Dissociative Disorders

1. Dissociative Disorders Persistent, maladaptive disruptions in memory, consciousness, or identity

2. Dissociative Identity Disorder • A. presence of two or more distinct identities or personality states • B. at least two of these identities recurrently take control • C. inability to recall important personal information

3. Possible Causes: • Biological vulnerability • Severe abuse/trauma history • Suggestibility

4. Treatment: • identify cues or triggers that provoke memories or dissociation • try to help person integrate personalities • hypnosis sometimes used • antidepressants may be helpful

5. Depersonalization Disorder • depersonalization disorder: severe feelings of unreality - dominates the person’s life • depersonalization • derealization

6. Depersonalization Disorder: Causes • Causes • Cognitive deficits • Attention • Short-term memory • Spatial reasoning • Easily distracted • Decreased emotional response

7. Dissociative Amnesia: • generalized amnesia: can’t remember anything- even identity • localized or selective amnesia: failure to recall specific events (often traumatic) • dissociative fugue: memory loss combined with flight • dissociative trance disorder: dissociative phenomena that appears as a trance or “possession”

8. Somatic Symptom and Related Disorders

9. Historical Roots • hysteria: “wandering uterus” • physical symptoms without a known cause • term dates back to Hippocrates and Egyptians • neurosis: emotional distress due to underlying unconscious conflicts, anxiety, and implementation of defense mechanisms

10. Illness Anxiety Disorder • Preoccupation with fears of having a serious disease based on a misinterpretation of bodily symptoms • Persists despite appropriate medical evaluation and reassurance • Causes distress or impairment in functioning • Disturbance lasts at least 6 months

11. Cultural Variations • Africa • Sensation of something crawling in one’s head • India and Pakistan • Sensation of burning in hands or feet • dhat – concern about losing semen accompanied by feelings of weakness and exhaustion • China, East Asia • koro – sudden intense anxiety that one’s genitals will recede into one’s body and possibly cause death

12. Somatic Symptom Disorder • A disorder in which persons become excessively distressed, concerned, and anxious about the bodily symptoms that they are experiencing. • Their lives are greatly and disproportionately disrupted by the symptoms.

13. Somatic Symptom Disorderand Antisocial Personality Disorder • Run in the same families • Gender differences • Common features

14. Conversion Disorder • Presence of one or more symptoms or deficits that affect voluntary or sensory functioning • paralysis • blindness • difficulty speaking • loss of sense of touch

15. Causes of Somatic Symptom and Related Disorders • Cognitive behavioral view • Psychodynamic view • Tends to run in families (genetic and environmental contributions) • Often develops in context of stressful life event

16. Treatment(Kroenke, 2007) • Reviewed 34 randomized controlled studies of treatment of somotaform disorders (3,922 patients) • Concluded that the most effective treatment for somatoform disorders was cognitive-behavioral therapy (CBT). • some evidence that antidepressants and a consultation letter to primary care physician can help.

17. Factitious Disorder • A disorder in which an individual feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person. • Different from Malingering • Specifiers of imposed on self vs. imposed on another (formerly factitious disorder by proxy) • http://abcnews.go.com/Health/arizona-mother-accused-poisoning-baby-munchausen-syndrome-proxy/story?id=13308998