Somatoform and Dissociative Disorders

1. Somatoform and Dissociative Disorders

2. Somatoform Disorders • Somatoform Disorders- Conditions involving physical complaints of disabilities that occur without any evidence of physical pathology to account for them. • Somatization Disorder • Hypochondriasis • Pain Disorder • Conversion Disorder

3. Somatization Disorder • Characteristics include • Multiple complaints and ailments that extend over a long period beginning before age 30 • These complaints are not explained by physical illness or injury. • Must include four levels of symptoms • Four pain symptoms (different areas of body) • Two gastrointestinal symptoms (nausea, bloating) • One sexual symptom (sexual dysfunction / irregularity) • One pseudoneurological symptom (sensory loss)

4. Somatization Disorder II • Up to 10x more common in females • Evidence is linked with some genetic factors. • Possibly the underlying etiology is expressed differently in females and males. These being somatization and antisocial behavior respectively. • Evidence is linked to family disoganization such as abuse

5. Hypochandriasis • Differentiation from Somatization Disorder • Onset may be after age 30 • Focus on having a disease rather than symptoms • Unrealistic fears of disease • Difficulty in describing exact symptoms (general) • Mental orientation of alertness for new symptoms • Focus on remedies and studying different diseases. • Lack of intense fear normally associated with having their feared disease • Has a 4-9% prevalence in medical practices • Malingering- consciously faking symptoms to achieve a nonmedical goal.

6. Hypochandriasis • Theories • Interpersonal • I deserve more attention • Don’t expect as much from me as a person • Maintanence by physicians rejection • Abuse and Trauma as children

7. Pain Disorder • A somatoform Disorder characterized by reported pain of sufficient duration and severity to cause significant life disruption and the absence of medical pathology that would explain the experienced pain. • Subjectivity of Pain

8. Conversion Disorder • A somatoform disorder in which symptoms of some physical malfunction or loss of control appear without any underlying organic pathology; originally called hysteria. • Secondary gain or excuse enabling escape or avoidance of an intolerably stressful situation.

9. Treatment of Somatoform Disorders • Caution against medication • Support, reassurance, explanations etc.. • Prognosis generally poor

10. Dissociative Disorders • Dissociative Amnesia • Memory loss following a stressful experience • Dissociative Fugue • Memory loss accompanied by leaving home and establishing a new identity • Depersonalization Disorder • Experience of the self is altered • Dissociative Identity Disorder • At least two distinct ego states

11. Dissociative Amnesia • Unable to recall important information usually of a traumatic or stressful nature • Amnestic episode- forgotten period • Dissociative amnesia may be: • localized –losses all memory within a period of time (most common) • selective- remember some but not all • generalized- may forget identity • Continuous- unlike others there is not an end

12. Dissociative Amnesia (Cont) • Interference is primarily with episodic memory (ones autobiographical memory) while semantic memory (facts) remains intact

13. Dissociative Fugue • Forget personal details, identity, and flee to an entirely new location • Tend to end abruptly • Majority regain most of memories without a recurrence • Must face consequences of their fugue • Illegal or violent activity etc…

14. Dissociative Identity Disorder • Develop two or more distinct personalities (subpersonalities or alternate personalities) • Switching- transition from one subpersonality to another • Primary or Host Personality- that personality which appears most often • 97% of cases are thought to have experienced abuse

15. Women are diagnosed 3 times as often as men • Subpersonality Interaction • Mutual Amnesia- no awareness of alters • Cognizant- each alter is aware of the other (hear each others voices and talk among themselves) • One-way Amnesic- some are aware of others without them being aware of them (most common) • Co-conscious- quiet observers with no interaction

16. How do subpersonalities differ • Vital statistics (age, sex, family history, race) • Abilities and Preferences • Evidence suggests different physiological responses • Iatrogenic- unintentionally produced by practitioners • 100 cases in 1973 and now thousands • Increase due to 1) belief that it exists and 2) diagnostic procedures tend to be more accurate

17. Etiology / Explanations • Psychodynamic • Caused by excessive memory repression • Behavioral • Operant conditioning in which forgetting is reinforced by drop in anxiety • State-Dependent Learning • Extremely rigid state-to-memory links • Self-Hypnosis • Self induced hypnotic amnesia

18. Treatments for Dissociative Amnesia and Fugues • Psychodynamic therapy • Hypnotic therapy • Drug therapy • Sodium pentobarbital (“truth serums”). Medication decreases inhibitions making recall more likely but may forget again upon awake. • All focus on uncovering memories

19. Treatment Dissociative Dissociative Disorder • Three Major Goals • 1) Help recognize fully the nature of their disorder • 2) Recover gaps in their memory • 3) Integrate their personalities into one functioning personality • Fusion- final merging of 2 or more alters

20. Goal is integration • Help each alter to understand they are part of one person • Use alters names for convenience not to confirm existence of separate autonomy • All alters should be treated with fairness • Encourage empathy amongst the alters • Gentleness and supportiveness are needed in consideration of childhood traumas