1. Dissociative Disorders Persistent, maladaptive disruptions in memory, consciousness, or identity

2. Dissociative Identity Disorder  A. presence of two or more distinct identities or personality states  B. at least two of these identities recurrently take control  C. inability to recall important personal information

3. Possible Causes:  Biological vulnerability  Severe abuse/trauma history  Suggestibility

4. Treatment:  identify cues or triggers that provoke memories or dissociation  try to help person integrate personalities  hypnosis sometimes used  antidepressants may be helpful

5. Depersonalization Disorder  depersonalization disorder : severe feelings of unreality - dominates the person’s life  depersonalization  derealization

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

7. Dissociative Amnesia :  generalized amnesia : can’t remember anything- even identity  localized or selective amnesia : failure to recall specific events (often traumatic)  dissociative fugue : memory loss combined with flight  dissociative trance disorder: dissociative phenomena that appears as a trance or “possession”

8. Somatic Symptom and Related Disorders

9. Historical Roots  hysteria : “wandering uterus”  physical symptoms without a known cause  term dates back to Hippocrates and Egyptians  neurosis : emotional distress due to underlying unconscious conflicts, anxiety, and implementation of defense mechanisms

10. Illness Anxiety Disorder  Preoccupation with fears of having a serious disease based on a misinterpretation of bodily symptoms  Persists despite appropriate medical evaluation and reassurance  Causes distress or impairment in functioning  Disturbance lasts at least 6 months

11. Cultural Variations  Africa  Sensation of something crawling in one’s head  India and Pakistan  Sensation of burning in hands or feet  dhat – concern about losing semen accompanied by feelings of weakness and exhaustion  China, East Asia  koro – sudden intense anxiety that one’s genitals will recede into one’s body and possibly cause death

12. Somatic Symptom Disorder  A disorder in which persons become excessively distressed, concerned, and anxious about the bodily symptoms that they are experiencing.  Their lives are greatly and disproportionately disrupted by the symptoms.

13. Somatic Symptom Disorder and Antisocial Personality Disorder  Run in the same families  Gender differences  Common features

14. Presence of one or more symptoms or deficits that affect voluntary or sensory functioning paralysis blindness difficulty speaking loss of sense of touch Conversion Disorder

15.  Cognitive behavioral view  Psychodynamic view  Tends to run in families (genetic and environmental contributions)  Often develops in context of stressful life event Causes of Somatic Symptom and Related Disorders

16. Treatment (Kroenke, 2007)  Reviewed 34 randomized controlled studies of treatment of somotaform disorders (3,922 patients)  Concluded that the most effective treatment for somatoform disorders was cognitive- behavioral therapy (CBT).  some evidence that antidepressants and a consultation letter to primary care physician can help.

17. Factitious Disorder  A disorder in which an individual feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person.  Different from Malingering  Specifiers of imposed on self vs. imposed on another (formerly factitious disorder by proxy)  http://abcnews.go.com/Health/arizona-mother- accused-poisoning-baby-munchausen-syndrome- proxy/story?id=13308998 http://abcnews.go.com/Health/arizona-mother- accused-poisoning-baby-munchausen-syndrome- proxy/story?id=13308998