Dissociative and Somatoform Disorders Chapter 6

1. Dissociative and Somatoform DisordersChapter 6

2. Dissociative Disorders Dissociative Disorders: Mental disorders in which a person�s identity, memory, or consciousness is altered or disrupted: Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder or MPD) Depersonalization Disorder -Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality", whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. -Dissociation is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world. -A dissociative disorder would be one in which the degree of dissociation (or the frequency of it) is such that one's functioning is somehow impaired. -When a situation becomes overwhelmingly stressful, sometimes people �dissociate� from themselves. Their conscious awareness becomes separated from the painful memories, thoughts or feelings. -Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality", whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. -Dissociation is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world. -A dissociative disorder would be one in which the degree of dissociation (or the frequency of it) is such that one's functioning is somehow impaired. -When a situation becomes overwhelmingly stressful, sometimes people �dissociate� from themselves. Their conscious awareness becomes separated from the painful memories, thoughts or feelings.

3. -Table 6.1: Disorders Chart: Dissociative Disorders.-Table 6.1: Disorders Chart: Dissociative Disorders.

4. Dissociative DisordersDissociative Amnesia Dissociative Amnesia: Partial or total loss of important personal information, may occur suddenly after stressful/traumatic event. Localized: Failure to recall all the events that happened during a specific period. Selective: Inability to remember certain details of an incident. -An 18 year old woman who survived a dramatic fire claimed not to remember it or the death of her child and husband in the fire. She claimed her relatives were lying about the fire. She became extremely agitated and emotional several hours later when her memory returned.-An 18 year old woman who survived a dramatic fire claimed not to remember it or the death of her child and husband in the fire. She claimed her relatives were lying about the fire. She became extremely agitated and emotional several hours later when her memory returned.

5. Dissociative DisordersDissociative Amnesia Generalized: Inability to remember anything about one�s past life. Systematized: Loss of memory for selected types of information. Continuous: Inability to recall events occurring between specific time in the past and the present. -In an episode of the Simpsons, Marge has a head injury and is unable to remember her past. In a short time, through pleasant associations, her memory comes back piece by piece. However, presumably because of the painful nature, memories of Homer do not return until the end when he finally does a decent act and she remembers the man she married.-In an episode of the Simpsons, Marge has a head injury and is unable to remember her past. In a short time, through pleasant associations, her memory comes back piece by piece. However, presumably because of the painful nature, memories of Homer do not return until the end when he finally does a decent act and she remembers the man she married.

6. Dissociative DisordersDissociative Amnesia Possibly due to repression (or closely related process) of a traumatic event: Posthypnotic Amnesia: Individual cannot recall events occurring during hypnosis with hypnotist suggesting what is to be forgotten. Dissociative Amnesia: Both the source and content of the amnesia are unknown (not caused by physical injury). In posthypnotic and dissociative amnesia, lost material can sometimes be retrieved with professional help. -Dissociative amnesia describes the condition of suddenly losing major chunks of memory. There are two types of this disorder: generalized amnesia, in which a person cannot remember anything about their lives, and localized amnesia, a common disorder in which a person forgets pieces of their identity but retains an overall understanding of who they are.-Dissociative amnesia describes the condition of suddenly losing major chunks of memory. There are two types of this disorder: generalized amnesia, in which a person cannot remember anything about their lives, and localized amnesia, a common disorder in which a person forgets pieces of their identity but retains an overall understanding of who they are.

