Dissociative and Somatoform Disorders Dissociative disorders include: Dissociative Amnesia, Dissociative Fugue, Depersonalization Disorder, Dissociative Identity Disorder Somatoform disorders include: Conversion Disorder, Somatization Disorder, Pain Disorder, Hypochondriasis, Body Dysmorphic Disorder Factitious disorder

Dissociative Disorders Disorders involve disruptions in the integration of memory, consciousness, or identity

Dissociative Disorders Dissociative amnesia –psychologically caused loss of memory Dissociative fugue –flight from familiar surroundings accompanied by memory loss Depersonalization disorder –the feeling of being detached from one’s body Dissociative identity disorder –multiple personalities in the same person

DSM-IV Criteria for Dissociative Amnesia One or more episodes of inability to recall personal information; usually a trauma; too extensive for ordinary forgetfulness Disturbance does not occur during another disorder; not directly related to substance abuse, brain injury, or general medical condition Symptoms cause clinically significant distress and impairment in social, occupational, other areas of functioning

DSM-IV Criteria for Dissociative Fugue Predominant disturbance is sudden; unexpected travel away from home or work; inability to recall one’s past Confusion about personal identity or assumption of a new identity Is not part of another dissociative disorder, substance abuse, or medical condition Causes significant distress, and impairment in functioning

Treatment for Dissociative Amnesia and Fugue Psychologists view severe traumatic stress as the cause Psychoanalysts focus on uncovering repressed trauma Behaviorists focus on state-dependent learning –Initial trauma will only be remembered under new forms of extreme stress – ethically psychologists do not create situations to severely stress clients –Treatment focuses on stress management and prevention of future episodes of amnesia or fugue

Depersonalization Disorder “Self” becomes dissociated or separated from rest of personality Derealization: feeling the world is not real, one is living in a dream

DSM-IV Criteria for Depersonalization Disorder Persistent, recurring feeling detached from one’s mental processes or body; as if an observer During depersonalization, reality testing intact Causes significant distress and impairment in social, occupational, other functioning Depersonalization not related to another disorder, substance abuse, or medical condition

DSM-IV Criteria for Dissociative Identity Disorder Shares elements of the other dissociative disorders (amnesia, loss of time or unexpected travel, depersonalization, derealization) Symptoms appear more extreme

DSM-IV Criteria for Dissociative Identity Disorder Presence of two or more distinct identities or personality states At least two identities or personality states recurrently take control of behavior Inability to recall personal information; too extensive for forgetfulness Disturbance not due to direct physiological effects, substance abuse, or general medical condition

Dissociative Identity Disorder Facts Affects more women than men Runs in families Seems to be increasing Linked with childhood sexual abuse Prevalence is 3.3 percent in U.S.

Dissociative Identity Disorder Treatment In the past, treatment involved picking one personality and focusing on it – this did nothing to prevent new personalities from forming Now, treatment focuses on integrating/fusing personalities into one and teaching coping skills for dealing with stress or trauma Medications sometimes are used to treat comorbid anxiety or depression No controlled tx outcome studies exist

Somatoform Disorders A category of psychological disorders characterized by unusual physical symptoms that occur in the absence of a known physical pathology

Somatoform Disorders Conversion disorder –physical symptoms usually confined to single organ/system and mimic symptoms of neurological condition Somatization disorder – multiple, vague, physical complaints Hypochondriasis – morbid preoccupation with imagined illness Pain disorder – preoccupation with pain Body dysmorphic disorder – obsessive concern with presumed defects in appearance

DSM-IV Criteria for Hypochondriasis Preoccupation with fears of having disease, misinterpretation of bodily symptoms Preoccupation persists despite medical assurances Fears of disease not delusional, not restricted to concern about appearance Preoccupation causes distress, impairment in social, occupational, other functioning Duration is at least 6 months

Hypochondriasis Treatment Patient’s rarely present for Mental Health treatment Explanations/Treatments vary with theory –Psychoanalysts – repressed conflict –Family clinicians – family dynamics –Behaviorists – reinforced learned behavior –Cognitivists – an attributional bias (attribute everyday experiences to serious illness)

DSM-IV Criteria for Body Dysmorphic Disorder Preoccupation with imagined specific defects in appearance, excessiveness over slight anomaly Preoccupation causes distress and impairment in social, occupational, other functioning

Body Dysmorphic Disorder Facts Usually starts during adolescence Females outnumber males 3 to 1 More common among single and divorced adults Shares many characteristics with OCD

Body Dysmorphic Disorder Treatment Difficult to treat because clients avoid confronting their anxiety Behavioral and Cognitive-behavioral therapy, and medication (SSRI antidepressant) have shown success.

Factitious Disorder Psychological disorder whereby people feign illness to gain attention Munchausen’s syndrome

DSM-IV Criteria for Factitious Disorder Intentional production or feigning of physical, psychological signs, symptoms Motivation is to assume sick role External incentives are absent