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Chapter 5 Somatoform and Dissociative Disorders

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Page 1: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Chapter 5 Somatoform and Dissociative Disorders

Page 2: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Somatoform Disorders

• Soma – Meaning Body

– Preoccupation with health and/or body appearance and functioning

– No identifiable medical condition causing the physical complaints

Page 3: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Somatoform Disorders (continued)

• Types of DSM-IV Somatoform Disorders

– Hypochondriasis

– Somatization disorder

– Conversion disorder

– Pain disorder

– Body dysmorphic disorder

Page 4: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

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

Page 5: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Hypochondriasis (continued)

• Statistics

– Good prevalence data are lacking

– Onset at any age

– Runs a chronic course

Page 6: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Hypochondriasis: Causes and Treatment

• Causes

– Cognitive perceptual distortions

– Familial history of illness

• Treatment

– Challenge illness-related misinterpretations

– Provide more substantial and sensitive reassurance

– Stress management and coping strategies

Page 7: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Fig. 5.1, p. 176

Page 8: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Somatization Disorder

• Clinical Description

– 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

Page 9: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Somatization Disorder (continued)

• Statistics

– Rare condition

– Onset usually in adolescence

– Mostly affects unmarried, low SES women

– Runs a chronic course

Page 10: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Somatization Disorder: Causes and Treatment

• Causes

– Familial history of illness

– Relation with antisocial personality disorder

– Weak behavioral inhibition system

• Treatment

– No treatment exists with demonstrated effectiveness

– Reduce the tendency to visit numerous medical specialists

Page 11: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Somatization Disorder: Causes and Treatment (continued)

– Assign “gatekeeper” physician

– Reduce supportive consequences of talk about physical symptoms

Page 12: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Conversion Disorder

• Clinical Description

– Physical malfunctioning

– Lack physical or organic pathology

– Malfunctioning often involves sensory-motor areas

– Persons show “la belle indifference”

– Retain most normal functions, but lack awareness

Page 13: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Conversion Disorder (continued)

• Statistics

– Rare condition, with a chronic intermittent course

– Seen primarily in females

– Onset usually in adolescence

– Common in some cultural and/or religious groups

Page 14: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Conversion Disorder: Causes

• Causes

– Freudian psychodynamic view is still popular

– Emphasis on the role of past trauma and conversion

• Detachment from the trauma and negative reinforcement

– Address primary/secondary gain

Page 15: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Conversion Disorder: Treatment

• 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

Page 16: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Body Dysmorphic Disorder

• Clinical Description

– Previously known as dysmorphophobia

– Preoccupation with imagined defect in appearance

– Often display ideas of reference for imagined defect

– Suicidal ideation and behavior are common

Page 17: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Body Dysmorphic Disorder (continued)

• Statistics

– More common than previously thought

– Seen equally in males and females

– Onset usually in early 20s

– Most remain single, and many seek out plastic surgeons

– Usually runs a lifelong chronic course

Page 18: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Body Dysmorphic Disorder: Causes

• Causes

– Little is known – Disorder tends to run in families

– Shares similarities with obsessive-compulsive disorder

Page 19: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Body Dysmorphic Disorder: Treatment

• 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

Page 20: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

An Overview of Dissociative Disorders

• Overview

– Involve severe alterations or detachments

– Affects identity, memory, or consciousness

– Depersonalization – Distortion is perception of reality

– Derealization – Losing a sense of the external world

Page 21: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

An Overview of Dissociative Disorders (continued)

• Types of DSM-IV Dissociative Disorders

– Depersonalization Disorder

– Dissociative Amnesia

– Dissociative Fugue

– Dissociative Trance Disorder

– Dissociative Identity Disorder

Page 22: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Depersonalization Disorder: An Overview

• Overview and Defining Features

– Severe and frightening feelings of unreality and detachment

– Feelings dominate and interfere with life functioning

– Primary problem involves depersonalization and derealization

Page 23: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Depersonalization Disorder: An Overview (continued)

• Facts and Statistics

– High comorbidity with anxiety and mood disorders

– Onset is typically around age 16

– Usually runs a lifelong chronic course

Page 24: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Depersonalization Disorder: Causes and Treatment

• Causes

– Cognitive deficits in

– Attention, short-term memory, spatial reasoning

– Deficits related to tunnel vision and mind emptiness

– Such persons are easily distracted

• Treatment

– Little is known

Page 25: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Amnesia: An Overview

• Dissociative Amnesia

– Includes several forms of psychogenic memory loss

– Generalized vs. localized or selective type

Page 26: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Fugue: An Overview

• Dissociative Fugue

– Related to dissociative amnesia

– 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

Page 27: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Amnesia and Fugue: Causes

• Statistics

– 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

Page 28: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Amnesia and Fugue: Causes and Treatment

• Treatment

– Most get better without treatment

– Most remember what they have forgotten

Page 29: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Trance Disorder: An Overview

• Clinical Description

– Symptoms resemble other dissociative disorders

– Dissociative symptoms and sudden changes in personality

– Changes often attributed to possession by a spirit

– Presentation varies across cultures

Page 30: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Trance Disorder: Causes, and Treatment

• Facts and Statistics

– More common in females than males

• Causes

– Often attributable to a life stressor or trauma

• Treatment

– Little is known

Page 31: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Identity Disorder (DID): An Overview

• Clinical Description

– Formerly known as multiple personality disorder

– Defining feature is dissociation of personality

– Adoption of several new identities (as many as 100)

– Identities display unique behaviors, voice, and posture

Page 32: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Identity Disorder (DID): An Overview (continued)

• Unique Aspects of DID

– Alters – Different identities or personalities

– Host – The identity that keeps other identities together

– Switch – Quick transition from one personality to another

Page 33: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Identity Disorder (DID): An Overview (continued)

• Statistics

– 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

Page 34: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Identity Disorder (DID): Causes

• Causes

– Histories of horrible, unspeakable, child abuse

– Closely related to PTSD

– Mechanism to escape from the impact of trauma

Page 35: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Dissociative Identity Disorder (DID): Treatment

• Treatment

– Focus is on reintegration of identities

– Identify and neutralize cues/triggers that provoke memories of trauma/dissociation

Page 36: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Diagnostic Considerations in Somatoform and Dissociative Disorders

• Separating Real Problems from Faking

– Malingering – Deliberately faking symptoms

• False Memories and Recovered Memory Syndrome

• Related Conditions – Factitious Disorder

– Factitious Disorder by Proxy

Page 37: Chapter 5 Somatoform and Dissociative Disorders. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning

Summary of Somatoform and Dissociative Disorders

• Features of Somatoform Disorders

– Physical problems without on organic cause

• Features of Dissociative Disorders

– Extreme distortions in perception and memory

• Well Established Treatments Are Generally Lacking