Chapter 7 Somatoform and Dissociative Disorders Ch 7.
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Transcript of Chapter 7 Somatoform and Dissociative Disorders Ch 7.
Chapter 7 Somatoform and Dissociative
Disorders
Ch 7
Historical Commonality
• Somatoform and dissociative disorders are very strongly historically linked and may share common features.
• They used to be categorized under one general heading, “hysterical neurosis” .
• The term “hysteria” (from the Greek “wandering uterus”) referred to physical symtoms without organic basis (somatoform disorder) or in dissociative experiences (alterations in consciousness, memory, or identity).
• Kihlstrom’s theory (D&N, p. 189): Both disorders are disruptions in the normal controlling functions of consciousness.
Somatoform Disorders
• Psychological factors produce physical symptoms in the Somatoform Disorders: – Hypochondriasis is a preoccupation with having a disease – Body dysmorphic disorder involves a preoccupation with an
imagined physical defect– Conversion disorder involves a change in sensory/motor
function– Somatization disorder involves recurrent, multiple somatic
complaints– In pain disorder, chronic pain results in distress, in which
psychological factors play a maintaining role
Ch 7.1
Common Features Lots of Physical Complaints Appear to be Medical Conditions No Identifiable Medical Cause Pathological Concern About
– Physical Appearance– Functioning of Their Bodies
Common Features Lots of Physical Complaints Appear to be Medical Conditions No Identifiable Medical Cause Pathological Concern About
– Physical Appearance– Functioning of Their Bodies
Clinical Description Ancient Roots Physical Complaints No Known Medical Cause Severe Anxiety / Fear About
Possibly Having a Serious Disease Reassurance Doesn’t Help
Clinical Description Ancient Roots Physical Complaints No Known Medical Cause Severe Anxiety / Fear About
Possibly Having a Serious Disease Reassurance Doesn’t Help
Clinical Description Essential Problem is Anxiety Preoccupied With Bodily
Symptoms Misinterpretation of Symptoms Strong Disease Conviction Many Medical Visits and Tests
Clinical Description Essential Problem is Anxiety Preoccupied With Bodily
Symptoms Misinterpretation of Symptoms Strong Disease Conviction Many Medical Visits and Tests
Why not Classify Such Persons With an Illness Phobia?
Why not Classify Such Persons With an Illness Phobia?
Facts and Statistics 1% to 14% Medical Patients Equal Rates (Males vs. Females) May Occur Any Time Strong Disease Conviction Many Medical Visits and Tests
Facts and Statistics 1% to 14% Medical Patients Equal Rates (Males vs. Females) May Occur Any Time Strong Disease Conviction Many Medical Visits and Tests
Causes Disorder of Cognition /
Perception More Disease in Family More Illness Concern in Family More Attention for Sick Behavior
Causes Disorder of Cognition /
Perception More Disease in Family More Illness Concern in Family More Attention for Sick Behavior
Psychological Treatment Modify Illness Perceptions Evoke Bodily Sensations Provide “Appropriate”
Reassurance More Research is Needed!
Psychological Treatment Modify Illness Perceptions Evoke Bodily Sensations Provide “Appropriate”
Reassurance More Research is Needed!