7. Dissociative DisordersDissociative Fugue Dissociative Fugue: Confusion over personal identity, together with unexpected travel away from home. Also called �fugue state� Usually involves only short periods of time with incomplete change of identity. -Dissociative fugue is a strange phenomena in which persons will be stricken with a sudden memory loss that prompts them to flee their familiar surroundings. These flights are usually caused by some traumatic event. People suffering from this disorder will suddenly find themselves in a new surrounding, hundreds or even thousands of miles from their homes with no memories of the weeks, months, or even years that have elapsed since their flight. -Jane Dee Williams says she remembers nothing before the day in May 1985 when she was found wandering and disoriented in an Aurora, CO shopping mall, wearing a green coat and carrying a Toyota key, a copy of Watership Down, two green pens, and a notebook�but having no clue as to who she was. She went to Aurora police for help and ended up at the CO Mental Health Institute with a diagnosis of psychogenic fugue. Jane Dee Williams was actually Jody Roberts, who had disappeared five days earlier from her home and job as a reporter in Tacoma. She was treated and released without recovering her memory. During the next twelve years she remained missing and amnesic. During that time she married and had two sets of twins. In 1997, a tip to the police from someone who recognized Roberts from photographs led to her discovery. She still has no memory of her biological family. -Dissociative fugue is a strange phenomena in which persons will be stricken with a sudden memory loss that prompts them to flee their familiar surroundings. These flights are usually caused by some traumatic event. People suffering from this disorder will suddenly find themselves in a new surrounding, hundreds or even thousands of miles from their homes with no memories of the weeks, months, or even years that have elapsed since their flight. -Jane Dee Williams says she remembers nothing before the day in May 1985 when she was found wandering and disoriented in an Aurora, CO shopping mall, wearing a green coat and carrying a Toyota key, a copy of Watership Down, two green pens, and a notebook�but having no clue as to who she was. She went to Aurora police for help and ended up at the CO Mental Health Institute with a diagnosis of psychogenic fugue. Jane Dee Williams was actually Jody Roberts, who had disappeared five days earlier from her home and job as a reporter in Tacoma. She was treated and released without recovering her memory. During the next twelve years she remained missing and amnesic. During that time she married and had two sets of twins. In 1997, a tip to the police from someone who recognized Roberts from photographs led to her discovery. She still has no memory of her biological family.

8. Dissociative DisordersDepersonalization Disorder Depersonalization Disorder: A dissociative disorder in which feelings of unreality concerning the self or the environment cause major impairment in social or occupational functioning. Depersonalization is the most common dissociative disorder. Precipitated by physical or psychological stress; evidence that it may be related to emotional abuse, especially by parents. -Depersonalization Disorder. An individual may feel like an automaton�mechanical and robotlike�when suffering from depersonalization disorder. This painting, �The Subway� (ca. 1950), by George Tooker, captures this feeling. -Depersonalization disorder is a condition marked by a persistent feeling of not being real. The DSM-IV describes its symptoms as "persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream)." -A 20 year old college student became alarmed when she suddenly perceived subtle changes in her appearance. The reflection she saw in mirrors did not seem to be hers. She became even more disturbed when her room, her friends, and the campus also seemed to take on a slightly distorted appearance. The world around her felt unreal and was no longer predictable. During the day before the sudden appearance of the symptoms the woman had been greatly distressed by the low grades she received on several important exams. When she finally sought help at the university clinic, her major concern was that she was going insane.-Depersonalization Disorder. An individual may feel like an automaton�mechanical and robotlike�when suffering from depersonalization disorder. This painting, �The Subway� (ca. 1950), by George Tooker, captures this feeling. -Depersonalization disorder is a condition marked by a persistent feeling of not being real. The DSM-IV describes its symptoms as "persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream)." -A 20 year old college student became alarmed when she suddenly perceived subtle changes in her appearance. The reflection she saw in mirrors did not seem to be hers. She became even more disturbed when her room, her friends, and the campus also seemed to take on a slightly distorted appearance. The world around her felt unreal and was no longer predictable. During the day before the sudden appearance of the symptoms the woman had been greatly distressed by the low grades she received on several important exams. When she finally sought help at the university clinic, her major concern was that she was going insane.

