Download Slides Chapter 6 - Dissociative & Somatoform

Dissociative & Somatoform
Disorders
DISORDER V. FAKING
Malingering = faking bad
- symptoms deliberate
- for gain
- not a disorder
Factitious Disorder
= psychological need to lie
- only for psychological gain
- symptoms deliberate
- a mental disorder
Ex. Munchausen’s Syndrome
- lies for medical attention
Munchausen by proxy
- creating physical problems in another for
medical attention
Somatoform Disorders
= physical symptoms without physical basis
- psychological disorder
- may be gain
- symptoms not deliberate**
Undiagnosed physical illness
Somatoform Disorders
Physical complaints with no physical cause
1. Conversion Disorder
Freud: conflicts converted into sxs
- women
Description
• Affects voluntary movement/sensation
• Identifiable stressors
• Not explained medically
• Not intentional
• Distress/impairment
• Decreasing incidence
Signs of conversion
• Sudden onset after stress
• La belle indifference
• Selective symptoms
Possible Causes
Psychodynamic: 4 processes:
1) traumatic event
--> impulse emerges
2) conflict is repressed
3) anxiety increases, is “converted” into
physical symptom
- avoid anxiety
(primary gain)
4) attention/sympathy & avoid tasks
(secondary gain)
Learning Theory
1) traumatic event => escape/avoid
2) symptom develops
3) environment reinforces symptoms
Other: Personality type
- histrionic
Treatment
1) Deal with stressor
2) Remove secondary gain
3) Teach reuse of body part
2. Hypochondriasis
Description
- belief of serious illness (anxiety)
- illness is long-term
- misinterpret body symptoms
- symptoms are wide-ranging
- agree that reaction is excessive
• “doctor shopping”
• distress/impairment
• men & women
Possible Causes
Theoretical agreement
• faulty interpretation of sensations
• biological hypersensitivity
• learned focus on illness
Treatment
• Uncover unconscious conflicts
• Attack illness beliefs
via cognitive-behavioral
• Support groups
3. Somatization Disorder
Description
• Multiple somatic complaints
• Most major body systems
• No physical basis
• Concern = symptoms themselves, not
illness
• Life revolves around symptoms
• Relating to others = symptoms
• Lengthy medical history
• Severe impairment
• Very rare - women
Possible Causes
• Childhood learning
• Identifiable stressor
• Personality traits
- insensitive to punishment
- impulsive (short-term gains)
- irresponsible
- aggressive
• Women
- socialization
Treatment
• Very difficult
• Reduce help-seeking behavior
• Increase independence
• No reinforcement for symptoms
• Teach more appropriate behavior
4. Body Dysmorphic Disorder
Description
• Perceived defect in appearance
• Imagined/exaggerated
• Face/head flaws
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Difficulty controlling obsession
Frequently check appearance
Requests reassurance
Plastic surgery
Distress & life impairment
• Prevalence unknown
but probably common
• Men & women
Causes & Treatment
• Little known
• Related to OCD?
- anxiety
• Surgery increases complaints
Dissociative Disorders
Splitting off of a psychological function from
rest of conscious mind
1. Dissociative Identity Disorder
(DID)
Description
• 2+ distinct personalities
• Alternate control of body
—> NOT INTEGRATED
• “Core” has amnesia
• DID vs. Schizophrenia
• Does DID exist?
(iatrogenic effects)
Indications of DID
• Amnestic periods
• Childhood abuse or trauma
• Unsuitable nickname
• Hypnotizability
2. Dissociative Amnesia
• Loss of memory
• Traumatic event
• Lack of distress
3. Dissociative Fugue
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Amnesia for identity
Flight
New life & identity
Brief duration
4. Depersonalization Disorder
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Recurrent detachment from self/body
Observing self
Good reality perception
Distress
Possible Causes
• Childhood sexual abuse/trauma
• Self-hypnosis
• Biological vulnerability
Treatment
• Amnesia & fugue get better on own
• Resolve trauma
• Improve coping
Tx for DID
• Uncover & deal with trauma
• Hypnosis to remember
• Goal: integrate personalities