Dissociative and Somatic Symptom Disorders Chapter 9

Forms of Dissociative Disorders Dissociative identity disorder: Formerly called multiple personality disorder An individual develops more than one self or personality People with DID have at least two distinct identities and when inhabiting the identity of one, are not aware that they also inhabit the other identity.

DSM 5 CRITERIA FOR DID Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to and thinking about the environment and self. 2. Amnesia must occur, defined as gaps in the recall of everyday events, important personal information and/or traumatic events. 3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.  4. The disturbance is not part of normal cultural or religious practices.  5. The symptoms are not due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures). 

Dissociative Amnesia Dissociative amnesia is usually associated with traumatic or very stressful events. Amnesia is not due to ordinary forgetfulness. What they forget is a traumatic or stressful experience. An inability to remember important personal details and experiences that is associated with traumatic or very stressful events.

DISSOCIATIVE AMNESIA Dissociative amnesia: An inability to remember important personal details and experiences; is usually associated with traumatic or very stressful events. Localized Amnesia - Most common - Can’t recall any details of the event. Selective Amnesia - Recall some, but not all details. Generalized amnesia - Cannot recall anything at all from past life. Continuous Amnesia - Failure to recall past event from a particular date to the present time.

depersonalization/ Derealization disorder A dissociative disorder in which the individual experiences recurrent and persistent episodes of depersonalization, derealization, or both: Depersonalization is the condition in which people feel they are detached from their own body. People feel that they are controlled by forces outside of themselves, or that they are observing themselves from outside their own bodies. Derealization is a condition in which people feel a sense of unreality or detachment from their surroundings. Condition in which people feel as though they are living in a dream and that their surroundings are not real.

Treatment of Dissociative Disorders Traumatic events can lead people to experience splitting apart of their conscious experiences, sense of self, or feelings of continuity over time. In normal development, people integrate the perceptions and memories they have of themselves and their experiences. In a dissociative disorder, the individual is trying to block out or separate from conscious awareness events that caused extreme psychological, if not physical, pain. Treatment goals Integrate alters: Integrate the disparate parts within the person’s consciousness of self, memory, and time. Methods Hypnotherapy Cognitive behavioral techniques: Clients develop a coherent sense of themselves and their experiences. Treatment of dissociative disorders often involves not only these disorders themselves, but also associated disorders of mood, anxiety, and post-traumatic stress.

Somatic Symptom and Related Disorders

SOMATOFORM DISORDERS Caused by “the mind,” their symptoms are reflected in “the body” in ways that differ from other psychological disorders because there is no apparent physiological basis for them. soma = “body” in Greek Conditions in which psychological conflicts are translated into physical problems or complaints Somatic disorders are psychological in nature, because although people with these disorders may or may not have a diagnosed medical condition, they seek treatment for both their physical symptoms and associated distressing behaviors, thoughts, and feelings.

Somatic Symptom Disorder Somatic Symptom Disorder involves physical symptoms that may or may not be accountable by a medical condition. These symptoms disrupt their everyday lives. People with this disorder think to a disproportionate degree about the seriousness of their symptoms, feel extremely anxious about them, and spend a great deal of time and energy to the symptoms or their concerns about their health. Somatic symptom disorder is relatively rare, but is present with higher than expected frequency among patients seeking treatment for chronic pain.

Illness Anxiety disorder Formerly called Hypocondriasis. Illness Anxiety Disorder is a somatic symptom disorder characterized by the misinterpretation of normal bodily functions as signs of serious illness. People with this disorder fear or mistakenly believe that normal bodily reactions represent the symptoms of a serious illness. They easily become alarmed about their health and seek unnecessary medical tests and procedures to rule out or treat their exaggerated or imagined illnesses.

Conversion Disorder(Functional Neurological Symptom Disorder) Somatic symptom disorder involving the translation of unacceptable drives or troubling conflicts into physical symptoms. Individual experiences a change in a bodily function not due to an underlying medical condition. Clients with conversion disorder show a wide range of physical ailments: Pseudoseizures Disorders of movement Paralysis Weakness Disturbances of speech Blindness and other sensory disorders Cognitive impairment Conversion disorders can be classifies as a form of dissociative disorder

Conditions Related to Somatic Symptom Disorders Factitious disorder imposed on self, people fake symptoms or disorders, not for the purpose of any particular external gain but because of an inner need to maintain a sick role. Munchausen's syndrome: An extreme form of factitious disorder in which the individual goes to great lengths to maintain a sick role. The person’s whole life becomes consumed with the pursuit of medical care. Factitious disorder by proxy (or Munchausen’s syndrome by proxy): A person induces symptoms in another person who is under that individual’s care. Malingering is the fabrication of physical or psychological symptoms for some ulterior motive. (No longer a Dx in DSM)