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Chapter 6 Somatoform and Dissociative Disorders. An Overview of Somatoform Disorders Soma = Body Preoccupation with health or appearance Physical complaints.

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Presentation on theme: "Chapter 6 Somatoform and Dissociative Disorders. An Overview of Somatoform Disorders Soma = Body Preoccupation with health or appearance Physical complaints."— Presentation transcript:

1 Chapter 6 Somatoform and Dissociative Disorders

2 An Overview of Somatoform Disorders Soma = Body Preoccupation with health or appearance Physical complaints No identifiable medical condition

3 An Overview of Somatoform Disorders Somatoform Disorders Hypochondriasis Somatization disorder Conversion disorder Pain disorder Body dysmorphic disorder

4 Hypochondriasis: An Overview Clinical Description Anxiety or fear of having a disease High comorbidity with anxiety/mood disorders Focus on bodily symptoms Normal Mild Vague

5 Hypochondriasis: An Overview Clinical Description (cont.) Little benefit from medical reassurance Strong disease conviction Misperceptions of symptoms Checking behaviors High trait anxiety

6 Hypochondriasis and Panic Disorder Similarities Focus on bodily symptoms Differences in hypochondriasis: Focus on long-term process of illness Constant concern Constant medical treatment seeking Wider range of symptoms

7 Hypochondriasis: An Overview Statistics 1% to 14% of medical patients 6.7% median rate Female : Male = 1:1 Onset at any age Peaks: adolescence, middle age, elderly Chronic course

8 Hypochondriasis Culture-Specific Syndromes China – koro India – dhat Africa Pakistan

9 Hypochondriasis Causes Disorder of cognition or perception Physical signs and sensations

10 Hypochondriasis Causes Familial history of illness Genetics Modeling/learning Other factors Stressful life events High family disease incidence Benefits of illness

11 Hypochondriasis - Treatment Psychodynamic Uncover unconscious conflict Limited efficacy data Educational & Supportive Ongoing and sensitive Detailed and repeated information Beneficial for mild cases

12 Hypochondriasis - Treatment Cognitive-Behavioral Identify and challenge misinterpretations Symptom creation Stress-reduction Best efficacy data Vs. medications (SSRI) Immediate and 1 year follow-up

13 Somatization Disorder Clinical Description Long history of physical complaints Significant impairment Concern about symptoms, not meaning Symptoms = identity

14 Somatization Disorder Statistics Rare 4.4%; 16.6% in medical settings Onset = adolescence Female : male = ~2:1 Unmarried, low SES Chronic course

15 Somatization Disorder: Causes History of family illness or injury Links to antisocial personality disorder Behavioral inhibition system Impulsivity Novelty-seeking Provocative sexual behavior Socialization Gender roles

16 Somatization Disorder: Treatment No cures Cognitive-behavioral interventions Initial reassurance Stress-reduction Reduce frequency of help-seeking behaviors

17 Somatization Disorder: Treatment Gatekeeper physician Reduce visits to numerous specialists Conditioning Reward positive health behaviors Punish problem behaviors Remove supportive consequences

18 Conversion Disorder Clinical Description Physical malfunctioning sensory-motor areas Lack physical or organic pathology Lack awareness La belle indifference Possible, but not always Intact functioning

19 Conversion Disorder : Differential Diagnosis Malingering Intentionally produced symptoms Clear benefit No precipitating stressful event Impaired function Factitious Disorder/Munchausens Intentionally produced symptoms No obvious benefit Sick role?

