chapter 5 somatoform and dissociative disorders
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Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders. Soma – Meaning Body Preoccupation with health and/or body appearance and functioning No identifiable medical condition causing the physical complaints. Somatoform Disorders (continued). - PowerPoint PPT PresentationTRANSCRIPT
Chapter 5 Somatoform and Dissociative Disorders
Somatoform Disorders
• Soma – Meaning Body
– Preoccupation with health and/or body appearance and functioning
– No identifiable medical condition causing the physical complaints
Somatoform Disorders (continued)
• Types of DSM-IV Somatoform Disorders
– Hypochondriasis
– Somatization disorder
– Conversion disorder
– Pain disorder
– Body dysmorphic disorder
Hypochondriasis
• Clinical Description
– Physical complaints without a clear cause
– Severe anxiety about the possibility of having a serious disease
– Strong disease conviction
– Medical reassurance does not seem to help
Hypochondriasis (continued)
• Statistics
– Good prevalence data are lacking
– Onset at any age
– Runs a chronic course
Hypochondriasis: Causes and Treatment
• Causes
– Cognitive perceptual distortions
– Familial history of illness
• Treatment
– Challenge illness-related misinterpretations
– Provide more substantial and sensitive reassurance
– Stress management and coping strategies
Fig. 5.1, p. 176
Somatization Disorder
• Clinical Description
– Extended history of physical complaints before age 30
– Substantial impairment in social or occupational functioning
– Concern about the symptoms, not what they might mean
– Symptoms become the person’s identity
Somatization Disorder (continued)
• Statistics
– Rare condition
– Onset usually in adolescence
– Mostly affects unmarried, low SES women
– Runs a chronic course
Somatization Disorder: Causes and Treatment
• Causes– Familial history of illness– Relation with antisocial personality disorder– Weak behavioral inhibition system
• Treatment– No treatment exists with demonstrated
effectiveness– Reduce the tendency to visit numerous
medical specialists
Somatization Disorder: Causes and Treatment (continued)
– Assign “gatekeeper” physician
– Reduce supportive consequences of talk about physical symptoms
Conversion Disorder
• Clinical Description
– Physical malfunctioning
– Lack physical or organic pathology
– Malfunctioning often involves sensory-motor areas
– Persons show “la belle indifference”
– Retain most normal functions, but lack awareness
Conversion Disorder (continued)
• Statistics
– Rare condition, with a chronic intermittent course
– Seen primarily in females
– Onset usually in adolescence
– Common in some cultural and/or religious groups
Conversion Disorder: Causes
• Causes
– Freudian psychodynamic view is still popular
– Emphasis on the role of past trauma and conversion
• Detachment from the trauma and negative reinforcement
– Address primary/secondary gain
Conversion Disorder: Treatment
• Treatment
– Similar to somatization disorder
– Core strategy is attending to the trauma
– Remove sources of secondary gain
– Reduce supportive consequences of talk about physical symptoms
Body Dysmorphic Disorder
• Clinical Description
– Previously known as dysmorphophobia
– Preoccupation with imagined defect in appearance
– Often display ideas of reference for imagined defect
– Suicidal ideation and behavior are common
Body Dysmorphic Disorder (continued)
• Statistics
– More common than previously thought
– Seen equally in males and females
– Onset usually in early 20s
– Most remain single, and many seek out plastic surgeons
– Usually runs a lifelong chronic course
Body Dysmorphic Disorder: Causes
• Causes
– Little is known – Disorder tends to run in families
– Shares similarities with obsessive-compulsive disorder
Body Dysmorphic Disorder: Treatment
• Treatment
– Treatment parallels that for obsessive compulsive disorder
– Medications (i.e., SSRIs) that work for OCD provide some relief
– Exposure and response prevention is also helpful
– Plastic surgery is often unhelpful
An Overview of Dissociative Disorders
• Overview
– Involve severe alterations or detachments
– Affects identity, memory, or consciousness
– Depersonalization – Distortion is perception of reality
– Derealization – Losing a sense of the external world
An Overview of Dissociative Disorders (continued)
• Types of DSM-IV Dissociative Disorders
– Depersonalization Disorder
– Dissociative Amnesia
– Dissociative Fugue
– Dissociative Trance Disorder
– Dissociative Identity Disorder
Depersonalization Disorder: An Overview
• Overview and Defining Features
– Severe and frightening feelings of unreality and detachment
– Feelings dominate and interfere with life functioning
– Primary problem involves depersonalization and derealization
Depersonalization Disorder: An Overview (continued)
• Facts and Statistics
– High comorbidity with anxiety and mood disorders
– Onset is typically around age 16
– Usually runs a lifelong chronic course
Depersonalization Disorder: Causes and Treatment
• Causes– Cognitive deficits in– Attention, short-term memory, spatial
reasoning– Deficits related to tunnel vision and mind
emptiness– Such persons are easily distracted
• Treatment– Little is known
Dissociative Amnesia: An Overview
• Dissociative Amnesia
– Includes several forms of psychogenic memory loss
– Generalized vs. localized or selective type
Dissociative Fugue: An Overview
• Dissociative Fugue
– Related to dissociative amnesia
– Take off and find themselves in a new place
– Unable to remember the past
– Unable to remember how they arrived at new location
– Often assume a new identity
Dissociative Amnesia and Fugue: Causes
• Statistics
– Usually begin in adulthood
– Show rapid onset and dissipation
– Occur most often in females
• Causes
– Little is known
– Trauma and stress can serve as triggers
Dissociative Amnesia and Fugue: Causes and Treatment
• Treatment
– Most get better without treatment
– Most remember what they have forgotten
Dissociative Trance Disorder: An Overview
• Clinical Description
– Symptoms resemble other dissociative disorders
– Dissociative symptoms and sudden changes in personality
– Changes often attributed to possession by a spirit
– Presentation varies across cultures
Dissociative Trance Disorder: Causes, and Treatment
• Facts and Statistics
– More common in females than males
• Causes
– Often attributable to a life stressor or trauma
• Treatment
– Little is known
Dissociative Identity Disorder (DID): An Overview
• Clinical Description
– Formerly known as multiple personality disorder
– Defining feature is dissociation of personality
– Adoption of several new identities (as many as 100)
– Identities display unique behaviors, voice, and posture
Dissociative Identity Disorder (DID): An Overview (continued)
• Unique Aspects of DID
– Alters – Different identities or personalities
– Host – The identity that keeps other identities together
– Switch – Quick transition from one personality to another
Dissociative Identity Disorder (DID): An Overview (continued)
• Statistics– Average number of identities is close to 15– Ratio of females to males is high (9:1)– Onset is almost always in childhood– High comorbidity rates & lifelong, chronic
course
Dissociative Identity Disorder (DID): Causes
• Causes– Histories of horrible, unspeakable, child
abuse– Closely related to PTSD– Mechanism to escape from the impact of
trauma
Dissociative Identity Disorder (DID): Treatment
• Treatment– Focus is on reintegration of identities– Identify and neutralize cues/triggers that
provoke memories of trauma/dissociation
Diagnostic Considerations in Somatoform and Dissociative Disorders
• Separating Real Problems from Faking
– Malingering – Deliberately faking symptoms
• False Memories and Recovered Memory Syndrome
• Related Conditions – Factitious Disorder
– Factitious Disorder by Proxy
Summary of Somatoform and Dissociative Disorders
• Features of Somatoform Disorders
– Physical problems without on organic cause
• Features of Dissociative Disorders
– Extreme distortions in perception and memory
• Well Established Treatments Are Generally Lacking