Amber Gilewski Tompkins Cortland Community College

1. Chapter 5 Somatoform and Dissociative Disorders Amber Gilewski Tompkins Cortland Community College

2. Somatoform Disorders • Soma – Meaning Body • Preoccupation with health and/or body appearance and functioning • No identifiable medical condition causing the physical complaints

3. 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

4. Hypochondriasis • Good prevalence data are lacking • Onset at any age • Causes • Cognitive perceptual distortions • Familial history of illness • Treatment • Challenge illness-related misinterpretations • Provide more substantial and sensitive reassurance • Stress management and copingstrategies

5. Somatization Disorder • 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

6. Somatization Disorder • Rare condition • Onset usually in adolescence • Mostly affects unmarried, low SES women • Causes • Familial history of illness • Relation with ASPD & weak behavioral inhibition system • Treatment • No treatment exists with demonstrated effectiveness • Assign “gatekeeper” physician • Reduce supportive consequences of talk about physical symptoms

7. Conversion Disorder • Physical malfunctioning • Lack physical or organic pathology • Malfunctioning often involves sensory-motor areas • Retain most normal functions, but lack awareness

8. Conversion Disorder • Freudian psychodynamic view is still popular • Emphasis on the role of past trauma and conversion • Differences: conversion disorder, actual illness, malingering(faking), & factitious disorder(faking w/o obvious cause), factitious disorder by proxy(caregiver making other’s sick)

9. Conversion Disorder • Rare condition, with a chronic intermittent course • Seen primarily in females • Onset usually in adolescence 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

10. Pain Disorder • Associated with psychological disorders • Pain is severe enough to interfere with functioning • Medical pain vs. psychiatric pain?

11. Body Dysmorphic Disorder • Preoccupation with imagined defect in appearance • Often display ideas of reference for imagined defect • Suicidal ideation and behavior are common

12. Body Dysmorphic Disorder • Seen equally in males and females • Onset usually in early 20s • Most remain single • 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

13. Dissociative Disorders • Involve severe alterations or detachments • Affects identity, memory, or consciousness • Depersonalization – Distortion is perception of reality • Derealization – Losing a sense of the external world • Severe and frightening feelings of unreality and detachment • Feelings dominate and interfere with life functioning

14. Depersonalization Disorder • Facts and Statistics • High comorbidity with anxiety and mood disorders • Onset is typically around age 16 • Usually runs a lifelong chronic course • Causes • Cognitive deficits in attention, short-term memory, spatial reasoning • Such persons are easily distracted • May begin with no trigger or stress/trauma • Treatment • Little is known

15. Dissociative Amnesia & Dissociative Fugue • Dissociative Amnesia • Includes several forms of psychogenic memory loss • Most common dissociative disorder • Generalized vs. localized or selective type • Dissociative Fugue • 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

16. Dissociative Amnesia & Fugue • 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 • Treatment • Most get better without treatment • Most remember what they have forgotten

17. Dissociative Trance Disorder • Dissociative symptoms and sudden changes in personality • Changes often attributed to possession by a spirit • Presentation varies across cultures • More common in females than males • Causes • Often attributable to a life stressor or trauma • Treatment • Little is known

18. Dissociative Identity Disorder (DID) • Adoption of several new identities (as many as 100) • Identities display unique behaviors, voice, and posture • Alters – Different identities or personalities • Host – The identity that keeps other identities together Can it be faked? • Hillside strangler case • Controversial diagnosis

19. Dissociative Identity Disorder (DID) • 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 • Considered rare

20. Dissociative Identity Disorder (DID) • Causes • Histories of horrible, unspeakable, child abuse or other trauma • Closely related to PTSD • Mechanism to escape from the impact of trauma • Treatment • Focus is on reintegration of identities • Identify and neutralize cues/triggers that provoke memories of trauma/dissociation