Clinical Description Preoccupation With Appearance
– Imagined Defect “Imagined” Ugliness Mirrors (Fixation or Avoidance) Ideas of Reference Suicidal Ideation and Tendencies
Clinical Description Preoccupation With Appearance
– Imagined Defect “Imagined” Ugliness Mirrors (Fixation or Avoidance) Ideas of Reference Suicidal Ideation and Tendencies
Common Locations of Defects Hair Nose Skin Eyes Head / Face Lips
Common Locations of Defects Hair Nose Skin Eyes Head / Face Lips
Facts and Statistics College Students
– 70% Report Some Dissatisfaction– 28% Meet Diagnostic Criteria
Many Consult Plastic Surgeons Males = Females Onset Late Adolescence
Facts and Statistics College Students
– 70% Report Some Dissatisfaction– 28% Meet Diagnostic Criteria
Many Consult Plastic Surgeons Males = Females Onset Late Adolescence
The Plastic Surgery Solution? Quite Popular but Expensive Most are Disappointed With
Results
The Plastic Surgery Solution? Quite Popular but Expensive Most are Disappointed With
ResultsBEFOREBEFORE AFTERAFTER
Causes and Treatment Little is Known Co-Occurs With OCD
– Intrusive Thoughts and Checking Compulsions About Appearance
Exposure + Response Prevention
Causes and Treatment Little is Known Co-Occurs With OCD
– Intrusive Thoughts and Checking Compulsions About Appearance
Exposure + Response Prevention
Conversion Disorder• Conversion Disorder involves sensory or motor
symptoms– Not related to known physiology of the body
• E.g. glove anesthesia– Conversion symptoms appear suddenly– Conversion symptoms are related to marked stress– The person experiencing conversion disorder is not distressed
by sudden paralysis or blindness (“La Belle Indifference”)
– Popularized by Freud
Ch 7.2
Facts and Statistics Relatively Rare (< 1% prevalence) Females > Males Onset Around Adolescence
Facts and Statistics Relatively Rare (< 1% prevalence) Females > Males Onset Around Adolescence
Somatization Disorder• Somatization Disorder involves recurrent, multiple somatic
complaints with no known physical basis• Diagnostic criteria include:
– Four pain symptoms in different locations– Two gastrointestinal symptoms– One sexual symptom other than pain– One pseudo-neurological symptom (e.g. those of conversion
disorder)• Lifetime prevalence is < 0.5%; females > males; chronic
condition
Ch 7.3
Causes Family Link Link to Antisocial Personality
– Weak Behavioral Inhibition– Strong Behavioral Activation– Short Term Gain (attention &
sympathy)
Causes Family Link Link to Antisocial Personality
– Weak Behavioral Inhibition– Strong Behavioral Activation– Short Term Gain (attention &
sympathy)
Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Maintain
Pain Can be Debilitating
Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Maintain
Pain Can be Debilitating
Etiology of Somatoform Disorders
• Somatoform disorder reflects oversensitivity to physical sensations
• Conversion disorder– Psychoanalytic view focuses on unconscious complexes
and secondary gain– Behavioral view focuses on similarity to malingering– The incidence of conversion disorder has declined,
suggesting a role for social factors
Ch 7.4
Therapy for Conversion Disorders
• Conversion disorder clients seek help from physicians and resent referrals to psychotherapists– Psychoanalytic therapy is not effective for conversion
disorder– The cognitive-behavioral approach involves pointing out
selective attention to physical sensations and discouraging the client from seeking medical assistance
Ch 7.5
Dissociative Disorders
• Dissociative Disorders involve the inability to recall important personal events or identity – Depersonalization disorder involves an alteration of a
person’s self-experience– Dissociative amnesia is the inability to recall important
personal information– Dissociative fugue involves extensive memory loss– Dissociative trance disorder involves a sudden change in
personality / “possession by spirits”– Dissociative identity disorder (DID) involves the presence of
two different identities (alters)
Ch 7.6
Depersonalization– Altered Perception of Self
Depersonalization– Altered Perception of Self
Derealization– Altered Perception of World
Derealization– Altered Perception of World
Dissociative Phenomena Dissociative Phenomena
Common ExperienceAltered consciousness, memory
Common ExperienceAltered consciousness, memory
Some people have the experience of driving a car and suddenly
realizing that they don’t remember what happened during all or part of
the trip.
Some people have the experience of driving a car and suddenly
realizing that they don’t remember what happened during all or part of
the trip.
0% 100%0% 100%0% 100%0% 100%
0% 100%0% 100%0% 100%0% 100%
Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear part or all of what was
just said.
Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear part or all of what was
just said.
0%0% 100%100%0%0% 100%100%
Some people find that they have no memory for some important events in
their lives (e.g. a wedding or graduation).
Some people find that they have no memory for some important events in
their lives (e.g. a wedding or graduation).
0% 100%0% 100%0% 100%0% 100%
Some people have the experience of finding themselves dressed in clothes that they don’t remember
putting on.
Some people have the experience of finding themselves dressed in clothes that they don’t remember
putting on.
0% 100%0% 100%0% 100%0% 100%
Some people sometimes have the experience of feeling that other people, objects, and the world around them are
not real.
Some people sometimes have the experience of feeling that other people, objects, and the world around them are
not real.
