Common Features Lots of Physical Complaints Appear to be Medical Conditions No Identifiable Medical Cause Pathological Concern About

– Physical Appearance– Functioning of Their Bodies

Common Features Lots of Physical Complaints Appear to be Medical Conditions No Identifiable Medical Cause Pathological Concern About

– Physical Appearance– Functioning of Their Bodies

Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Clinical Description Ancient Roots Physical Complaints No Known Medical Cause Severe Anxiety / Fear About

Possibly Having a Serious Disease Reassurance Doesn’t Help

Clinical Description Ancient Roots Physical Complaints No Known Medical Cause Severe Anxiety / Fear About

Possibly Having a Serious Disease Reassurance Doesn’t Help

Clinical Description Essential Problem is Anxiety Preoccupied With Bodily Symptoms Misinterpretation of Symptoms Strong Disease Conviction Many Medical Visits and Tests

Clinical Description Essential Problem is Anxiety Preoccupied With Bodily Symptoms Misinterpretation of Symptoms Strong Disease Conviction Many Medical Visits and Tests

Why not Classify Such Persons With an Illness Phobia?

Why not Classify Such Persons With an Illness Phobia?

Facts and Statistics 1% to 14% Medical Patients Equal Rates (Males vs. Females) May Occur Any Time Strong Disease Conviction Many Medical Visits and Tests

Facts and Statistics 1% to 14% Medical Patients Equal Rates (Males vs. Females) May Occur Any Time Strong Disease Conviction Many Medical Visits and Tests

Causes Disorder of Cognition / Perception More Disease in Family More Illness Concern in Family More Attention for Sick Behavior

Causes Disorder of Cognition / Perception More Disease in Family More Illness Concern in Family More Attention for Sick Behavior

Psychological Treatment Modify Illness Perceptions Evoke Bodily Sensations Provide “Appropriate” Reassurance More Research is Needed!

Psychological Treatment Modify Illness Perceptions Evoke Bodily Sensations Provide “Appropriate” Reassurance More Research is Needed!

Five Somatoform Disorders Hypochondriasis

Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Five Somatoform Disorders Hypochondriasis

Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Clinical Description Briquet’s Syndrome Many Physical Complaints No Known Medical Cause Little Concern About Symptoms

La Belle Indifference Life Revolves Around Symptoms

Clinical Description Briquet’s Syndrome Many Physical Complaints No Known Medical Cause Little Concern About Symptoms

La Belle Indifference Life Revolves Around Symptoms

Facts and Statistics Extremely Rare About 4.4% of Population Onset in Adolescence Females > Males Often a Chronic Condition

Facts and Statistics Extremely Rare About 4.4% of Population Onset in Adolescence Females > Males Often a Chronic Condition

Causes Family Link Link to Antisocial Personality

– Weak Behavioral Inhibition– Strong Behavioral Activation– Short Term Gain

Causes Family Link Link to Antisocial Personality

– Weak Behavioral Inhibition– Strong Behavioral Activation– Short Term Gain

Treatment Difficult to Treat No Proven Treatments Extensive Medical Visits Treatment Focuses on

– Reduction of Medical Visits– Reducing Secondary Gain

Treatment Difficult to Treat No Proven Treatments Extensive Medical Visits Treatment Focuses on

– Reduction of Medical Visits– Reducing Secondary Gain

Five Somatoform Disorders Hypochondriasis Somatization Disorder

Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Five Somatoform Disorders Hypochondriasis Somatization Disorder

Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Clinical Description Physical Malfunctioning

– Paralysis, Blindness, Aphonia– Mutism, Lost Sense of Touch

No Organic Pathology Looks Like Neurological Disease Popularized by Freud

Clinical Description Physical Malfunctioning

– Paralysis, Blindness, Aphonia– Mutism, Lost Sense of Touch

No Organic Pathology Looks Like Neurological Disease Popularized by Freud

Related Conditions Malingering or Something Else?

