PsychopathologySomatoform and Dissociative DisordersWhat you should know when you finish

studying Chapter 6:1. The common features of somatoform

disorders2. The defining features of Hypochondriasis3. The defining features of Somatization

Disorder (Briquet’s Syndrome)4. The defining features of Conversion

Disorder

PsychopathologySomatoform and Dissociative DisordersWhat you should know when you finish

studying Chapter 6: (cont.)5. Defining features of Body Dysmorphic

Disorder6. Common features of Dissociative

Disorders7. Defining features that distinguish different

dissociative disorders8. Factitious disorders and malingering

Common features of Somatoform Disorders

• Soma – Meaning Body– Overly preoccupied with health or body appearance– Physical complaints without a medical condition

• Types of DSM-IV Somatoform Disorders– Hypochondriasis– Somatization disorder– Conversion disorder– Pain disorder– Body dysmorphic disorder

Defining features of Hypochondriasis

Defining features of Hypochondriasis

• Causes– Cognitive perceptual distortions– Familial history of illness

• Treatment– Cognitive-Behavioral treatment to help person

learn to challenge illness-related misinterpretations

– Provide substantial and sensitive reassurance

Defining features of SomatizationDisorder (Briquet’s Syndrome)

Defining features of SomatizationDisorder (Briquet’s Syndrome)

• Hypothesized Causes– Familial history of illness– Relation with antisocial personality disorder– Weak behavioral inhibition system

• Treatment– No treatment exists with demonstrated effectiveness– Reduce tendency to visit numerous medical

specialists– Assign “gatekeeper” physician– Reduce supportive consequences of talk about

symptoms

Defining features of Conversion Disorder

• Overview and Defining Features– 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– Formerly known as Hysteria

Defining features of Conversion Disorder

• Facts and Statistics– Rare condition, with a chronic intermittent

course– Seen primarily in females– Onset usually in adolescence– Not uncommon in some cultural and/or

religious groups

Conversion Disorder

Pain disorderMaybe initial clear reasons for pain, but pain

continues after physical reasons are (apparently) no longer present.

Pain is real, but is thought to be influenced by psychological factors

Very little known about the disorderBook illustrates with cases of medical

student and woman with cancer

Body Dysmorphic Disorder(“Imagined Ugliness”)

• Overview and Defining Features– Previously known as dysmorphophobia– Preoccupation with imagined defect in

appearance– Either fixation or avoidance of mirrors– Suicidal ideation and behavior are common– Often display ideas of reference for imagined

defect

Body Dysmorphic Disorder(“Imagined Ugliness”)

• Facts and 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

Body Dysmorphic Disorder(“Imagined Ugliness”)

• Causes– Little is known– Some similarities with obsessive-compulsive disorder

• Treatment– Parallels that for obsessive-compulsive disorder– Medications (i.e., SSRIs) provide some relief– Exposure and response prevention is also helpful– Plastic surgery is often unhelpful

Common features of DissociativeDisorders

• Overview – Involve severe alterations or detachments– Affect identity, memory, and/or consciousness– Severe form of normal perceptual

experiences– Depersonalization – Distortion in perception of

reality– Derealization – Losing a sense of the external

world

Common features of DissociativeDisorders

• Types of DSM-IV Dissociative Disorders– Depersonalization Disorder– Dissociative Amnesia– Dissociative Fugue– Dissociative Trance Disorder– Dissociative Identity Disorder

Defining features that distinguish different dissociative disorders

• Overview and Defining Features of Depersonalization Disorder– Severe and frightening feelings of unreality

and detachment– These dominate and interfere with life

functioning– Problem involves depersonalization and

derealization

Defining features that distinguish different dissociative disorders

• Facts and Statistics (Depersonalization disorder)– High comorbidity with anxiety and mood disorders– Onset is typically around age 16– Usually runs a lifelong chronic course

• Causes– Cognitive deficits in attention– Cognitive deficits in short-term memory– Cognitive Deficits in spatial reasoning– Deficits related with tunnel vision and mind emptiness– Such persons are easily distracted

• Treatment– Little is known

Defining features that distinguish different dissociative disorders

Dissociative Amnesia: Overview and Defining Features– Several forms of psychogenic memory loss– Generalized type – Inability to recall anything,

including their identity– Localized or selective type – Failure to recall

specific (usually traumatic) events

Defining features that distinguish different dissociative disorders

Dissociative Fugue: Overview and Defining Features– Related to dissociative amnesia– Take off to a new place – Unable to remember the past– Unable to remember how they arrived at a

new location– Often assume a new identity

Defining features that distinguish different dissociative disorders

Facts and Statistics -- Dissociative Amnesia and Fugue– Usually begin in adulthood– Both show rapid onset and dissipation– Both are mostly seen in females

• Causes– Little is known– Trauma and life stress can serve as triggers

• Treatment– Most get better without treatment– Most remember what they have forgotten

Defining features that distinguish different dissociative disorders

Defining features that distinguish different dissociative disorders

Factitious disorders & Malingering• Separating Real Problems from Faking

– Malingering – Deliberately faking symptoms• Related Conditions – Factitious disorders

– Factitious disorder by proxy• False Memories and Recovered Memory

Syndrome

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

• Most are relatively rare