1. Dissociative and Somatic Symptom Disorders
Chapter 9
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2. Dissociative Disorders
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3. 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.
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4. Dissociative Amnesia
An inability to remember important personal details and experiences that is associated with traumatic or very stressful events.
This amnesia can be diagnosed with a specifier of dissociative fugue:
During which they travel or wander without knowing their identity.
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.
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5. 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.
Derealization is a condition in which people feel a sense of unreality or detachment from their surroundings
People feel that they are controlled by forces outside of themselves, or that they are observing themselves from outside their own bodies.
Derealization: Condition in which people feel as though they are living in a dream and that their surroundings are not real.
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6. Treatment of Dissociative Disorders
Goal
Integrate alters
Methods
Hypnotherapy
Cognitive behavioral techniques
Treatment of dissociative disorders oft en involves not only these disorders themselves, but also associated disorders of mood, anxiety, and post-traumatic stress.
Treatment goal - Integrate the disparate parts within the person’s consciousness of self, memory, and time.
Through hypnotherapy, clients recall traumatic experiences that seem to have caused the dissociation.
Cognitive Behavioral techniques - Clients develop a coherent sense of themselves and their experiences.
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.
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7. Items from the SCID-D-R
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8. The Biopsychosocial Perspective
Distinctions between real and fake psychological symptoms
Cognitive-behavioral explanations
How stress affects physical functioning
Cognitive-behavioral explanations provide useful approaches for treatment.
Learning more about how stress affects physical functioning, including the impact of social discrimination on chronic conditions.
Heart disease and diabetes.
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9. Somatic Symptom and Related Disorders
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10. SOMATOFORM DISORDERS
Somatic symptoms involving physical problems and/or concerns about medical symptoms.
The term “somatic” comes from the Greek word “soma,” meaning body.
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
Psychological in nature
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.
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11. somatic symptom disorder
Somatic Symptom Disorder involves physical symptoms that may or may not be accountable by a medical condition.
They also have maladaptive thoughts, feelings, and behaviors.
People with this disorder think to a disproportionate degree about the seriousness of their symptoms.
They feel extremely anxious about them, and spend a great deal of time and energy to the symptoms or their concerns about their health.
People with somatic symptom disorder have physical symptoms that may or may not be accountable by a medical condition; they also have maladaptive thoughts, feelings, and behaviors. Th ese 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.
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12. illness anxiety disorder
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.
Formerly called Hypocondriasis.
People with illness anxiety 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.
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13. Conversion Disorder (Functional Neurological Symptom Disorder)
A somatic symptom disorder involving the translation of unacceptable drives or troubling conflicts into physical symptoms.
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
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 classified as a form of dissociative disorder.
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14. 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.
The individual may also feign the illness of someone else in cases of factitious disorder imposed on another (or Munchausen’s syndrome by proxy)
Malingering is the fabrication of physical or psychological symptoms for some ulterior motive.
No longer a diagnosis in the DSM
Malingering: Fabrication of physical or psychological symptoms for some ulterior motive.
Factitious disorder: 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.
Primary gain: The relief from anxiety or responsibility due to the development of physical or psychological symptoms.
Secondary gain: The sympath
Factitious disorder imposed on self, people show a pattern of falsifying symptoms that are either physical, psychological, or a combination of the two. Th e individual falsifies these symptoms not to achieve economic gain, but for the purpose of adopting the sick role.
In extreme cases, known more informally as Munchausen’s syndrome, the individual’s entire existence becomes consumed with the pursuit of medical care in which case it is called factitious disorder imposed on self. Th e individual may also feign the illness of someone else in cases of factitious disorder imposed on another (or
Munchausen’s syndrome by proxy)
Malingering is not a diagnosis in DSM-5
y and attention that a sick person receives from other people.
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15. Theories and Treatment of Somatic Symptom and Related Disorders
Cognitive behavioral therapy
Hypnotherapy
Medication
Interpersonal therapy
In applying cognitive behavioral therapy to clients with somatoform disorders, clinicians help their clients gain a more realistic appraisal of their body’s reactions.
In hypnotherapy, the therapist instructs the hypnotized client to, for example, move the paralyzed limb.
The therapist then makes the post-hypnotic suggestion to enable the client to sustain the movement after the therapist brings him or her out of hypnosis.
SSRIs are the medication that clinicians most likely use in treating conversion disorder.
Health anxiety: Worry about physical symptoms and illness.
Interpersonal therapy - Useful to help people with BDD develop improved strategies for dealing the distress they feel in their relationships with others.
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16. Psychological Factors Affecting Other Medical Conditions
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17. Psychological Factors Affecting Medical Conditions
Disorder in which clients have a medical disease or symptom that appears to be exacerbated by psychological or behavioral factors.
Depression, stress, denial of a diagnosis, or engaging in poor or even dangerous health related behaviors
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18. Psychological Factors Affecting Other Medical Conditions
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19. Stress and Coping Stress Coping strategies for stress
Problem-focused
Emotion-focused
Emotional expression
Personality style
Type A behavior pattern
Type D personality
Stress: Unpleasant emotional reaction a person has when he or she perceives an event to be threatening.
Stressor: Event that disrupts the individual’s life.
Coping: Process through which people reduce stress.
Types of events that qualify as stressors:
Social Readjustment Rating Scale (SRRS)
Life events scales
Cognitive stress models
Hassle: A relatively minor event that can cause stress.
Uplifts: Events that boost your feelings of well-being.
Problem-focused coping: The individual reduces stress by acting to change whatever makes the situation stressful.
Emotion-focused coping: Person does not change the situation itself but tries to improve his or her feelings about the situation.
Emotional expression: Expressing your emotions can improve your physical and mental well-being.
Personality style
Type A behavior pattern: Pattern of behaviors that include being hard-driving, competitive, impatient, cynical, suspicious of and hostile toward others, and easily irritated.
Type D personality: People who experience emotions that include anxiety, irritation, and depressed mood.
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20. Applications to Behavioral Medicine
Behavioral medicine: An interdisciplinary approach to medical conditions affected by psychological factors that is rooted in learning theory
Psychoeducation
The field of behavioral medicine applies the growing body of scientific evidence regarding mind-body relationships to helping improve people’s physical health by addressing its relationships to:
Psychological factors of stress
Emotions
Behavior patterns
Personality
Psychoeducation is an important component of behavioral medicine.
Behavioral medicine is moving increasingly toward interventions that the profession once considered “alternative”, including mindfulness training, relaxation, and meditation.
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