– La Belle Indifference– Precipitated by Marked Stress– Can Function Normally

Factitious Disorders– Munchausen’s Syndrome by Proxy

Related Conditions Malingering or Something Else?

– La Belle Indifference– Precipitated by Marked Stress– Can Function Normally

Factitious Disorders– Munchausen’s Syndrome by Proxy

Facts and Statistics Relatively Rare Females > Males Onset Around Adolescence

Facts and Statistics Relatively Rare Females > Males Onset Around Adolescence

Causes Experience of Trauma Getting Sick is Acceptable Symptoms to Escape From the

Effects of Trauma What Influences Choice of

Symptoms?

Causes Experience of Trauma Getting Sick is Acceptable Symptoms to Escape From the

Effects of Trauma What Influences Choice of

Symptoms?

Treatment Address the Traumatic Event Remove Sources of Secondary Gain No Well Established Treatments

Treatment Address the Traumatic Event Remove Sources of Secondary Gain No Well Established Treatments

Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder

Pain Disorder Body Dysmorphic Disorder

Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder

Pain Disorder Body Dysmorphic Disorder

Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Maintain Pain Can be Debilitating

Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Maintain Pain Can be Debilitating

Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Five Somatoform Disorders Hypochondriasis Somatization Disorder Conversion Disorder Pain Disorder Body Dysmorphic Disorder

Clinical Description Preoccupation With Appearance

– Imagined Defect “Imagined” Ugliness Mirrors (Fixation or Avoidance) Ideas of Reference Suicidal Ideation and Tendencies

Clinical Description Preoccupation With Appearance

– Imagined Defect “Imagined” Ugliness Mirrors (Fixation or Avoidance) Ideas of Reference Suicidal Ideation and Tendencies

Common Locations of Defects Hair Nose Skin Eyes Head / Face Lips

Common Locations of Defects Hair Nose Skin Eyes Head / Face Lips

Facts and Statistics College Students

– 70% Report Some Disatisfaction– 28% Meet Diagnostic Criteria

Many Consult Plastic Surgeons Males = Females Onset Late Adolescence

Facts and Statistics College Students

– 70% Report Some Disatisfaction– 28% Meet Diagnostic Criteria

Many Consult Plastic Surgeons Males = Females Onset Late Adolescence

The Plastic Surgery Solution? Quite Popular but Expensive Most are Disappointed With Results

The Plastic Surgery Solution? Quite Popular but Expensive Most are Disappointed With Results

BEFOREBEFORE AFTERAFTER

Causes and Treatment Little is Known Co-Occurs With OCD

– Intrusive Thoughts and Checking Compulsions About Appearance

Exposure + Response Prevention

Causes and Treatment Little is Known Co-Occurs With OCD

– Intrusive Thoughts and Checking Compulsions About Appearance

Exposure + Response Prevention

Depersonalization– Altered Perception of Self

Depersonalization– Altered Perception of Self

Derealization– Altered Perception of World

Derealization– Altered Perception of World

Dissociative Phenomena Dissociative Phenomena

Common Experience Common Experience

Some people have the experience of driving a car and suddenly realizing that

they don’t remember what happened during all or part of the trip.

Some people have the experience of driving a car and suddenly realizing that

they don’t remember what happened during all or part of the trip.

0% 100%0% 100%0% 100%0% 100%

0% 100%0% 100%0% 100%0% 100%

Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear

part or all of what was just said.

Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear

part or all of what was just said.

0% 100%0% 100%0% 100%0% 100%

Some people find that they have no memory for some important events in their lives

(e.g. a wedding or graduation).

Some people find that they have no memory for some important events in their lives

(e.g. a wedding or graduation).

0% 100%0% 100%0% 100%0% 100%

Some people have the experience of finding themselves dressed in clothes that

they don’t remember putting on.

Some people have the experience of finding themselves dressed in clothes that

they don’t remember putting on.

