1. Dissociative & Somatic Symptom and Related Disorders

2. Dissociative Disorders I. Dissociative Identity Disorder (DID): a dissociative disorder in which a person has two or more distinct (alternate) personalities each with a unique set of memories, behaviors, thoughts, and emotions (a.k.a. Multiple Personality Disorder). At any given time, one of the alternate personalities dominates the person’s functioning. Usually one of these alternate personalities – called the primary, or host, personality – appears more often than the others.

3. Most cases are first diagnosed in late adolescence or early adulthood. Symptoms generally begin in childhood after episodes of abuse. Women receive the diagnosis three times as often as men. A. Mutually Amnesic Relationships: the alternate personalities have no awareness of one another. B. Mutually Cognizant Patterns: each alternate personality is well aware of the rest. C. One-way Amnesic Relationships: most common pattern; some personalities are aware of others, but the awareness is not mutual. Note that the real person is NOT one of the personalities. The real person has been divided up into the distinct personalities.

4. However, there is a main host personality through which the other alternate personalities typically must transfer through before another alternate personality can surface. Studies suggest that the average number of alternate personalities is 15 for women and 8 for men. D. The Controversy Only a handful of cases worldwide were reported from 1920 to 1970, but since then the number of reported cases has skyrocketed into the thousands. It’s almost exclusively found in North America. Many DID clients have been in therapy for years before the different personalities emerge. It has been noted that people with DID are often very suggestible, imaginative, and easily hypnotized.

5. 1) Self-Fulfilling Prophecy: the case whereby people have an expectation about what another person is like, which influences how they act toward that person, which causes that person to behave consistently with people’s original expectations, making the expectations come true. 2) Self-Monitoring: being aware of how one is presenting oneself in a social context and being able to adjust that image in different social contexts to create favorable impressions. E. Documented DID Characteristics of different personalities that would be difficult (if not impossible) to fabricate... 1) handedness 2) presence/absence of visible allergic reactions 3) differences in blood pressure levels 4) EEG brain-response pattern variations

6. F. Documented DID Characteristics of different personalities that would be easier to fabricate... 1) different ages 2) different sexes / sexual orientations 3) different eyeglass prescriptions 4) presence/absence of psychotic features (hallucinations, paranoia, disorganized thinking) 5) different skills (playing musical instruments, other artistic abilities) 6) understanding foreign languages 7) different styles of handwriting 8) different food preferences 9) different recreational interests 10) differences in social behavior (e.g. introversion vs extraversion) 11) differences in emotional responses (reserved/timid vs aggressive/confident)

7. G. The role of childhood abuse

8. H. Posttraumatic Theory: DID starts from the child’s attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse. Lacking other resources or routes of escape, the child may dissociate or escape into fantasy, becoming someone else. Severe childhood sexual and/or physical abuse An unusually imaginative and suggestible disposition Coping via the unintentional development of multiple personalities that serve as an escape from reality

9. I. Sociocognitive Theory: DID develops when a highly suggestible person learns to adopt the roles of multiple identities mostly because clinicians have inadvertently suggested, legitimized, and reinforced them and because these different identities are geared to the individual’s own personal goals. Severe childhood sexual and/or physical abuse Coping via the unintentional development of multiple personalities that serve as an escape from reality An unusually imaginative and suggestible disposition High self-monitoring tendencies Exposure to a self-focused & individualistic culture Exposure to those who promote a self-fulfilling prophecy

10. II. Dissociative Amnesia: a condition in which people are unable to recall important information, usually of an upsetting nature, about their lives. A. Types of Dissociative Amnesia 1) Localized: most common type; loss of all memory of events occurring within a limited period. 2) Selective: loss of memory for some, but not all, events occurring within a period. 3) Generalized: loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends. 4) Continuous: forgetting from a certain point in time that continues into the future; quite rare in cases of dissociative amnesia. 5) Systemized: memory loss of a particular category of information such as family members or coworkers.

