Somatoform & dissociative disorders
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Somatoform & Dissociative Disorders
Aloha|Faye|Jai|Lenard
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Somatoform Disorders
Characterized by a pathological concern with physical functioning or appearance
Soma means “body”, and problem preoccupying an individual seem, initially to be physical orders
DSM-5 Proposal: to change to “Somatic Symptom Disorders” to include other psychologcial disorders affecting medical conditions
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Somatoform Disorders
characterized by anxiety or fear that one has a serious disease
Ancient root (Greeks): it has something to do
with hypochondria, a region below the
ribs wherein organs that can be found in
this region can affect mental state
1. Hypochondriasis
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Somatoform DisordersHypochondriasis
- Severe anxiety over physical problems that are medically undetectable
- Affects men and women equally- May emerge at any age- Comorbid w/ Anxiety & Mood disorders- Course: Chronic- Evident in diverse cultures
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Somatoform DisordersHypochondriasis
CULTURE-SPECIFIC SYNDROMES THAT FIT WITH HYPOCHONDRIASIS
• Koro: belief, accompanied by severe anxiety and sometimes panic, that the genitals are retracting into the abdomen [mostly Chinese males]
• Dhat: associated w/ vague mix of physical symptoms, including dizziness, weakness and fatigue that are not so specific
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Somatoform DisordersHypochondriasis
Faulty interpretation of
physical sensations
Intensified focus on symptoms
Increased anxiety
Additional physical
symptoms
CAUSES
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Somatoform DisordersHypochondriasis
Explanatory therapy
Cognitive-behavioral treatment to challenge illness perception
Counseling and/or support groups to provide reassurance
TREATMENT
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Somatoform Disorders
Formerly known as Briquet’s syndrome [for more than 100 yrs] and was changed in 1980 to somatization disorder
2. Somatization disorder
- Reports of multiple physical symptoms without medical basis
- Runs in families (probable heritable basis)- Rare (most prevalent among unmarried
women low in socioeconomic groups)- Onset usually in adolescence; often
persists into old age
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Somatoform DisordersSomatization Disorder
Continual development
of new symptoms
Immediate sympathy and
attention
Eventual social isolation
CAUSES
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Somatoform DisordersSomatization Disorder
Hard to treat!
Cognitive-behavioral therapy to provide reassurace, reduce stress, and minimize help-seeking behaviors
Therapy to broaden basis for relating to others
TREATMENT
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Somatoform Disorders
Refers to pain in one or more sites in the body that is associated with significant distress or impairment
3. Pain disorder
There may have been physical reasons for pain but psychological
factors play a major role in maintaining it.
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Somatoform Disorders
Generally have to do with physical malfunctioning, such as paralysis, blindness or difficulty speaking, without any physical or organic pathology to account for malfunctionDSM-5 Proposal: Functional Neurological Disorder
4. Conversion disorder
The term was used by Freud who believed that anxiety resulting from unconscious conflicts
somehow was “converted” into physical
symptoms to find expression
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Somatoform DisordersConversion disorder
- Comorbid with: Anxiety & Mood disorders
- Coincide with somatization disorders
- Affected people are genuinely unaware that they can function normally
- Most prevalent in low socio-economic groups, primarily in women and also in men under extreme stress
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Somatoform DisordersConversion disorder
Life stresses or psychological
conflict
Reduced by incapacitating
symptoms
Social influences (symptoms learned from observing real
illness or injury)
CAUSES
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Somatoform DisordersConversion disorder
Same as for somatization disorder, with emphasis on resolving life stress or conflict and reducing help-seeking behaviors
CBT & Catharsis
TREATMENT
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Somatoform Disorders
Features a disruptive preoccupation with some imagined defect in appearance (imagined ugliness) by someone who actually looks reasonably normal. This was previously known as dysmorphobia.
