Somatoform Disorders and Dissociative Disorders

1. Somatoform Disorders and Dissociative Disorders

2. Psychosomatic v. Somatoform Disorders • Psychosomatic Disorders: Disorders in which there is a real physical illness that is caused by psychological factors (usually stress) • Somatoform: Disorders in which there is an apparent physical illness, but there is no organic cause • Usually people go to the doctor rather than a psychiatrist/psychologist!

3. Common Somatoform Disorders • Conversion Disorder: Anxiety is converted into physical symptoms (may lose feeling in a limb, paralysis, blindness, deafness, perception of pregnancy) • This is what interested Freud! • Rare in our time • Hypochondriasis: People interpret normal sensations as symptoms of a dreaded disease (headaches, stomach cramps, etc.) • May move from physician to physician looking for treatment and diagnosis • NOT faking it for attention • Relatively common • Body dysmorphic disorder: • Preoccupation with defects in one’s body • When faced with an imperfection, concern about it becomes obsessive

5. Dissociative Disorders • Type of disorder in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings • Types • Dissociative Amnesia: Loss of identity • Dissociative Fugue: Involves flight from home and the assumption of a new identity with amnesia for past identity and events • Dissociative Identify Disorder (DID)

6. DID (Formerly known as Multiple Personality Disorder) • Two or more distinct identities are said to alternately control a person’s behavior • Typically the original personality denies any awareness of the others • Usually not violent (not Dr. Jekyll/Mr. Hyde) • Personalities have their own names, memories, speaking voices, mannerisms

7. Controversy Over DID • Is it simply an extension of our own normal capacity for personality shifts? • Are clinicians who discover it just triggering role-playing by fantasy-prone people? • Are these patients, like actors, convincing themselves of the authenticity of their own role enactments?

8. Both Sides of the Debate Skeptics Believers • DID patients also tend to be highly hypnotizable • Seem to be localized to time and place • Number of cases and personalities (3-12) has been ballooning over time • Not very prevalent outside of N. America • Nonexistent in Japan and India • British consider it a “wacky American fad” • Is it a cultural phenomenon created by therapists in a particular social context? • Therapists go fishing for identities • Distinct brain and body states associated with different personalities • Can have different blood pressures! • Handedness and visual acuity can change based on the personality!

9. Why? • Psychoanalytic perspective: defenses against anxiety caused by the eruption of unacceptable impulses • Learning (behavioral) perspective: behaviors are reinforced by anxiety reduction • Maybe it should be included under PTSD? A response to childhood trauma • Child abuse is reported in ¾ of cases of DID • One of the personalities is often a child • “Having the abuse happen to someone else”