medical condition or other mental disorder)
Forms of memory loss
Localized amnesia: for a distinct period of time
Selective amnesia: for some of the events surrounding a trauma
Generalized amnesia: Total loss of memory for a person’s entire life or identity
Continuous amnesia: for events from a particular time or trauma up to the present
Systemized amnesia: for certain classes of information
With dissociative fugue: Individuals travel to a new location without remembering their pre-fugue life
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5. Depersonalization/Derealization Disorder
Marked by episodes of depersonalization, derealization, or both
Depersonalization
Detachment from oneself
Derealization
Detachment from one’s environment
Symptom clusters
Anomalous (strange) body experiences
Emotional numbing
Anomalous subjective recall
Alienation from surroundings
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6. Causes of Dissociative Disorders
Post-traumatic Model - Links severe childhood abuse to DID
Sociocognitive Model - Enactment of multiple identities usually serves specific personal goals
Fantasy Model - Suggestibility, fantasy proneness, and absorption are related to dissociative experiences
Integrative View - Research suggests that childhood trauma and sociocultural influences – including iatrogenic factors - all contribute to DID
Biological Causes - 48% to 59% of the variance accounted for in dissociation is attributable to genetics
Psychological Causes - Attributions, appraisals, and increased attention to stimuli play important roles in the development and maintenance of dissociative disorders
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7. Treatment of Dissociative Disorders
Treatment of DID
Long-term diagnosis of DID is not favorable
Therapy can be challenging due to difficulty with interpersonal trust and concerns about rejection
Goal: achieve fusion—alters moving into their host personality
Stimulants, antidepressants, anticonvulsants
3 phases of psychotherapy:
Establishing a therapeutic relationship
Exploring trauma narratives and resolving emotions
Integrating identities, reducing reliance on dissociation for coping
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8. Somatic Symptom and Related Disorders
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder (Functional Neurological Symptom Disorder)
Factitious Disorder
Psychological Factors Affecting Other Medical Conditions
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9. Table 11.2 The DSM-5 in Simple Language:
Diagnosing Somatic Symptom Disorder (p. 366)
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10. Table 11.3 The DSM-5 in Simple Language: Diagnosing Illness Anxiety Disorder (p. 367)
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11. Table 11.5 The DSM-5 in Simple Language: Diagnosing Conversion Disorder (p. 371)
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12. Table 11.6 The DSM-5 in Simple Language: Diagnosing Factitious Disorder (p. 373)
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13. Table 11.7 Warning Signs of Factitious Disorder by Proxy
(Munchausen’s Syndrome by Proxy)
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14. Other Medical Conditions (p. 374)
Table 11.8 The DSM-5 in Simple Language: Diagnosing Psychological Factors Affecting
Other Medical Conditions (p. 374)
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