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Somatoform and Dissociative

Disorders
Chapter 5
Basic definitions
Somatoform disorders
pathological concern of individuals with the
appearance or functioning of their bodies when there
is no identifiable medical condition causing the
physical complaints
Dissociative disorders
individuals feel detached from themselves or their
surroundings, and reality, experience, and identity
may disintegrate
Historically, both somatoform and dissociative
disorders used to be categorized as hysterical
neurosis
in psychoanalytic theory neurotic disorders result from
underlying unconscious conflicts, anxiety that resulted
from those conflicts and ego defense mechanisms
Somatoform Disorders
Soma Meaning Body
Preoccupation with health and/or body appearance and
functioning
No identifiable medical condition causing the physical
complaints
Types of DSM-IV Somatoform Disorders
Hypochondriasis
Somatization disorder
Conversion disorder
Pain disorder
Body dysmorphic disorder

Somatoform Disorders
Hypochondriasis
severe anxiety focused on the possibility of having a
serious disease
shares age of onset, personality characteristics anf
running in families with panic disorder
illness phobia vs. hypochondriasis
60% of patients with illness phobia develop
hypochondriasis
1% to 14% of medical patients
treatment usually invoves cognitive-behavioral
therapy and general stress management treatment
(gain retained after 1 year follow-up)

Somatoform Disorders
Causes of hypochondriasis

Somatoform Disorders
Somatization disorder
Briquets syndrome (100 years ago)
patients have a history of many physical complaints
that can not be explained by a medical condition, the
complaints are not intentionally produced
20% of patients in primary care setting
develops during adolescence (majority women)
may be connected to Antisocial personality disorder
difficult to treat (reassurance, stress reduction, more
adoptive methods of interacting with family are
encouraged)
Somatoform Disorders
Conversion Disorder
Physical malfunctioning without any physical or organic
pathology
Malfunctioning often involves sensory-motor areas
Persons show la belle indifference
Retain most normal functions, but without awareness of this
ability
Statistics
Rare condition, with a chronic intermittent course
Seen primarily in females, with onset usually in adolescence
Not uncommon in some cultural and/or religious groups

Somatoform Disorders
Conversion disorder (cont.)
Freudian psychodynamic view is still popular (anxiety converted into
physical symptoms)
Emphasis on the role of trauma (stress), conversion, and
primary/secondary gain
Detachment from the trauma and negative reinforcement seem critical
Different from factitious disorder (intentional)
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
Somatoform Disorders
Body Dysmorphic Disorder
Preoccupation with imagined defect in appearance
Either fixation or avoidance of mirrors
Previously known as dysmorphophobia
Suicidal ideation and behavior are common
Often display ideas of reference for imagined defect
Statistics
More common than previously thought
Usually runs a lifelong chronic course
Seen equally in males and females, with onset usually in early
20s
Most remain single, and many seek out plastic surgeons

Somatoform Disorders
Body Dysmorphic Disorder (cont.)
Causes
Little is known Disorder tends to run in families
Shares similarities with obsessive-compulsive disorder
Treatment
Treatment parallels that for obsessive compulsive disorder
Medications (i.e., SSRIs) that work for OCD provide some
relief
Exposure and response prevention are also helpful
Plastic surgery is often unhelpful
Dissociative Disorders
Derealization
Loss of sense of the reality of the external world
Depersonalization
Loss of sense of your own reality
5 types
Depesonalization disorder
Dissociative amnesia
Dissociative fugue
Dissociative trance disorder
Dissociative identity disorder
Dissociative Disorders
Depersonalization disorder
Severe feelings of depersonalization
dominate the individuals life and prevent
normal functioning
It is chronic
50% suffer from additional mood and anxiety
disorders
Cognitive profile (cognitive deficits in
attention, STM, spatial reasoning, perception
(3D))
Dissociative Disorders
Dissociative Amnesia
Inability to recall personal information, usually
of a stressful or traumatic nature
Generalized vs. selective amnesia
Dissociative Fugue
Sudden, unexpected travel away from home,
along with an inability to recall ones past
(new identity)
Occur in adulthood and usually end abruptly
Dissociative Disorders
Dissociative trance disorder
Altered state of consciousness in which the person
believes firmly that he or she is possessed by spirits;
considered a disorder only where there is distress
and dysfunction
Trance and possession are a common part of some
traditional religious and cultural practices and are not
considered abnormal in that context
Only undesirable trance considered pathological
within that culture is characterized as disorder
Dissociative Disorders
Dissociative Identity Disorder
Formerly multiple personality disorder
Many personalities (alters) or fragments of
personalities coexist within one body
The personalities or fragments are dissociated
Switch (transition form one personality to another,
includes physical changes)
Can be simulated by malingers are usually eager to
demonstrate their symptoms whereas individuals with
DID attempt to hide symptoms
Very high comorbidity
Prevalence about 3%

Dissociative Disorders
Dissociative Identity Disorder
Auditory hallucinations (coming from inside
their heads)
97% severe child abuse
Extreme subtype of PTSD
Onset approximately 9 years
Suggestible people may use dissociation as
defense against severe trauma
Real and false memories
Temporal lobe pathology (out of body
experiences)
Dissociative Disorders
Treatment
Dissociative amnesia and fugue
Get better on their own
Coping mechanisms to prevent future episodes
DID
Reintegration of identities
Neutralization of cues
Confrontation of early trauma
hypnosis

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