9. Dissociative DisordersCulture-Bound Syndromes

10. Dissociative DisordersDissociative Identity Disorder (DID) Formerly called Multiple Personality Disorder Dissociative Identity Disorder: Dissociative disorder in which two or more relatively independent personalities appear to exist in one person, with only one evident at a time. Tone of voice, mannerisms, and other personality characteristics change. -Persons suffering from dissociative identity disorder (DID) adopt one or more distinct identities which co-exist within one individual. Each personality is distinct from the other in specific ways. For instance, tone of voice and mannerisms will be distinct, as well as posture, vocabulary, and everything else we normally think of as marking a personality. -In the autumn of 1990, reporters nationwide gathered in Oshkosh, Wisconsin. They hoped to meet Emily, Franny, John, Ginger, Eleanor, Leona, Frank, Beth, Sam, and 34 other personalities occupying the mind of Sarah, an alleged rape victim. Oshkosh prosecutors argued that the accused rapist exploited Sarah's mental disorder by coaxing one of her personalities, a flirtatious 20-year-old named Jennifer, into having sex with him. A jury convicted the man of second-degree sexual assault. The verdict was later overturned. -Persons suffering from dissociative identity disorder (DID) adopt one or more distinct identities which co-exist within one individual. Each personality is distinct from the other in specific ways. For instance, tone of voice and mannerisms will be distinct, as well as posture, vocabulary, and everything else we normally think of as marking a personality. -In the autumn of 1990, reporters nationwide gathered in Oshkosh, Wisconsin. They hoped to meet Emily, Franny, John, Ginger, Eleanor, Leona, Frank, Beth, Sam, and 34 other personalities occupying the mind of Sarah, an alleged rape victim. Oshkosh prosecutors argued that the accused rapist exploited Sarah's mental disorder by coaxing one of her personalities, a flirtatious 20-year-old named Jennifer, into having sex with him. A jury convicted the man of second-degree sexual assault. The verdict was later overturned.

11. Dissociative DisordersDissociative Identity Disorder (DID) Originates in childhood: Reports of extreme physical or sexual abuse Comorbid with conversion symptoms, depression, and anxiety Diagnostic controversy Number of personalities has increased. Much higher in highly suggestible patients. Often �discovered� in hypnosis. -Bianchi attempted to setup an insanity defense, claiming one of his multiple personalities committed the murders while he was in an altered, unconscious state. Court psychologists observed Bianchi and found that he was faking the illness. -After the movies Sybil and the Three Faces of Eve, the prevalence of the disorder skyrocketed. -Over 1/3 of psychiatrists think the disorder is �created� in therapy. -Actually a reflection of changes in mood, memory or attention. -Rarely diagnosed in most parts of the world. -Difficult to differentiate between genuine and faked cases.-Bianchi attempted to setup an insanity defense, claiming one of his multiple personalities committed the murders while he was in an altered, unconscious state. Court psychologists observed Bianchi and found that he was faking the illness. -After the movies Sybil and the Three Faces of Eve, the prevalence of the disorder skyrocketed. -Over 1/3 of psychiatrists think the disorder is �created� in therapy. -Actually a reflection of changes in mood, memory or attention. -Rarely diagnosed in most parts of the world. -Difficult to differentiate between genuine and faked cases.

12. -Figure 6.1: Comparison of Characteristics of Reported Cases of Dissociative Identity Disorder (Multiple Personality Disorder). This graph illustrates characteristics of multiple-personality-disorder (MPD) cases reported in the 1980s versus those between 1800 and 1965. What could account for these differences?-Figure 6.1: Comparison of Characteristics of Reported Cases of Dissociative Identity Disorder (Multiple Personality Disorder). This graph illustrates characteristics of multiple-personality-disorder (MPD) cases reported in the 1980s versus those between 1800 and 1965. What could account for these differences?

