1. DISSOSIATION DISORDER

2. Dissociative and somatoform disorders
Dissociative disorders
a change/disturbance in function of self- identity, memory, unconscious that make personality whole.
There is a disruption/dissociation (splitting off)

3. Dissociative identity disorder
Alternate personalities may require different eyeglass prescription, display different allergies, different response to same medicine, differences in color blindness. It is as if conflicting internal impulses cannot coexist or achieve dominance.

4. Cont. dissociative identity disorder
Mechanism of dissociation is controlled by unconscious process.
Individual may report auditory hallucinations like 2 voices arguing about them, some complain of being “possessed.”

5. they may display wide range abnormal behavior before being accurately diagnosed:
physical complaints without an organic basis
amnesia,
depression/suicide,
anxiety/ panic attacks
depersonalization
derealization (loss of sense of reality: people/objects change size/shape or in the sense of time)

6. Dissociative amnesia
Inability to recall important personal information usually involving traumatic experiences that cannot be explained by simple forgetfulness. May last hours/years
There are 5 types:
localized a: cannot recall events for a number of hours after stressful/traumatic incident.
Selective a: forget only disturbing particulars during certain time.
Generalized a: forget entire life but retain habits, tastes, skills. (rare)

7. Continuous a: forget all events that take place after the problem begins.
Systematized a: memories relating to specific categories of information are lost, ie., college experiences.
Malingering: attempt to fabricate symptoms/make false claims of amnesia for personal gain.

8. Dissociative fugue Fugue means flight.
Individual travels suddenly from home/work, shows loss of memory for past personal information, becomes confused about identity or assumes a new one.

9. To differentiate amnesia from fugue:
Amnesia is wandering aimlessly
Fugue Is acting more purposefully
Not psychotic
when memory returns can’t remember fugue state.
Rare
Most likely to occur in wartime/disasters,
Difficult to distinguish from malingering.

10. Depersonalization disorder
Experience of depersonalization are persistent/recurrent and cause distress.
Controversy of including depersonalization disorder with dissociative because depersonalization disorder does not affect memory.
In other dissociative disorders, it protects individual from anxiety; depersonalization generates anxiety.

11. Theoretical Perspectives
Psychodynamic
trauma (abuse, warfare, severe problems, averting punishment) plays a role.
Dissociating helps to block out troubling memory.
Use repression.

12. Learning:
Individual learns not to think about disturbing thoughts to avoid guilt/shame.
Negative reinforcement when relieved from anxiety.
Learned through observational learning.

13. Treatment Psychodynamic: Behavioral: uncover early childhood traumas
learn to cope.
Behavioral:
Consider personalities
Reinforcement contingencies.

14. Somatoform Disorders
A condition where people have physical symptoms but no organic abnormalities can be found to account for them. There is some reason to believe that the symptoms reflect psychological factors or conflict.

16. Conversion disorder
A major change in or loss of physical functioning, although there are no medical findings to support the physical symptoms or deficits.
The physical symptoms usually come on suddenly during a stressful time.
It is named because it is believed that repressed sexual/aggressive energy is converted into physical symptoms.

17. Symptom patterns involve
paralysis
epilepsy
problems in coordination
blindness/tunnel vision
loss of hearing, smell, feeling in a limb

18. Hypochondriasis A fear of having a serious illness.
A fear that their bodily signs or sensations are due to a serious illness.
Unlike conversion disorder, hypochondriasis does not involve the loss or distortion of physical functioning.
Unlike conversion disorder, hypochondriacs are very concerned about their symptoms.

19. Hypochondriasis
The disorder is about equally common in men and women, and most often begins between 20 and 30.
They are more likely to report being sick as children.
They frequently doctor shop.

20. Somatization Disorder
Formerly known as Briquet’s syndrome.
Multiple, recurrent somatic complaints that began prior to the age of 30, usually begins in late adolescence. Complaints usually involve different organ systems.
The groups of symptoms are categorized as pain involving multiple sites.
10 times more likely to be found in women; 4 times more likely among Afr-Americans.

21. Theoretical Perspectives
Hippocrates believed the strange bodily symptoms were caused by a wandering uterus which created internal chaos.
Freud believed that hysteria was rooted in psychological rather than physical causes.

22. Cont. theoretical
Hysterical symptoms are functional. They allow the patients to achieve primary(keeping internal conflicts repressed) and secondary gains (avoiding burdensome responsibilities)
Example of primary - hand paralysis to prevent masturbation or murder
secondary - hand paralysis to keep from firing a gun in battle thus being removed from the front line.

23. Cont. Theoretical
Psychodynamic and learning concur that the symptoms reduce anxiety.
Learning theory - the symptoms carry the benefits or reinforcing properties of the “sick role” though it is not conscious.
Distinguish from malingering which is conscious.

24. Cognitive -
Hypochondriasis may represent a type of self- handicapping.
May also be a cognitive bias to misinterpret changes in bodily cues or sensations.

25. Treatment Psychodynamic Behavioral Biological
Uncover unconscious conflicts.
Behavioral
Remove the secondary gains.
Biological
Use anti-depressants

26. Münchausen Syndrome Patients who tell tall tales to their doctors.
A type of factitious disorder. Münchausen syndrome is a term for psychiatric disorders known as factitious disorders wherein those affected feign disease, , illness, or psychological trauma in order to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome.

27. Medical professionals suspecting Münchausen's in a patient should first rule out the possibility that the patient does indeed have a disease state, but it is in an early stage and not yet clinically detectable.
take a careful patient history, and seek medical records,
to look for early deprivation, childhood abuse, mental illness.
If a patient is at risk to himself or herself, inpatient psychiatric hospitalization. should be initiated.

28. Medical providers should consider working with mental health specialists to help treat the underlying mood or disorder as well as to avoid countertransference.
Therapeutic and medical treatment should center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder, or borderline personality disorder.

29. The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication and/or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time,thus offers the worst prognosis.

30. Ganser’s Syndrome
Ganser syndrome is a rare dissociative disorder previously classified as a factitious disorder.. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness.

31. Ganser is an extremely rare variation of dissociative disorder
Ganser is an extremely rare variation of dissociative disorder. It is a reaction to extreme stress and the patient thereby suffers from approximation or giving absurd answers to simple questions.
Symptoms
clouding of consciousness, somatic conversion symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia.
Individuals also give approximate answers to simple questions. For example, "How many legs are on a cat?", to which the subject may respond '3?'.
The syndrome may occur in persons with other mental disorders such as schizophrenia, depressive disorders, toxic states, paresis, alcohol use disorders and factitious disorders. EEG data does not suggest any specific organic cause.

32. It is also sometimes called nonsense syndrome, syndrome of approximate answers, pseudodementia, hysterical pseudodementia or prison psychosis. This last name, prison psychosis, is sometimes used because the syndrome occurs most frequently in prison inmates, where it may represent an attempt to gain leniency from prison or court officials.