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Chapter 6 Somatoform and Dissociative Disorders Somatoform and Dissociative Disorders Considered by some to be the result of psychological process known as dissociation, in which different parts of an individual’s identity, memories, or consciousness become split off from one another. Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 2 Dissociative Experiences in the General Population 90 80 Percent acknowledging Percent in pathological range 83 70 60 56 47 50 45 40 29 30 26 18 20 10 12 11 0 Missing part of Talking outloud to Feeling as Fantasy seems conversation oneself thought one were real two different people Chapter 6 23 14 7 4 1 Hearing voices Feeling as though Not recognizing one's body is not one's reflection in one's own a mirror Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 3 Somatoform Disorders A group of disorders in which people experience significant physical symptoms for which there is no apparent organic cause Symptoms are often inconsistent with possible physiological processes Strong reason to believe that psychological factors are involved People do not consciously produce or control the symptoms but truly experience the symptoms Symptoms pass only when the psychological factors that led to the symptoms are resolved Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 4 Somatoform Disorders Somatoform and Pain Disorders Subjective experience of many physical symptoms, with no organic causes Psychosomatic Disorders Actual physical illness present and psychological factors seem to be contributing to the illness Malingering Deliberate faking of physical symptoms to avoid an unpleasant situation, such as military duty Factitious Disorder Deliberate faking of physical illness to gain medical attention Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 5 Distinguishing Somatoform from Related Disorders Psychosomatic Disorders Malingering Factitious Disorders Factitious Disorders by Proxy Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 6 Somatoform Disorders Conversion disorder Somatization Pain disorder disorder Loss of functioning in some part of the body for psychological rather than physical reasons History of complaints about physical symptoms, affecting many different areas of the body, for which medical attention has been sought but no physical cause found History of complaints about pain, for which medical attention has been sought but that appears to have no physical cause Hypchondriasis Chronic Body Excessive dysmorphic disorder Chapter 6 worry that one has a physical disease in the absence of evidence that one does; frequently seek medical attention preoccupation with some part of the body the person believes is defective Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 7 Conversion Disorder Symptoms Loss of functioning in some part of the body due to psychological rather than physiological causes—there may be indifference to the loss of functioning (la belle indifference) Etiology Often can occur after trauma or stress, perhaps because the individual cannot face memories or emotions associated with the trauma Treatment Psychoanalytic therapy focuses on helping the individual expression of emotions or memories. Behavioral therapy uses systematic desensitization and other techniques Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 8 Somatization & Pain Disorders Symptoms Somatization disorder involves a long history of multiple physical complaints for which people have sought treatment but for which there is no apparent organic cause. Pain disorder involves only the experience of chronic, unexplainable pain Etiology These disorders run in families, but it is not clear whether this is due to genetics or modeling. Different theories claim different origins for this disorder Treatment Psychoanalytic treatment involves helping people identify feelings and thoughts behind the symptoms and find more adaptive ways of coping Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 9 Hypochondriasis Symptoms Chronic worry that one has a serious medical disease despite evidence that one does not; frequent consultations with physicians over this worry Etiology A family history of depression or anxiety is common. These people may suffer from chronic distress and cope with this distress by exaggerating physical symptoms Treatment Same as somatization disorder, involving helping people identify feelings and thoughts behind the symptoms and find more adaptive ways of coping Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 10 Body Dysmorphic Disorder Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 11 Dissociative Disorders Process in which different parts of an individual’s identity, memories, or consciousness become split off from one another. Most people experience some form of dissociation— daydreaming is one example of dissociation. When dissociation becomes chronic and a defining features of people’s lives, people may be diagnosed with a dissociative disorder. Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 12 Dissociative Disorders Dissociative Identity Disorder There are separate, multiple personalities in the same individual Dissociative Fugue The person moves away and assumes a new identity, with amnesia for the previous identity Dissociative Amnesia The person loses memory of important personal facts, including personal identity, for no apparent organic cause Depersonalizati on Disorder Frequent episodes in which individual feels detached from his or her mental state or body Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 13 Dissociative Identity Disorder Symptoms Presence of two or more separate personalities or identities in the same individual. These personalities may have different ways of speaking and relating to others and may even have different ages, genders, and physiological responses Etiology Alters may be created by people under conditions of extreme stress, often child abuse. Self-hypnosis may be involved. Some evidence it runs in families Treatment Long-term psychotherapy and use of hypnosis to discover functions of the personalities and to assist in “integration.” Antidepressants and antianxiety drugs may be used Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 14 Dissociative Fugue Symptoms Person suddenly moves away from home and assumes an entirely new identity, with no memory of previous identity Etiology Fugue states usually occur in response to some stressor, but because they are extremely rare, little is known about etiology Treatment Psychotherapy to help the person identify the stressors leading to the fugue state and learn better coping skills Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 15 Dissociative Amnesia Symptoms Loss of memory due to psychological rather than physiological causes. The memory loss is usually confined to personal information only Etiology Typically occurs following traumatic events. May involve motivated forgetting of events, poor storage of information during events due to overarousal, or avoidance of emotions experience during an event Treatment Help the individual remember traumatic events and accept them Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 16 Depersonalization Disorder People with this disorder have frequent episodes in which they feel detached from their own mental processes or bodies, as if they are outside observers of themselves. Occasional experiences of depersonalization are common, especially when people are sleep deprived. Depersonalization disorder is only diagnosed when they are so frequent and distressing that they interfere with an individual’s ability to function. Chapter 6 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 17