Somatoform and Dissociative Disorders

Mind-body inter relationship

This term used to describe individuals who manifested significant physical symptoms

that appeared to be associated with psychological distress such as peptic ulcer .

While the symptoms of somatoform disorders are physically, they are classified

as a group of mental disorders. Because demonstrable organic pathology found in

the laboratory test or physical examination is absent .

The root of somatic symptoms are linked to psychological rather biological findings .

Etiology of somatoform disorders

.1Psychological factors :Life change that have been stress full such as

marriage, death of love one, trouble at work.

2 .Nuro biological factor : *Abnormal control nervous system regulation of

incoming sensory information may be key factor in some cases, because decrease awareness in

connection

Etiology cont..

between mind and body. *Deficiency in communication between

brain hemisphere that impedes awareness and expression of emotion .

Somatoform Disorders

•The common focus of somatoform disorders is physical sx in the absence of clinically significant organic disease

•Includes:–Body dysmorphic disorder

–Pain disorder–Somatization disorder

–Conversion disorder–Hypochondriasis

Body Dysmorphic Disorder

•Characterized by a preoccupation with an imagined defect in appearance

–If the individual has a slight physical anomaly, the person’s concern is markedly excessive

•The preoccupation causes clinically significant distress or impairment in social or occupational functioning

•The preoccupation is not better accounted for by another mental d/o

Body Dysmorphic Disorder (cont)

•Typical concerns focus on imagined or minor flaws of the face or head—wrinkles, complexion tone, markings such as scars or freckles, excessive or thinning hair, or asymmetry of the face, eyes, ears, or nose

•These individuals spend inordinate amounts of time checking their “defect” in mirrors

•Often extreme grooming rituals are present•OCD has been observed in number of individuals

with body dysmorphic disorders .

Pain Disorder

•The characteristic symptoms in pain disorders is the non intentional presence

of physical pain .•Individuals suffering from pain disorders

experience the pain as a major focus in their life and pain disorder is with a definable medical condition but appear to be linked with emotional distress such as mood and anxiety disorders.

DSM-IV Diagnostic criteria for pain disorder

.1Pain in one or more anatomical sites is the predominant focus of the clinical presentation of sufficient severity to warrant clinical attention.

.2The pain causes clinically significant distress or impairment in social, occupational or other important areas.

.3Psychological factors are judged to have an important role in the onset , severity, exacerbation, or

maintenance of the pain ..4The symptoms or deficit is not intentionally produced.

Somatization Disorders

•These clients frequently seek and obtain medical treatment for multiple, clinically significant somatic complaints

•The c/o must begin before age 30•The c/o cannot be adequately explained by any

general medical d/o or the direct effects of a substance

•If there is a medical condition present, the c/o or impairment in functioning are in excess of what would be expected from the Health assessment &Physical examination or lab findings

Somatization Disorders (cont)

•Each of the following criteria must have been met:–Four pain sx: a hx of pain r/t at least 4 different sites of

function (head, back, abdomen, joints, extremities, chest, rectum, during menstruation, during sex, or during urination)

–Two GI sx: nausea, bloating, vomiting, diarrhea, or intolerance to several different foods

–One sexual sx: sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding

Somatization Disorders (cont)

•Each of the following criteria must have been met:

–One pseudoneurological sx•Conversion sx such as impaired coordination or

balance, paralysis or localized weakness, difficulty swallowing or lum in the throat, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures

__Autonomic Nervous Symptoms

Conversion DisorderThe predominant feature of conversion dis is a loss in voluntary motor or sensory function that appears to represent physiology disfunction but related to psychological conflict.

The onset of nonfeigood symptom follows an event or experience perceived as major stressor .

The symptom are a way of assisting the individual to defend against the intrapschic anxiety generated by the event or experience.

*Conversion symptoms are defined as pseudo urological because they cont be explained by medical

test or lab test .

Conversion Disorder•The term conversion comes from the idea that the individual

uses the somatic sx in an unconscious manner to reduce or repress a psychological conflict that creates anxiety

•The most common sx is a d/o of movement—inability to walk, stand, or move an arm

–Researchers have found that 71% of clients present with CNS sx

•Other sx may take the form of blindness, deafness, or difficulty swallowing

•The client often seems unconcerned about this serious, sudden incapacitation

Conversion Disorder Diagnostic criteria

•Clients exhibit 1 or more sx or deficits affecting voluntary motor or sensory function that suggests a neurological or other general medical condition

•Psychological factors are judged to be associated with the sx or deficit

•The sx or deficit is not intentionally produced or feigned

• the symptom or deficit cannot, after appropriate investigation , be fully explained by a general medical condition.

•The sx or deficit is not limited to pain or sexual dysfunction

Hypochondriasis

•Individual is preoccupied with fears of having—or the idea of having—a serious medical d/o based on the

individual’s misinterpretation of bodily sx•The misinterpretation of sx persists despite

appropriate medical evaluation and reassurance•The individual’s preoccupation is not as intense or

distorted as in delusional d/o nor is it as restricted as in body dysmorphic d/o

Dissociative DisordersDissociation is splitting in ones personality or part of the personality when the individual encounters stress that is intolerable to the conscious. It is adaptive mechanism that allows the person to “turn-out” for a while. In dissociative disorder the individual has no

control over what happened .Dissociation: is a mental process which produce lack of connection in ones thoughts,

memories, actions or sense of identity .

Dissociative Disorders

•Includes:–Dissociative amnesia

–Dissociative fugue–Dissociative identity disorder

–Depersonalization

Dissociative Amnesia

• sudden forgetfulness or inability to recall personal information following severe psychological stress ( death, divorce, abuse….). It may be also associated with PTSD . It is increase in adolescent females. Termination of amnesia is typically abrupt and recovery is complete. the symptoms interfere with normal functioning or

cause significant distress .

Dissociative Fugue

•Fugue is a latin word that mean to “flee ”

•Characterized by travel away from one’s home or one’s customary place of work with an inability to recall one’s past

•Relatively uncommon•The individual demonstrates confusion

about personal identity

Dissociative Identity Disorder

•Individual must demonstrate 2 or more distinct identities or personality states, each of which is dominant at a particular time. Usually, the two or more personalities may

talk to each other or argue about an issue .•In DID one personality is the opposite of

the other which reflect the splitting inside the individual .

•At least 2 of these personality states take control of the person’s behavior

•Individuals with this d/o describe very different personalities, with distinct histories, ages, gender, names, and mood styles such as angry depressed or domineering

•Most individuals with this dx have histories of severe childhood abuse

Depersonalization disorder

•Persistent or recurrent feeling of being detached from one’s mental process or body

•Person may describe feelings as though they are in a dream state that they are outside observer of their lives.

Psychotherapy

•Focus on person’s response to traumatic events

•The goal is make an integration of the person’s part of personality “Alters ”