Dissociative & Somatoform Disorders

1. Dissociative & Somatoform Disorders DISORDER V. FAKING Malingering = faking bad - symptoms deliberate - for gain - not a disorder

2. Factitious Disorder = psychological need to lie • only for psychological gain • symptoms deliberate • a mental disorder

3. Ex. Munchausen’s Syndrome - lies for medical attention Munchausen by proxy - creating physical problems in another for medical attention

4. Somatoform Disorders = physical symptoms without physical basis • psychological disorder • may be gain • symptoms not deliberate**

5. Undiagnosed physical illness

6. Somatoform Disorders Physical complaints with no physical cause

7. 1. Conversion Disorder Freud: conflicts converted into sxs - women

8. Description • Affects voluntary movement/sensation • Identifiable stressors • Not explained medically • Not intentional • Distress/impairment • Decreasing incidence

9. Signs of conversion • Sudden onset after stress • La belle indifference • Selective symptoms

10. Possible Causes Psychodynamic: 4 processes: 1) traumatic event --> impulse emerges 2) conflict is repressed

11. 3) anxiety increases, is “converted” into physical symptom - avoid anxiety (primary gain) 4) attention/sympathy & avoid tasks (secondary gain)

12. Learning Theory 1) traumatic event => escape/avoid 2) symptom develops 3) environment reinforces symptoms

13. Other: Personality type - histrionic

14. Treatment • Deal with stressor • Remove secondary gain • Teach reuse of body part

15. 2. Hypochondriasis Description • belief of serious illness (anxiety) • illness is long-term • misinterpret body symptoms • symptoms are wide-ranging • agree that reaction is excessive

16. “doctor shopping” • distress/impairment • men & women

17. Possible Causes Theoretical agreement • faulty interpretation of sensations • biological hypersensitivity • learned focus on illness

18. Treatment • Uncover unconscious conflicts • Attack illness beliefs via cognitive-behavioral • Support groups

19. 3. Somatization Disorder Description • Multiple somatic complaints • Most major body systems • No physical basis

20. Concern = symptoms themselves, not illness • Life revolves around symptoms • Relating to others = symptoms • Lengthy medical history • Severe impairment • Very rare - women

21. Possible Causes • Childhood learning • Identifiable stressor

22. Personality traits - insensitive to punishment - impulsive (short-term gains) - irresponsible - aggressive • Women - socialization

23. Treatment • Very difficult • Reduce help-seeking behavior • Increase independence • No reinforcement for symptoms • Teach more appropriate behavior

24. 4. Body Dysmorphic Disorder Description • Perceived defect in appearance • Imagined/exaggerated • Face/head flaws

25. Difficulty controlling obsession • Frequently check appearance • Requests reassurance • Plastic surgery • Distress & life impairment

26. Prevalence unknown but probably common • Men & women

27. Causes & Treatment • Little known • Related to OCD? - anxiety • Surgery increases complaints

28. Dissociative Disorders Splitting off of a psychological function from rest of conscious mind

29. 1. Dissociative Identity Disorder (DID) Description • 2+ distinct personalities • Alternate control of body —> NOT INTEGRATED • “Core” has amnesia

30. DID vs. Schizophrenia • Does DID exist? (iatrogenic effects)

31. Indications of DID • Amnestic periods • Childhood abuse or trauma • Unsuitable nickname • Hypnotizability

32. 2. Dissociative Amnesia • Loss of memory • Traumatic event • Lack of distress

33. 3. Dissociative Fugue • Amnesia for identity • Flight • New life & identity • Brief duration

34. 4. Depersonalization Disorder • Recurrent detachment from self/body • Observing self • Good reality perception • Distress

35. Possible Causes • Childhood sexual abuse/trauma • Self-hypnosis • Biological vulnerability

36. Treatment • Amnesia & fugue get better on own • Resolve trauma • Improve coping

37. Tx for DID • Uncover & deal with trauma • Hypnosis to remember • Goal: integrate personalities