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Somatoform and dissociatives disorders
This document discusses somatoform and dissociative disorders as defined in the DSM-IV. Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and are thought to be linked to psychological issues. Dissociative disorders involve disruptions or breakdowns in consciousness, memory, identity or perception. The document provides overviews of specific disorders including their defining features, causes, prevalence and treatment approaches. These include conversion disorder, pain disorder, hypochondriasis and dissociative disorders like dissociative identity disorder.
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Somatoform and dissociatives disorders
- 2. pathological concernof individuals with the appearance or functioning of their bodies when there is no identifiable medical condition causing the physical complaints
- 3. individuals feeldetached from themselves or their surroundings, and reality, experience, and identity may disintegrate
- 4. Somatoform disordershave been around for most of history. The ancient Egyptians reported cases of somatoform disorders, as did the ancient Greeks, Romans and most modern societies. It was believed that somatoform disorders only happened in women. Egyptian doctors suggested that perhaps the problem was that the womb had detached and was floating around inside the body. Greeks gave somatoform disorders the name hysteria or Womb.
- 5. In the19th century, Sigmund Freud finally gave hysteria a new name, Conversion Disorder, because he believed that it was caused by converting psychological pain into physical pain In the 20th century, the American Psychiatric Association distinguished between the various types of disorders and gave the group of them the name somatoform disorders. By this time, psychologists recognized that both men and women could suffer from somatoform disorders.
- 6. Soma –Meaning Body ◦ Overly preoccupied with health or body appearance ◦ Physical complaints without a medical condition Types of DSM-IV Somatoform Disorders ◦ Hypochondriasis ◦ Somatization disorder ◦ Conversion disorder ◦ Pain disorder ◦ Body dysmorphic disorder
- 7. Overview andDefining Features ◦ Severe anxiety – The possibility of having a disease ◦ Strong disease conviction ◦ Medical reassurance does not seem to help Facts and Statistics ◦ Good prevalence data are lacking ◦ Onset at any age ◦ Runs a chronic course
- 8. Causes ◦Cognitive perceptual distortions ◦ Familial history of illness Treatment ◦ Challenge illness-related misinterpretations ◦ Provide more substantial and sensitive reassurance
- 10. Overview andDefining Features ◦ Extended history of physical complaints before age 30 ◦ Substantial social and occupational impairment ◦ Concerned with the symptoms, not what they might mean ◦ Symptoms become the person’s identity ◦ patients have a history of many physical complaints that can not be explained by a medical condition, the complaints are not intentionally produced
- 11. Facts andStatistics ◦ Rare condition ◦ Onset usually in adolescence ◦ Mostly affects unmarried, low SES women ◦ Runs a chronic course
- 12. Causes ◦Familial history of illness ◦ Relation with antisocial personality disorder ◦ Weak behavioral inhibition system Treatment ◦ No treatment exists with demonstrated effectiveness ◦ Reduce tendency to visit numerous medical specialists ◦ Assign “gatekeeper” physician ◦ Reduce supportive consequences of talk about symptoms
- 13. This isa less specific version of somatization disorder. diagnosis requires a person to have one or more physical complaints of unexplained symptoms for at least six months. The physical complaints usually begin or worsen when the patient is under stress . Undifferentiated somatoform disorder is also sometimes referred to as somatization syndrome.
- 14. Causes arenot clear. Problems in the family Depression and stress Treatments Visiting physicians looking for treatments for physical complaints Later, he or she may be referred to a mental health professional.
- 15. Overview andDefining Features ◦ 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 Facts and Statistics ◦ Rare condition, with a chronic intermittent course ◦ Seen primarily in females ◦ Onset usually in adolescence ◦ Not uncommon in some cultural and/or religious groups
- 16. Causes ◦Freudian psychodynamic view is still popular (anxiety converted into physical symptoms) ◦ Focus on past trauma and conversion ◦ Detachment from the trauma and negative reinforcement Treatment ◦ Similar to somatization disorder ◦ Core strategy is attending to the trauma ◦ Reduce supportive consequences of talk about symptoms
- 17. Overview andDefining Features ◦ Previously known as dysmorphophobia ◦ Preoccupation with imagined defect in appearance ◦ Either fixation or avoidance of mirrors ◦ Suicidal ideation and behavior are common ◦ Often display ideas of reference for imagined defect Facts and 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
- 18. Causes ◦Little is known ◦ Shares similarities with obsessive-compulsive disorder Treatment ◦ Parallels that for obsessive-compulsive disorder ◦ Medications (i.e., SSRIs) provide some relief ◦ Exposure and response prevention is also helpful ◦ Plastic surgery is often unhelpful
- 19. People whohave pain disorder typically experience pain that started with a psychological stress or trauma. Pain is the focus of the disorder. But psychological factors are believed to play a role in the perception and severity of the pain. People with pain disorder frequently seek medical care. They may become socially isolated and experience problems with work and family life.
