SOMATOFORM DISORDERS AND DISSOCIATIVE

DISORDERS

Psychosomatic v. Somatoform Disorders

Psychosomatic Disorders: Disorders in which there is a real physical illness that is caused by psychological factors (usually stress)

Somatoform: Disorders in which there is an apparent physical illness, but there is no organic cause Usually people go to the doctor rather than a

psychiatrist/psychologist!

Common Somatoform Disorders Conversion Disorder: Anxiety is converted into

physical symptoms (may lose feeling in a limb, paralysis, blindness, deafness, perception of pregnancy) This is what interested Freud! Rare in our time

Hypochondriasis: People interpret normal sensations as symptoms of a dreaded disease (headaches, stomach cramps, etc.) May move from physician to physician looking for

treatment and diagnosis NOT faking it for attention Relatively common

Body dysmorphic disorder: Preoccupation with defects in one’s body When faced with an imperfection, concern about it

becomes obsessive

Dissociative Disorders

Type of disorder in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings

Types Dissociative Amnesia: Loss of identity Dissociative Fugue: Involves flight from home

and the assumption of a new identity with amnesia for past identify and events

Dissociative Identify Disorder (DID)

DID (Formerly known as Multiple Personality Disorder)

Two or more distinct identities are said to alternately control a person’s behavior Typically the original personality denies any

awareness of the others Usually not violent (not Dr. Jekyll/Mr. Hyde)

Personalities have their own names, memories, speaking voices, mannerisms

Controversy Over DID

Is it simply an extension of our own normal capacity for personality shifts?

Are clinicians who discover it just triggering role-playing by fantasy-prone people?

Are these patients, like actors, convincing themselves of the authenticity of their own role enactments?

Both Sides of the Debate SKEPTICS BELIEVERS

DID patients also tend to be highly hypnotizable

Seem to be localized to time and place Number of cases and

personalities (3-12) has been ballooning over time

Not very prevalent outside of N. America

Nonexistent in Japan and India British consider it a “wacky

American fad” Is it a cultural phenomenon

created by therapists in a particular social context?

Therapists go fishing for identities

Distinct brain and body states associated with different personalities Can have different

blood pressures! Handedness and visual

acuity can change based on the personality!

Why? Psychoanalytic perspective: defenses

against anxiety caused by the eruption of unacceptable impulses

Learning (behavioral) perspective: behaviors are reinforced by anxiety reduction

Maybe it should be included under PTSD? A response to childhood trauma Child abuse is reported in ¾ of cases of DID

One of the personalities is often a child “Having the abuse happen to someone else”