Somatoform and Dissociative DisordersChapter five

Somatoform Disorders

• Overly preoccupied with health and or body appearance

• Usually no identifiable medical condition causing the physical complaints

Somatoform Disorders

• Hypochondriasis

• Somatization disorder

• Conversion disorder

• Pain disorder

• Body dysmorphic disorder

Hypochondriasis

• Physical complaints without a clear medical cause and severe anxiety focused on the possibility of having a serious illness

• Medical reassurance does not seem to help

• Comorbidity with anxiety and mood disorders

Hypochondriasis

• Anxiety and features of panic disorder

• Expression of anxiety is different– Preoccupation with physical symptoms

• Reassurance seems to have temporary impact at best

• Disease Conviction: core diagnostic feature

Hypochondriasis

• Differs from illness phobia: fear of getting a disease

• Hypochondriasis: fear they already have a disease

• Chronic course

Hypochondriasis

• Distortions in cognition, perception and emotion

• Interpret minor pain as threatening

• Self focusing creates anxiety which leads to more symptoms

• View of health as being completely symptom-free

Hypochondriasis

• Treatment?

• CBT with focused reassurance

Somatization Disorder

• Extended history of physical complaints starting before age 30 and substantial impairment in social or occupational functioning

• Multitude of symptoms– 4 pain– 3 gastrointestinal– 1 sexual– 1 neurological

Somatization Disorder

• Focus on symptoms instead of what they might mean

• Often show little urgency to do anything about symptoms

• Symptoms become major part of indentity

• Most are unmarried women, lower SES

• chronic

Somatization Disorder

• Family studies: link to antisocial personality disorder

• Males more likely to show aggression

• Females more likely to display dependence

• No known effective treatment

• Physician as “gatekeeper”

Conversion Disorder

• Physical malfunctioning without apparent physical cause

• Often resemble neurological diseases

• Usually apathy towards symptoms

• Usually stressful precipitator

• Extremely rare

Pain Disorder

• Psychological factors play a role in the persistence of pain

• Pain is real

Body Dysmorphic Disorder

• Preoccupation with imagined defect

• Fixated on mirrors, engage in suicidal behavior, display ideas of reference and avoidance

• Severe disruption of daily functioning

• CBT and SSRI’s

• Big business for plastic surgeons

Dissociative Disorders

• Depersonalization– Distortion in perception– Sense or reality is lost– Person dissociates from reality

• Derealization– Losing sense of external world

• Both can be panic and acute stress disorder

Dissociative Disorders

• Alterations or detachments in consciousness or identity involving either dissociation or depersonalization

• Extreme variants on normal phenomena

Depersonalization Disorder

• Severe and frightening feelings of detachment and unreality

• Very rare

• Cognitive deficits– Attention, short-term memory, spatial

reasoning– Reports of tunnel vision and mind emptiness

Dissociative Amnesia

• Psychogenic memory loss

• Usually in females

• Generalized– Unable to recall anything including identity

• Selective (localized)– Selective forgetting related to trauma

Dissociative Fugue

• Leaves and may set up another identity in another place

• Very rare

• Inability to recall why or how they got there and little memory of the past

Dissociative Trance Disorder

• Attributed to spirit posession

Dissociative Identity Disorder (DID)

• Adoption of new identities• Often display unique behaviors, voice

and posture• As many as 100 “Alters”• Host: identity that seeks treatment• Switch• Mostly female• Severe, chronic sexual abuse

Dissociative Identity Disorder (DID)

• Natural tendency to dissociate from negative affect related to abuse

• Survival mechanism

• Lack of social support while abuse is going on

• Thought to be extreme subtype of PTSD