- 20. People whohave a history of physical or sexual abuse are more likely to have this disorder. However, not every person with somatoform pain disorder has a history of abuse. Emotional well-being affects the way in which pain is perceived. Treatments Cognitive-Behavior therapy Medication
- 21. is ageneral diagnosis given when a person has physical symptoms without physical illness but does not fit the criteria for one of the other somatoform disorders. Conditions that fall into this category include pseudocyesis. This is the mistaken belief of being pregnant based on other signs of pregnancy, including an expanding abdomen; feeling labor pains, nausea, breast changes, fetal movement; breast changes; and cessation of the menstrual period.
- 22. Overview ◦Involve severe alterations or detachments ◦ Affect identity, memory, and/or consciousness ◦ Severe form of normal perceptual experiences ◦ Depersonalization – Distortion in perception of reality ◦ Derealization – Losing a sense of the external world Types of DSM-IV Dissociative Disorders ◦ Depersonalization Disorder ◦ Dissociative Amnesia ◦ Dissociative Fugue ◦ Dissociative Trance Disorder ◦ Dissociative Identity Disorder
- 23. Overview andDefining Features ◦ Severe and frightening feelings of unreality and detachment ◦ These dominate and interfere with life functioning ◦ Problem involves depersonalization and derealization Facts and Statistics ◦ High comorbidity with anxiety and mood disorders ◦ Onset is typically around age 16 ◦ Usually runs a lifelong chronic course
- 24. Causes ◦Cognitive deficits in attention ◦ Cognitive deficits in short-term memory ◦ Cognitive Deficits in spatial reasoning ◦ Deficits related with tunnel vision and mind emptiness ◦ Such persons are easily distracted Treatment ◦ Little is known
- 25. ◦ Several formsof psychogenic memory loss: ◦ Generalized type – Inability to recall anything, including their identity ◦ Localized or selective type – Failure to recall specific (usually traumatic) events
- 26. Retrograde amnesiais when a patient forgets their past, up to a certain point, but is able to form new memories. This kind of patient would basically be starting a new life as a new person, functioning in most ways except totally unable to remember the past. Retrograde amnesia, which literally means forward moving .
- 27. Anterograde amnesiais the opposite of retrograde Literally means moving backward. Patients with Anterograde amnesia can't form new memories, but do remember everything before the amnesia set in.
- 28. Dissociative Fugue:Overview and Defining Features ◦ Related to dissociative amnesia ◦ Take off to a new place ◦ Unable to remember the past ◦ Unable to remember how they arrived at a new location ◦ Often assume a new identity
- 29. Facts andStatistics -- Dissociative Amnesia and Fugue ◦ Usually begin in adulthood ◦ Both show rapid onset and dissipation ◦ Both are mostly seen in females Causes ◦ Little is known ◦ Trauma and life stress can serve as triggers Treatment ◦ Most get better without treatment ◦ Most remember what they have forgotten
- 30. Overview andDefining Features ◦ Symptoms resemble those of other dissociative disorders ◦ Dissociative symptoms and sudden changes in personality ◦ Changes are often attributed to possession of a spirit ◦ Presentation differs in important ways across cultures Facts and Statistics ◦ More common in females Causes ◦ Often attributable to a life stressor or trauma ◦ Only abnormal if the trance is considered undesirable/pathological by the culture Treatment ◦ Little is known
- 31. Overview andDefining Features ◦ Formerly known as multiple personality disorder ◦ Defining feature – Dissociation of personality ◦ Adopt several new identities (as many as 100) ◦ Identities show unique behaviors, voice, and posture Unique Aspects of DID ◦ Alters – The different identities ◦ Host – The identity that keeps other identities together ◦ Switch – Quick transition from one personality to another
- 32. Facts andStatistics ◦ 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, with a lifelong chronic course Causes ◦ Most have histories of horrible, unspeakable, child abuse ◦ Most are also highly suggestible ◦ DID – Mechanism to escape from impact of trauma ◦ Closely related to PTSD Treatment ◦ Focus is on reintegration of identities ◦ Identify and neutralize cues/triggers that provoke memories of trauma/dissociation
- 33. These categoriesare used for forms of pathological dissociation that do not fully meet the criteria of the other specified dissociative disorders, or if the correct category has not been determined.
- 34. 1. Other SpecifiedDissociative Disorder This disorder is characterized by a complete loss (or near loss) of awareness of one’s immediate surroundings or of one’s identity. 2. Unspecified Dissociative Disorder Sometimes, one may show signs of a noteworthy dissociative condition or an event that does not fit neatly into the typical presentation of a known dissociative disorder. At other times, the source of dissociative symptoms may be unclear
- 35. Separating RealProblems from Faking ◦ Malingering – Deliberately faking symptoms Related Conditions – Factitious disorders ◦ Factitious disorder by proxy False Memories and Recovered Memory Syndrome