5. Body Dysmorphic Disorder
- Prevalence is not known- Affects men and women equally- Associated with obsessive-compulsive
disorder
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Somatoform DisordersBody Dysmorphic Disorder
Intrusive, anxiety-provoking idea that
individual has a physical defect apparent to
everyone
Intensified focus on imagined defects accompanied by
extreme self-consciousness
Increased anxiety
Pathological attempts to “fix” the problem that
prevents a more reality-based appraisal of the
defect
CAUSES
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Somatoform DisordersBody Dysmorphic Disorder
CBT Treatments seem most effective
Drug treatments can provide relief for some sufferers
Without treatment, BDD lasts a lifetime
TREATMENT
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Dissociative Disorders
Disorder in which individuals feel detached from themselves (depersonalization) or their surroundings and reality (derealization), experience and identity may disintegrate
Influence of social and cultural factors is strong in dissociative disorders
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Dissociative Disorders
1. Depersonalization disorder- Severe and frightening feelings of
detachment dominate the person’s life- Causes significant distress or impairment in
functioning, especially emotional expression and deficits in perception
- Some symptoms are similar to those of panic disorder
- Rare; onset usually in adolescence
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Dissociative Disorders
Psychological treatments similar to those for panic disorder may help
Stresses associated with onset or disorder should be addressed
Tends to be lifelong
TREATMENT
DepersonalizationDisorder
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Dissociative Disorders
2. Dissociative AmnesiaFeatures the inability to recall personal information, usually of a stressful and traumatic nature; adult onset
*Generalized amnesia
-inability to remember anything including identity, comparatively rare
(lifelong or may extend from a
period in the more recent past)
*Localized or selective amnesia-failure to recall specific events,
usually traumatic, that occur a specific period; frequently
occurs in war (more common than
general amnesia)
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Dissociative Disorders
Usually self-correcting when current life stress is resolved
If needed, therapy focuses on retrieving lost information
TREATMENT
Dissociative Amnesia
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Dissociative Disorders
3. Dissociative FugueFeatures sudden, unexpected travel away from home, along with an inability to recall the past
-sometimes with assumption of a new identity or confusion about an old identity-fugue states usually end abruptly-typically adult onset and may continue in old age
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Dissociative Disorders
Usually self-correcting when current life stress is resolved
If needed, therapy focuses on retrieving lost information
TREATMENT
Dissociative Fugue
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Dissociative Disorders
4. Dissociative Trance Disorder (DTD)
Features altered state of consciousness in which
people firmly believe they are possessed by spirits;
considered only a disorder when there is distress and
dysfunctionDSM-5 Proposal: Diagnose DTD as a subtype of DID
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Dissociative Disorders
- Sudden changes in personality accompany a trance or possession
- Causes significant distress and/or impairment in functioning
- Often associated with stress or trauma
- Prevalent worldwide, usually in a religious context; rare in western cultures
- More common in women than in men
Dissociative Trance Disorder
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Dissociative Disorders
5. Dissociative Identity Disorder (DID)
Formerly known as multiple personality disorder; a disorder
in which as many as 100 personalities or fragments of
personalities coexist within one body and mind
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Dissociative Disorders
- Affected person adopts new identities, or alters that coexist simultaneously
- Average no. of alters is 15 (*alters: diff. identities)
- Childhood onset; affects more women than men
- Rare outside of western culture- Patients often suffer from other
psychological disorders simultaneously
Dissociative Identity Disorder
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Dissociative DisordersDissociative Identity Disorder Severe abuse during
childhood*Fantasy life is only
“escape”*Practice becomes automatic and then
involuntary
High suggestibility a possible trait
Biological vulnerability likely
Similar etiology to posttraumatic stress disorder
CAUSES
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Dissociative DisordersDissociative Identity Disorder
Long-term psychotherapy may reintegrate separate personalities in 25% patients
Treatment of associated trauma similar to posttraumatic stress disorder
Lifelong condition without treatment
TREATMENT