20 Conversion Disorder Statistics Rare Prevalence depends on setting Female > male Onset = adolescence Chronic, intermittent course

21 Conversion Disorder Special populations Soldiers Children Better prognosis? Cultural considerations Religious experiences Rituals

22 Conversion Disorder: Causes Freudian psychodynamic view Trauma, conflict experience Repression Conversion to physical symptoms Primary gain Attention and support Secondary gain

23 Conversion Disorder: Causes Behavioral Traumatic event must be escaped Avoidance is not an option Social acceptability of illness Negative reinforcement

24 Conversion Disorder: Causes Family/Social/Cultural Low SES Limited disease knowledge Family history of illness

25 Conversion Disorder: Treatment Similar to somatization disorder Attending to trauma Remove secondary gain Reduce supportive consequences Reward positive health behaviors

26 Pain Disorder Clinical Description Pain in one or more areas Significant impairment Etiology may be physical Maintained by psychological factors

27 Pain Disorder Statistics Fairly common 5% - 12% Treatment Combined medical and psychological

28 Body Dysmorphic Disorder Clinical Description Preoccupation with imagined defect in appearance Impaired function Social Occupational

29 Body Dysmorphic Disorder Clinical Description Fixation or avoidance of mirrors Suicidal ideation and behavior Unusual behaviors Ideas of reference Checking/compensating rituals Delusional disorder: somatic type?

30 Body Dysmorphic Disorder Statistics 1% to 15% Female : Male = ~1:1 Different areas of focus Onset = early 20s Most remain single Lifelong, chronic course

31 Body Dysmorphic Disorder: Causes Little scientific knowledge Cultural imperatives Body size Skin color Similarities with OCD Intrusive thoughts Rituals Age of onset and course

32 Body Dysmorphic Disorder: Treatment Similar to OCD Medications (SSRIs) Exposure and response prevention Plastic surgery is often unhelpful

33 Severe alterations or detachments Normal perceptual experiences Significant impairments Identity Memory Consciousness Depersonalization Derealization An Overview of Dissociative Disorders

34 Types Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder

35 Depersonalization Disorder: An Overview Clinical Description Feelings of unreality and detachment Severe/frightening Depersonalization Derealization Significant impairment

36 Depersonalization Disorder: An Overview Statistics 0.8% Female : Male = ~1:1 High comorbidities Anxiety and mood disorders Onset = ~ age 16 Lifelong, chronic course

37 Depersonalization Disorder: Causes Cognitive deficits Attention Short-term memory Spatial reasoning Easily distracted Decreased emotional response

38 Depersonalization Disorder: Treatment Psychological treatments are unstudied Prozac appears ineffective

39 Dissociative Amnesia Psychogenic memory loss Generalized type Localized or selective type

40 Dissociative Fugue Dissociative Fugue: Flight or travel Memory loss Retrograde vs. anterograde Hows or whys of travel Assumption of new identity

41 Dissociative Amnesia and Fugue Statistics Tends to occur in adulthood Rapid onset Rapid dissipation Females > males

42 Dissociative Amnesia and Fugue Causes and Treatments Little is known Trauma and life stress Treatment Resolution without treatment Memory returns

43 Dissociative Trance Disorder Clinical Description Dissociative symptoms Sudden personality changes State is undesirable Cultural/religious variations

44 Dissociative Trance Disorder: An Overview Statistics Female > male Causes Life stressor or trauma Treatment ?

45 Clinical Description Amnesia Dissociation of personality Adopt several new identities or alters 2 to 100 Average = 15 Unique characteristics Host Switch Dissociative Identity Disorder (DID)

46 Real vs. false memories Suggestibility Hypnosis studies Simulated amnesia Demand characteristics Physiological measures Eye movements GSR EEG Can DID be Faked?

47 Statistics 1.5% (year) Female : male = 9:1 Onset = childhood High comorbidity rates Axis I Axis II Lifelong, chronic course Dissociative Identity Disorder (DID)

48 Causes Biological vulnerability Reactivity Hippocampus and amygdala Severe abuse/trauma history Links with PTSD Highly suggestible Auto hypnotic model DID: Causes

49 Similar to PTSD treatment Reintegration of identities Identify and neutralize cues/triggers Visualization Coping Antidepressant medications? DID: Treatment

50 Possible changes to the DSM-V Reorganization Physical and psychological origins Health anxiety disorder BDD and OCD Axis I or II classification Future Directions

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