Somatoform Disorders & Dissociative Disorders Kimberley Clow

Outline  Somatoform Disorders Somatization Disorder Pain Disorder Hypochondriasis Conversion Disorder Body Dysmorphic Disorder  Dissociative Disorders Dissociative Amnesia Dissociative Fugue Depersonalization Disorder Dissociative Identity Disorder

Somatoform Disorders  Bodily symptoms that suggest a physical defect or dysfunction BUT no physiological basis can be found Emotions  Physical Symptoms  Different from Malingering Factitious Disorder

Somatization Disorder

Causes & Treatment  Contributors Behaviour rewarded Excessive illness growing up Association with Antisocial Personality Disorder Runs in families  Treatment Focus on stress Reduce help-seeking behaviour Eliminate reinforcers

Pain Disorder  Predominant complain is pain and psychological factors have an important role in the onset, severity, exacerbation, or maintenance of the pain  Types Acute Chronic  Causes Psychodynamic Behavioural

Hypochondriasis

Causes & Treatment

Conversion Disorder  Motor or sensory symptoms suggesting a neurological impairment when there is none  Conversion refers to unconscious conflicts being converted into physical symptoms Discharging anxiety without experiencing it Freud

Causes & Treatment  Contributors Triggered by a stressful / traumatic event  Primary & Secondary Gain  Treatment Need to address initial stressful event Remove reinforcers Glove Anesthesia

Body Dysmorphic Disorder  Dysfunctional preoccupation about imagined physical defects Ideas of reference Successive changes & surgeries With insight Without insight  Delusional Disorder

Causes & Treatment  Contributors Societal beauty images High comorbidity with OCD  Treatment Drugs  Same ones for OCD Behavioural Therapy  Exposure and Response Prevention Same therapy as for OCD

General Considerations  Psychodynamic Neurosis  Primary gain  Secondary gain  Behavioural Sick role Modeling  Stress & Trauma High incidences of child abuse History of illness  Cognitive Faulty interpretations  Biological History of illness Sensitivity to bodily sensations  Cultural Factors More prevalent in cultures that stigmatize mental disorders

Dissociative Disorders  Disruptions of consciousness, memory, and identity Missing time  No memory for a period  Weren’t conscious when it happened Don’t know who you are  Lost memories  Don’t identify with self  Multiple identities Don’t feel real

Dissociative Experiences Scale 1. Able to ignore pain 2. Missing part of a conversation 3. Usually difficult things can be done with ease and spontaneity 4. Not sure whether you have done something or only thought about it 5. Absorption in TV program or movie 6. Remembering past so vividly you seem to be reliving it 7. Staring into space 8. Talking out loud to yourself when alone 9. Finding evidence of having done things you can’t remember doing

10. Not sure if remembered event happened or was a dream 11. Being approached by people you doesn’t know who call you by a different name 12. Feeling as though you were two different people 13. So involved in fantasy that it seems real 14. Driving a car and realizing you don’t remember part of the trip 15. Not remembering important events in your life 16. Being in a familiar place but finding it unfamiliar 17. Being accused of lying when you are telling the truth 18. Finding notes or drawings that you must have done but don’t remember doing

19. Seeing yourself as if looking at another person 20. Hearing voices inside your head 21. Not recognizing friends or family members 22. Other people and objects do not seem real 23. Looking at the world through a fog 24. Finding unfamiliar things among your belongings 25. Feeling as though your body is not your own 26. Finding yourself in a place but unaware of how you got there 27. Finding yourself dressed in clothes that you don’t remember putting on 28. Not recognizing your own reflection in a mirror

Dissociative Amnesia  Person is unable to recall important personal information Usually related to a traumatic or stressful event  Variations Generalized Localized Selective 24

Dissociative Fugue  Person suddenly leaves home and work and assumes a new identity Usually triggered by stress or trauma

Depersonalization Disorder  Person’s perception or experience of the self is disconcertingly and disruptively altered Frequent episodes Reality does remain intact during episodes No amnesia or new identities

Causes & Treatment

Dissociative Identity Disorder (DID)

Causes & Treatment

Is DID A Real Disorder?  Yes It Is Many symptoms of PTSD are similar to those of DID Alters show several physiological and / or behavioural differences  No It Isn’t The use of hypnosis may be a source of therapist contamination Physiological changes are also seen in subjects asked to fake DID