0% 100%0% 100%0% 100%0% 100%

Some people sometimes have the experience of feeling that other people, objects, and the world

around them are not real.

Some people sometimes have the experience of feeling that other people, objects, and the world

around them are not real.

Nor

mal

Dis

soci

atio

nN

orm

alD

isso

ciat

ion

AmnesiaAmnesia

FugueFugue

PartialDID

PartialDID

ComplexDID

ComplexDID

Poly-F

ragmented

DID

Poly-F

ragmented

DID

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder

Primary Features– Depersonalization– Derealization

Primary Features– Depersonalization– Derealization

Impairs Functioning Causes Significant Distress Runs a Chronic Course

Impairs Functioning Causes Significant Distress Runs a Chronic Course

Clinical Description Clinical Description

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Clinical Description Clinical Description

Localized or Selective– Failure to Recall Specific Events

Localized or Selective– Failure to Recall Specific Events

Several Patterns Generalized

– Unable to Remember Anything

Several Patterns Generalized

– Unable to Remember Anything

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Clinical Description Clinical Description

Go to Another Location– Unaware “How They Arrived”

Go to Another Location– Unaware “How They Arrived”

Memory Loss – Specific Incident

Memory Loss – Specific Incident

May Assume New Identity May Assume New Identity Fugue Usually Ends Abruptly Fugue Usually Ends Abruptly

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Clinical Description Clinical Description Differ Across Cultures

– Sudden Changes in Personality– Possession by Spirits

Differ Across Cultures – Sudden Changes in Personality– Possession by Spirits

Females > Males Females > Males Often Related to Trauma Often Related to Trauma

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trace Disorder Dissociative Identity Disorder

Clinical Description Clinical Description Formally

– Multiple Personality Disorder

Formally – Multiple Personality Disorder

Person’s Identity is Dissociated Person’s Identity is Dissociated

May Adopt 100 Identities – “Alters”– The Nature of Alters

May Adopt 100 Identities – “Alters”– The Nature of Alters

Central Features Central Features Host Identity

– One Who Asks for Treatment– Attempt to Hold Alters Together

Host Identity – One Who Asks for Treatment– Attempt to Hold Alters Together

A Switch – Abrupt Change in Personalities– Usually Instantaneous

A Switch – Abrupt Change in Personalities– Usually Instantaneous

Facts and Statistics Facts and Statistics Average Number of Alters?

– 15

Average Number of Alters? – 15

Females > Males (9:1) Females > Males (9:1) Onset in Childhood

– Linked to Extreme Abuse

Onset in Childhood– Linked to Extreme Abuse

Runs a Chronic Course Runs a Chronic Course

Causes Causes Unspeakable Childhood Abuse

– 97% of Cases – Escape Into Fantasy World– Become Someone Else– Do What It Takes to Survive

Unspeakable Childhood Abuse– 97% of Cases – Escape Into Fantasy World– Become Someone Else– Do What It Takes to Survive

DID as a Means of Coping? DID as a Means of Coping?

Other Related Features Other Related Features Suggestibility Hypnotizability

– Similar to Dissociation

Suggestibility Hypnotizability

– Similar to Dissociation Are These Related to DID? Are These Related to DID?

Abuse: Controversial Issues Abuse: Controversial Issues False vs. Real Memories Do Therapists Plant Memories? Can False Memories be Created?

– Elizabeth Loftus– Other Related Research

False vs. Real Memories Do Therapists Plant Memories? Can False Memories be Created?

– Elizabeth Loftus– Other Related Research

Consequences of the Debate? Consequences of the Debate?

Treatment Treatment Dissociative Amnesia & Fugue

– Usually Improve on Their Own– Stress Reduction and Coping

Dissociative Amnesia & Fugue– Usually Improve on Their Own– Stress Reduction and Coping

Dissociative Identity Disoder– No Controlled Research– Treatments are Similar to PTSD

Dissociative Identity Disoder– No Controlled Research– Treatments are Similar to PTSD