13. Etiology of Dissociative Disorders Psychodynamic perspective: Repression blocks unpleasant/traumatic events from consciousness. Amnesia and fugue: Part of personal identity blocked DID: Conflicts in personality structure; opposing personality components disable ego�s ability to control incompatible elements -A 27 year old man found lying in the middle of a busy intersection was brought to a hospital. He appeared agitated and said, �I wanted to get run over.� He claimed not to know his personal identity or anything about his past. He only remembered being brought to the hospital by the police. The inability to remember was highly stressful to him. Psychological tests using the TAT and the Rorschach revealed primarily anxiety-arousing, violent and sexual themes. The clinician hypothesized that a violent incident involving sex might underlie the amnesia. Under hypnosis the patient�s memory returned, and he remembered being severely assaulted. He had repressed the painful experience.-A 27 year old man found lying in the middle of a busy intersection was brought to a hospital. He appeared agitated and said, �I wanted to get run over.� He claimed not to know his personal identity or anything about his past. He only remembered being brought to the hospital by the police. The inability to remember was highly stressful to him. Psychological tests using the TAT and the Rorschach revealed primarily anxiety-arousing, violent and sexual themes. The clinician hypothesized that a violent incident involving sex might underlie the amnesia. Under hypnosis the patient�s memory returned, and he remembered being severely assaulted. He had repressed the painful experience.

14. -Figure 6.3: Posttraumatic Model for Dissociative Identity Disorder. Note the importance of the capacity for self-hypnosis in the development of dissociative identity disorder. -DID development involving distress, suggestibility, and a lack of social support. -Figure 6.3: Posttraumatic Model for Dissociative Identity Disorder. Note the importance of the capacity for self-hypnosis in the development of dissociative identity disorder. -DID development involving distress, suggestibility, and a lack of social support.

15. Etiology of Dissociative Disorders Behavioral perspective: Indirect avoidance of stress. Sociocognitive model: Rule-governed/goal-directed experiences and displays created, legitimized, and maintained by social reinforcement. Learn behaviors from observing what works for others. Reinforced by the removal of unpleasant memories. Iatrogenic: Created by the therapeutic situation (hypnotic suggestibility).

16. -Figure 6.2: Multipath Model for Dissociative Disorders. The dimensions interact with one another and combine in different ways to result in a specific dissociative disorder.-Figure 6.2: Multipath Model for Dissociative Disorders. The dimensions interact with one another and combine in different ways to result in a specific dissociative disorder.

17. Treatment of Dissociative Disorders No specific medication, but medications can treat accompanying anxiety or depression. Survivors of childhood sexual abuse who have dissociated are often treated with psychoeducation, use of group resources, and cognitive/social skills training. -Psychoeducation-Teaching about dissociation -Use of Group Resources-Identify dissociation and ask group to identify the trigger of it. Use it as a way of discussing ways to handle stress. -Cognitive/Social Skills training-Teach ways to change irrational cognitions. -Psychoeducation-Teaching about dissociation -Use of Group Resources-Identify dissociation and ask group to identify the trigger of it. Use it as a way of discussing ways to handle stress. -Cognitive/Social Skills training-Teach ways to change irrational cognitions.

18. Treatment of Dissociative Disorders Amnesia and fugue (usually spontaneously remit): Supportive counseling Treat depression and stress

19. Treatment of Dissociative Disorders Depersonalization disorder (slower spontaneous remission) Alleviate feelings of anxiety, depression, fear of going insane. Occasionally behavioral therapy (reinforcement of appropriate responses)

20. Treatment of Dissociative Disorders Dissociative identity disorder (DID): Controversial treatments, not always successful Psychotherapy and hypnosis Personalities introduce selves to patient (in hypnosis) and recall traumatic experiences/memories which developed them Therapist suggests personalities served a purpose but now alternative coping strategies will be more effective Integrate personalities

21. Factitious Disorders Factitious Disorders: Mental disorders in which the symptoms of physical or mental illnesses are deliberately induced or simulated with no apparent incentive. Distinct from Malingering, faking a disorder to achieve some goal such as an insurance settlement. -People with factitious disorders will often doctor shop and use aliases to make the shopping easier.-People with factitious disorders will often doctor shop and use aliases to make the shopping easier.

