Understanding Somatoform and Dissociative Disorders: Causes, Symptoms, and Treatment

1. Somatoform Disorders &Dissociative Disorders Kimberley Clow kclow2@uwo.ca http://instruct.uwo.ca/psychology/155b/

2. Outline • Somatoform Disorders • Somatization Disorder • Pain Disorder • Hypochondriasis • Conversion Disorder • Body Dysmorphic Disorder • Dissociative Disorders • Dissociative Amnesia • Dissociative Fugue • Depersonalization Disorder • Dissociative Identity Disorder

3. Somatoform Disorders • Bodily symptoms that suggest a physical defect or dysfunction • BUT no physiological basis can be found • Emotions  Physical Symptoms • Different from • Malingering • Factitious Disorder

4. Somatization Disorder

5. Causes & Treatment • Contributors • Behaviour rewarded • Excessive illness growing up • Association with Antisocial Personality Disorder • Runs in families • Treatment • Focus on stress • Reduce help-seeking behaviour • Eliminate reinforcers

6. Pain Disorder • Predominant complain is pain and psychological factors have an important role in the onset, severity, exacerbation, or maintenance of the pain • Types • Acute • Chronic • Causes • Psychodynamic • Behavioural

7. Hypochondriasis

8. Causes & Treatment

9. Freud Conversion Disorder • Motor or sensory symptoms suggesting a neurological impairment when there is none • Conversion refers to unconscious conflicts being converted into physical symptoms • Discharging anxiety without experiencing it

10. Causes & Treatment • Contributors • Triggered by a stressful / traumatic event • Primary & Secondary Gain • Treatment • Need to address initial stressful event • Remove reinforcers Glove Anesthesia

11. Body Dysmorphic Disorder • Dysfunctional preoccupation about imagined physical defects • Ideas of reference • Successive changes & surgeries • With insight • Without insight • Delusional Disorder

12. Causes & Treatment • Contributors • Societal beauty images • High comorbidity with OCD • Treatment • Drugs • Same ones for OCD • Behavioural Therapy • Exposure and Response Prevention • Same therapy as for OCD

13. Psychodynamic Neurosis Primary gain Secondary gain Behavioural Sick role Modeling Stress & Trauma High incidences of child abuse History of illness Cognitive Faulty interpretations Biological History of illness Sensitivity to bodily sensations Cultural Factors More prevalent in cultures that stigmatize mental disorders General Considerations

14. Dissociative Disorders • Disruptions of consciousness, memory, and identity • Missing time • No memory for a period • Weren’t conscious when it happened • Don’t know who you are • Lost memories • Don’t identify with self • Multiple identities • Don’t feel real

15. Dissociative Experiences Scale • Able to ignore pain • Missing part of a conversation • Usually difficult things can be done with ease and spontaneity • Not sure whether you have done something or only thought about it • Absorption in TV program or movie • Remembering past so vividly you seem to be reliving it • Staring into space • Talking out loud to yourself when alone • Finding evidence of having done things you can’t remember doing

16. Not sure if remembered event happened or was a dream • Being approached by people you doesn’t know who call you by a different name • Feeling as though you were two different people • So involved in fantasy that it seems real • Driving a car and realizing you don’t remember part of the trip • Not remembering important events in your life • Being in a familiar place but finding it unfamiliar • Being accused of lying when you are telling the truth • Finding notes or drawings that you must have done but don’t remember doing

17. Seeing yourself as if looking at another person • Hearing voices inside your head • Not recognizing friends or family members • Other people and objects do not seem real • Looking at the world through a fog • Finding unfamiliar things among your belongings • Feeling as though your body is not your own • Finding yourself in a place but unaware of how you got there • Finding yourself dressed in clothes that you don’t remember putting on • Not recognizing your own reflection in a mirror

18. Dissociative Amnesia • Person is unable to recall important personal information • Usually related to a traumatic or stressful event • Variations • Generalized • Localized • Selective 24

19. Dissociative Fugue • Person suddenly leaves home and work and assumes a new identity • Usually triggered by stress or trauma

20. Depersonalization Disorder • Person’s perception or experience of the self is disconcertingly and disruptively altered • Frequent episodes • Reality does remain intact during episodes • No amnesia or new identities

21. Causes & Treatment

22. Dissociative Identity Disorder (DID)

23. Causes & Treatment

24. Yes It Is Many symptoms of PTSD are similar to those of DID Alters show several physiological and / or behavioural differences No It Isn’t The use of hypnosis may be a source of therapist contamination Physiological changes are also seen in subjects asked to fake DID Is DID A Real Disorder?