Nor
mal
Dis
soci
atio
nN
orm
alD
isso
ciat
ion
AmnesiaAmnesia
FugueFugue
PartialDID
PartialDID
ComplexDID
ComplexDID
Poly-F
ragmen
tedD
IDP
oly-Fragm
ented
DID
Etiology of Dissociative Disorders
• Consciousness is normally a unified experience,consisting of cognition, emotion and motivation– Stress may alter the fashion in which memories
are stored resulting in amnesia or fugue– May result from
• Severe physical/sexual abuse• Learned social role enactment
Ch 7.7
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Primary Features– Depersonalization– Derealization
Primary Features– Depersonalization– Derealization
Impairs Functioning Causes Significant Distress Runs a Chronic Course
Impairs Functioning Causes Significant Distress Runs a Chronic Course
Clinical Description Clinical Description
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Clinical Description Clinical Description
Localized or Selective– Failure to Recall Specific Events
Localized or Selective– Failure to Recall Specific Events
Several Patterns Generalized
– Unable to Remember Anything
Several Patterns Generalized
– Unable to Remember Anything
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Clinical Description Clinical Description
Go to Another Location– Unaware “How They Arrived”
Go to Another Location– Unaware “How They Arrived”
Memory Loss – Specific Incident
Memory Loss – Specific Incident
May Assume New Identity May Assume New Identity Fugue Usually Ends Abruptly Fugue Usually Ends Abruptly
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Clinical Description Clinical Description Differ Across Cultures
– Sudden Changes in Personality– Possession by Spirits
Differ Across Cultures – Sudden Changes in Personality– Possession by Spirits
Females > Males Females > Males Often Related to Trauma Often Related to Trauma
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Trance Disorder Dissociative Identity Disorder
Clinical Description Clinical Description Formally
– Multiple Personality Disorder
Formally – Multiple Personality Disorder
Person’s Identity is Dissociated Person’s Identity is Dissociated
May Adopt 100 Identities – “Alters”– The Nature of Alters
May Adopt 100 Identities – “Alters”– The Nature of Alters
Central Features Central Features Host Identity
– One Who Asks for Treatment– Attempt to Hold Alters Together
Host Identity – One Who Asks for Treatment– Attempt to Hold Alters Together
A Switch – Abrupt Change in Personalities– Usually Instantaneous
A Switch – Abrupt Change in Personalities– Usually Instantaneous
Facts and Statistics Facts and Statistics Average Number of Alters?
– 15
Average Number of Alters? – 15
Females > Males (9:1) Females > Males (9:1) Onset in Childhood
– Linked to Extreme Abuse
Onset in Childhood– Linked to Extreme Abuse
Runs a Chronic Course Runs a Chronic Course
Causes Causes Unspeakable Childhood Abuse
– 97% of Cases – Escape Into Fantasy World– Become Someone Else– Do What It Takes to Survive
Unspeakable Childhood Abuse– 97% of Cases – Escape Into Fantasy World– Become Someone Else– Do What It Takes to Survive
DID as a Means of Coping?--Age 9 “developmental window”
DID as a Means of Coping?--Age 9 “developmental window”
Other Related Features Other Related Features Suggestibility, Role PlayingSpanos et al. (1994) experiment, Hypnotizability Similar to Dissociation Are these related to DID?
Suggestibility, Role PlayingSpanos et al. (1994) experiment, Hypnotizability Similar to Dissociation Are these related to DID???
Abuse: Controversial Issues Abuse: Controversial Issues False vs. Real Memories Do Therapists Plant Memories? Can False Memories be Created?
– Elizabeth Loftus (D&N, p.178)– (Williams, 1995; Elliott, 1997)
False vs. Real Memories Do Therapists Plant Memories? Can False Memories be Created?
– Elizabeth Loftus (D&N, p.178)– (Williams, 1995; Elliott, 1997)
Consequences of the Debate? Consequences of the Debate?
Treatment: Psychoanalysis Relevant Treatment: Psychoanalysis Relevant Dissociative Amnesia & Fugue
– Usually Improve on Their Own– Stress Reduction and Coping
Dissociative Amnesia & Fugue– Usually Improve on Their Own– Stress Reduction and Coping
Dissociative Identity DisoderChronic, Treatment Process Difficult– No Controlled Research– Treatments are Similar to PTSD
Dissociative Identity DisoderChronic, Treatment Process Difficult– No Controlled Research– Treatments are Similar to PTSD
Diagnostic Considerations in Somatoform
and Dissociative Disorders• Separating Real Problems from Faking
– The Problem of Malingering – Deliberately faking symptoms
• Related Conditions – Factitious disorders– Factitious disorder by proxy
• False Memories and Recovered Memory Syndrome