22. Factitious DisordersMunchausen Syndrome Munchausen Syndrome: Sufferers feign disease, illness, or psychological trauma despite varying degrees of personal risk, in order to draw attention or sympathy to themselves. The term has also been used to refer to medical professionals who purposely cause inflicted injury or discomfort to a patient so they are able to later treat or heal the patient and receive attention or compliments from co-workers; commonly referred to in modern parlance as "playing god". -Munchausen syndrome is a form of psychological disorder, named after the fictional representation of the German baron, Karl von M�nchhausen, and his affinity for telling tall tales. -It is not clear how much of the story material derives from the Baron himself; however, it is known that the majority of the stories are based on folktales that have been in circulation for many centuries before M�nchhausen's birth.-Munchausen syndrome is a form of psychological disorder, named after the fictional representation of the German baron, Karl von M�nchhausen, and his affinity for telling tall tales. -It is not clear how much of the story material derives from the Baron himself; however, it is known that the majority of the stories are based on folktales that have been in circulation for many centuries before M�nchhausen's birth.

23. Factitious DisordersMunchausen Syndrome Variations Munchausen Syndrome by Proxy: A caregiver, usually the mother, feigns or induces an illness in another person, usually her or his child, to gain attention and sympathy as the "worried" parent. Munchausen Syndrome by Internet: Instead of seeking care at numerous hospitals, they gain new audiences merely by clicking from one support group to another. Under the guise of illness, they can also join multiple groups simultaneously. Using different names and accounts, they can even sign on to one group as a stricken patient, his frantic mother, and his distraught son all to make the ruse utterly convincing.

24. Somatoform Disorders Physical symptoms that mimic medical conditions with no physiological basis. Symptoms are not under voluntary or conscious control Somatoform disorders: Somatization Disorder Conversion Disorder Pain Disorder Hypochondriasis Body Dysmorphic Disorder -DSM IV TR requirements for diagnosis. -A history of complaints that involve at least four pain symptoms in different sites, such as the back, head, and extremities. -Two gastrointestinal symptoms, such as nausea, diarrhea, and bloating. -One sexual symptom, such as sexual indifference, irregular menses, or erectile dysfunction. -One pseudoneurological symptom, such as conversion symptoms, amnesia, or breathing difficulties.-DSM IV TR requirements for diagnosis. -A history of complaints that involve at least four pain symptoms in different sites, such as the back, head, and extremities. -Two gastrointestinal symptoms, such as nausea, diarrhea, and bloating. -One sexual symptom, such as sexual indifference, irregular menses, or erectile dysfunction. -One pseudoneurological symptom, such as conversion symptoms, amnesia, or breathing difficulties.

25. Somatoform Disorders Comorbid disorders: Mood, personality, and substance use disorders. Differentiated from malingering or factitious disorders. Cultural differences: Psychosomatic versus somatopsychic perspectives -People with Somatoform disorders tend to doctor shop. -Previously called hysteria.-People with Somatoform disorders tend to doctor shop. -Previously called hysteria.

26. -Table 6.2 Disorders Chart: Somatoform Disorders. -Key word to diagnosing Somatoform disorders is not produced �voluntarily�. -Table 6.2 Disorders Chart: Somatoform Disorders. -Key word to diagnosing Somatoform disorders is not produced �voluntarily�.