11. B. Dissociative Fugue: a condition in which people not only forget their personal identities and details of their past, but also flee to an entirely different location. People may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics. It usually follows a severely stressful event. Fugues tend to end abruptly. Interestingly, when the fugue ends on its own, the person is flooded with memories of their original identity AND typically forgets all of the events and circumstances surrounding their new identity.

12. III. Depersonalization / Derealization Disorder: characterized by persistent or recurrent episodes of depersonalization (a temporary change in their usual sense of reality in which people feel detached from themselves and their surroundings) and/or derealization (a sense of unreality about the external world involving odd changes in the perception of one’s surroundings or in the passage of time).

13. IV. Theories and Treatment of Dissociative Disorders A. Psychodynamic Theory B. Psychodynamic Treatment 1) How do therapists help individuals with Dissociative Amnesia? People with dissociative amnesia often recover on their own. Therapists guide patients to search their unconscious and bring forgotten experiences into consciousness. 2) How do therapists help individuals with DID? Therapists try to help patients recover missing memories. Therapists usually try to help the client by integrating the personalities. Integration is a continuous process; fusion is the final merging.

14. Somatic Symptom and Related Disorders I. Somatic Symptom Disorder: excessive distress, concern, and anxiety about bodily symptoms that one is experiencing. A sufferer’s ailments often include pain symptoms, gastrointestinal symptoms, sexual symptoms, and neurological symptoms. Patients with this pattern often describe their symptoms in dramatic and exaggerated terms. As high as 2% of all women in the U.S. experience Somatic Symptom Disorder in any given year (compared with less than 0.2% of men).

15. A. Hypochondriasis: when one has a belief or fear that one has a serious disease when one is only experiencing normal bodily reactions. II. Illness Anxiety Disorder: the experience of chronic anxiety about one’s health and concern that one is developing a serious medical illness, despite the absence of somatic symptoms. Sometimes they have physiological symptoms, but they’re remarkable mild. Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating. This disorder starts most often in early adulthood, among men and women in equal numbers. Between 1% and 5% of all people experience the disorder.

16. III. Functional Neurological Symptom Disorder: characterized by symptoms or deficits that affect the ability to control voluntary movements or that impair sensory functions, such as an inability to see, hear, or feel tactile stimulation (a.k.a. Conversion Disorder). Individuals experience neurological-like symptoms – blindness, paralysis, or loss of feeling – that have no neurological basis. Symptoms may only persist for minutes, but often continue for hours or days. It is diagnosed in women twice as often as in men occurring in 0.5% of the U.S. population.

17. IV. Factitious Disorder: (popularly referred to as Münchausen Syndrome) characterized by intentional fabrication of psychological or physical symptoms for no clear tangible gain. Perhaps motivated by the experience of care and sympathy that they receive in settings such as a hospital. Overall, the pattern appears to be more common in women than men and the disorder usually begins during early adulthood. A. Factitious Disorder Imposed on Another: parents make up or produce physical illnesses in their children. It appears that parents who do this to their children, for example, are trying to gain external sympathy for their supposedly sick children and themselves as well. They seem to take great pleasure in the experience of taking care of sick people and will sometimes make their children sick just so that they can care for them.

19. V. Theories of Somatic Symptom and Related Disorders A. Psychodynamic Theory Psychodynamic theorists propose that two mechanisms are at work in hysterical disorders: 1) Primary gain: bodily symptoms keep internal conflicts out of conscious awareness. 2) Secondary gain: bodily symptoms allow the individual to avoid burdensome responsibilities and to gain the support, rather than condemnation, of those around them. B. Behavior / Learning Theory From this perspective, the symptoms in conversion and related disorders may also carry the benefits, or reinforcing properties, of the “sick role.” Hypochondriasis is often linked to obsessive–compulsive disorder.

20. VI. Treatment of Somatic Symptom and Related Disorders A. Psychodynamic Treatment B. Behavioral Treatment C. Biological Treatment