Post on 31-Dec-2015
description
transcript
Dissociative and Somatoform Disorders
Dissociative disorders include:
Dissociative Amnesia, Dissociative Fugue, Depersonalization Disorder, Dissociative Identity Disorder
Somatoform disorders include:
Conversion Disorder, Somatization Disorder, Pain Disorder, Hypochondriasis, Body Dysmorphic Disorder
Factitious disorder
Dissociative Disorders
Disorders involve disruptions in the integration of memory, consciousness, or identity
Dissociative Disorders• Dissociative amnesia
– psychologically caused loss of memory
• Dissociative fugue– flight from familiar surroundings accompanied
by memory loss
• Depersonalization disorder– the feeling of being detached from one’s body
• Dissociative identity disorder– multiple personalities in the same person
DSM-IV Criteria for Dissociative Amnesia
• One or more episodes of inability to recall personal information; usually a trauma; too extensive for ordinary forgetfulness
• Disturbance does not occur during another disorder; not directly related to substance abuse, brain injury, or general medical condition
• Symptoms cause clinically significant distress and impairment in social, occupational, other areas of functioning
DSM-IV Criteria for Dissociative Fugue
• Predominant disturbance is sudden; unexpected travel away from home or work; inability to recall one’s past
• Confusion about personal identity or assumption of a new identity
• Is not part of another dissociative disorder, substance abuse, or medical condition
• Causes significant distress, and impairment in functioning
Treatment for Dissociative Amnesia and Fugue
• Psychologists view severe traumatic stress as the cause• Psychoanalysts focus on uncovering repressed trauma• Behaviorists focus on state-dependent learning
– Initial trauma will only be remembered under new forms of extreme stress – ethically psychologists do not create situations to severely stress clients
– Treatment focuses on stress management and prevention of future episodes of amnesia or fugue
Depersonalization Disorder
• “Self” becomes dissociated or separated from rest of personality
• Derealization: feeling the world is not real, one is living in a dream
DSM-IV Criteria for Depersonalization Disorder
• Persistent, recurring feeling detached from one’s mental processes or body; as if an observer
• During depersonalization, reality testing intact• Causes significant distress and impairment in
social, occupational, other functioning• Depersonalization not related to another disorder,
substance abuse, or medical condition
DSM-IV Criteria for Dissociative Identity Disorder
• Shares elements of the other dissociative disorders (amnesia, loss of time or unexpected travel, depersonalization, derealization)
• Symptoms appear more extreme
DSM-IV Criteria for Dissociative Identity Disorder
• Presence of two or more distinct identities or personality states
• At least two identities or personality states recurrently take control of behavior
• Inability to recall personal information; too extensive for forgetfulness
• Disturbance not due to direct physiological effects, substance abuse, or general medical condition
Dissociative Identity Disorder Facts
• Affects more women than men
• Runs in families
• Seems to be increasing
• Linked with childhood sexual abuse
• Prevalence is 3.3 percent in U.S.
Dissociative Identity Disorder Treatment
• In the past, treatment involved picking one personality and focusing on it – this did nothing to prevent new personalities from forming
• Now, treatment focuses on integrating/fusing personalities into one and teaching coping skills for dealing with stress or trauma
• Medications sometimes are used to treat comorbid anxiety or depression
• No controlled tx outcome studies exist
Somatoform Disorders
A category of psychological disorders characterized by unusual physical symptoms that occur in the absence of a known physical pathology
Somatoform Disorders• Conversion disorder
– physical symptoms usually confined to single organ/system and mimic symptoms of neurological condition
• Somatization disorder– multiple, vague, physical complaints
• Hypochondriasis– morbid preoccupation with imagined illness
• Pain disorder– preoccupation with pain
• Body dysmorphic disorder– obsessive concern with presumed defects in appearance
DSM-IV Criteria for Hypochondriasis
• Preoccupation with fears of having disease, misinterpretation of bodily symptoms
• Preoccupation persists despite medical assurances
• Fears of disease not delusional, not restricted to concern about appearance
• Preoccupation causes distress, impairment in social, occupational, other functioning
• Duration is at least 6 months
Hypochondriasis Treatment• Patient’s rarely present for Mental Health
treatment
• Explanations/Treatments vary with theory– Psychoanalysts – repressed conflict
– Family clinicians – family dynamics
– Behaviorists – reinforced learned behavior
– Cognitivists – an attributional bias (attribute everyday experiences to serious illness)
DSM-IV Criteria for Body Dysmorphic Disorder
• Preoccupation with imagined specific defects in appearance, excessiveness over slight anomaly
• Preoccupation causes distress and impairment in social, occupational, other functioning
Body Dysmorphic Disorder Facts
• Usually starts during adolescence
• Females outnumber males 3 to 1
• More common among single and divorced
adults
• Shares many characteristics with OCD
Body Dysmorphic Disorder Treatment
• Difficult to treat because clients avoid
confronting their anxiety
• Behavioral and Cognitive-behavioral
therapy, and medication (SSRI
antidepressant) have shown success.
Factitious Disorder
• Psychological disorder whereby people
feign illness to gain attention
• Munchausen’s syndrome