27. Somatoform DisordersSomatization Disorder Chronic complaints of many bodily symptoms with no physical basis. Complaints include at least four pain symptoms in different sites (DSM-IV-TR): Two gastrointestinal One sexual One pseudoneurological Undifferentiated Somatoform Disorder Relatively rare diagnosis world-wide

28. Somatoform DisordersConversion Disorder Conversion Disorder: Complaints of physical problems or impairments of sensory or motor functions controlled by voluntary nervous system, suggesting neurological disorder, with no underlying physical cause. Often related to stress -D.B. was a 38 year old, single white male who was employed in a clerical job and who lived with his parents. D.B.�s visual disorder began when he was hit in the right eye with a rifle butt during military training. D.B. reported pain and impaired vision in his right eye and was hospitalized for three weeks. He reported seeing only �shapes and silhouettes� of objects and �cones of white rings� in the right eye. D.B. then received intensive ophthalmological and neuropsychological assessment. None of the assessments revealed any apparent physical basis for his visual disorder. -Despite his claiming to not see in his right eye, D.B. performed tasks far better than chance when needing information from his right eye. -D.B. was a 38 year old, single white male who was employed in a clerical job and who lived with his parents. D.B.�s visual disorder began when he was hit in the right eye with a rifle butt during military training. D.B. reported pain and impaired vision in his right eye and was hospitalized for three weeks. He reported seeing only �shapes and silhouettes� of objects and �cones of white rings� in the right eye. D.B. then received intensive ophthalmological and neuropsychological assessment. None of the assessments revealed any apparent physical basis for his visual disorder. -Despite his claiming to not see in his right eye, D.B. performed tasks far better than chance when needing information from his right eye.

29. Somatoform DisordersConversion Disorder Most common conversion symptoms: Psychogenic pain Disturbances of stance and gait Sensory symptoms Dizziness Psychogenic seizures Some symptoms are easily diagnosed as conversion disorders, while others require extensive neurological and physical examination.

30. Glove Anesthesia -Figure 6.4: Glove Anesthesia. In glove anesthesia, the lack of feeling covers the hand in a glovelike shape. It does not correspond to the distribution of nerve pathways. This discrepancy leads to a diagnosis of conversion disorder. -Easily diagnosed as conversion disorder because no nerves exists that could create the symptoms.-Figure 6.4: Glove Anesthesia. In glove anesthesia, the lack of feeling covers the hand in a glovelike shape. It does not correspond to the distribution of nerve pathways. This discrepancy leads to a diagnosis of conversion disorder. -Easily diagnosed as conversion disorder because no nerves exists that could create the symptoms.

31. Somatoform DisordersPain Disorder Pain Disorder: Reports of severe pain, but: No physiological or neurological basis (vague descriptions) Pain is greatly in excess of that expected with an existing condition, OR Pain lingers long after a physical injury has healed Frequent visits to doctors with numerous physical complaints; potential for drug or medication abuse. -People with pain disorder are less able to clearly localize the area of pain. -However, there are cases where the pain receptors continue to fire despite the lack of a presence of an injury, thus, despite no injury, the patient can feel pain.-People with pain disorder are less able to clearly localize the area of pain. -However, there are cases where the pain receptors continue to fire despite the lack of a presence of an injury, thus, despite no injury, the patient can feel pain.

32. Physical Complaints: A Comparison of Individuals with Pain Disorder Versus Healthy Controls -Physical Complaints: A Comparison of Individuals with Pain Disorder versus Healthy Controls. Individuals with somatoform disorders have numerous physical complaints. This graph illustrates the percentage of complaints expressed by a group of individuals with pain disorders.-Physical Complaints: A Comparison of Individuals with Pain Disorder versus Healthy Controls. Individuals with somatoform disorders have numerous physical complaints. This graph illustrates the percentage of complaints expressed by a group of individuals with pain disorders.

33. Somatoform DisordersHypochondriasis Hypochondriasis: Persistent preoccupation with one�s health and physical condition, despite physical evaluations that reveal no organic problems. Prevalence: 2-7% of general medical population

34. Somatoform DisordersHypochondriasis Predisposing factors: History of physical illness Parental attention to somatic symptoms Low pain threshold Greater sensitivity to somatic cues Anxiety/stress-arousing event, plus perception of somatic symptoms, plus fear that sensations reflect disease = greater attention to somatic cues.

35. Somatoform DisordersBody Dysmorphic Disorder Body Dysmorphic Disorder: Preoccupation with imagined physical defect in a normal-appearing person, or excessive concern with slight physical defect. May be underdiagnosed due to embarrassment to discuss the problem Comorbid: Functional impairment, mood disorders, social phobia, low self-esteem; may be suicidal Possibly related to obsessive-compulsive disorder -The patient was a 24 year old Caucasian male in his senior year of college. He presented at intake by stating �I�ve got a physical deformity (small hands) and it makes me very uncomfortable, especially around women with hands bigger than mine. I see my deformity as a sign of weakness; it�s like I�m a cripple. He spent considerable time researching hand sizes for different populations and stated at intake that his middle finger was one and one-fourth inches shorter than the average size for a male in the United States. He also reported being concerned that women might believe small hands are indicative of having a small penis.-The patient was a 24 year old Caucasian male in his senior year of college. He presented at intake by stating �I�ve got a physical deformity (small hands) and it makes me very uncomfortable, especially around women with hands bigger than mine. I see my deformity as a sign of weakness; it�s like I�m a cripple. He spent considerable time researching hand sizes for different populations and stated at intake that his middle finger was one and one-fourth inches shorter than the average size for a male in the United States. He also reported being concerned that women might believe small hands are indicative of having a small penis.

36. -Figure 6.5: Imagined Defects in Patients with Body Dysmorphic Disorder. This graph illustrates the percentage of thirty patients who targeted different areas of their body as having �defects�. Many of the patients selected more than one body region. -Not surprisingly, people with this disorder often seek surgery to correct the �deformity�-Figure 6.5: Imagined Defects in Patients with Body Dysmorphic Disorder. This graph illustrates the percentage of thirty patients who targeted different areas of their body as having �defects�. Many of the patients selected more than one body region. -Not surprisingly, people with this disorder often seek surgery to correct the �deformity�

37. Etiology of Somatoform Disorders Diathesis-stress models: Predisposition may be learned or �hard-wired� Predisposition involves hypervigilance or exaggerated focus on bodily sensations, increased sensitivity to weak bodily sensations, and disposition to react to somatic sensations with alarm. Predisposition becomes fully developed disorder when person can�t deal with trauma or stress.

38. -Figure 6.6: Multipath Model for Somatoform Disorders. The dimensions interact with one another and combine in different ways to result in a specific somatoform disorder.-Figure 6.6: Multipath Model for Somatoform Disorders. The dimensions interact with one another and combine in different ways to result in a specific somatoform disorder.

39. Etiology of Somatoform Disorders Psychodynamic perspective: Somatic symptoms defend against awareness of unconscious emotional issues. Freud: Hysterical reactions result from repression of conflict (usually sexual) Two mechanisms produce and sustain symptoms: Primary gain (protection from anxiety) Secondary gain (dependency needs fulfilled)

40. Etiology of Somatoform Disorders Behavioral perspective: Reinforcement Modeling Cognitive styles Combination of all three Sociocultural perspective: Societal restrictions on women

41. Etiology of Somatoform Disorders Biological perspective: There may be innate physical bases Hypochondriacs are more sensitive to bodily sensations

42. Treatment of Somatoform Disorders Psychodynamic: Psychoanalysis and hypnosis to help person relive feelings associated with repressed trauma. Determining the validity of memories dating from an early age is very difficult. Behavioral: Many strategies, including exposure and response prevention (extinction and nonreinforcement of complaints); systematic desensitization. Cognitive-behavioral: Correct cognitive distortions and reattribution training

43. Treatment of Somatoform Disorders Biological: Antidepressant medications, increased physical activity, SSRIs Family systems treatment: Place identified patient�s disorder in perspective, teach family adaptive ways of support, prepare family members to deal with problems.

44. Variables that Distinguish Subgroups of Confirmed Somatoform Disorder