somatoform disorders & dissociative disorders kimberley clow kclow2@uwo.ca

Somatoform Disorders &Dissociative Disorders

Kimberley Clow

kclow2@uwo.cahttp://instruct.uwo.ca/psychology/155b/

Outline

Somatoform Disorders Somatization Disorder Pain Disorder Hypochondriasis Conversion Disorder Body Dysmorphic Disorder

Dissociative Disorders Dissociative Amnesia Dissociative Fugue Depersonalization Disorder Dissociative Identity Disorder

Somatoform Disorders

Bodily symptoms that suggest a physical defect or dysfunctionBUT no physiological basis can be

foundEmotions Physical Symptoms

Different fromMalingeringFactitious Disorder

Somatization Disorder

Causes & Treatment

Contributors Behaviour rewarded Excessive illness growing up Association with Antisocial Personality

Disorder Runs in families

Treatment Focus on stress Reduce help-seeking behaviour Eliminate reinforcers

Pain Disorder

Predominant complain is pain and psychological factors have an important role in the onset, severity, exacerbation, or maintenance of the pain

Types Acute Chronic

Causes Psychodynamic Behavioural

Hypochondriasis

Causes & Treatment

Conversion Disorder

Motor or sensory symptoms suggesting a neurological impairment when there is none

Conversion refers to unconscious conflicts being converted into physical symptoms Discharging anxiety without

experiencing it

Freud

Causes & Treatment

ContributorsTriggered by a stressful

/ traumatic event Primary & Secondary

Gain

TreatmentNeed to address initial

stressful eventRemove reinforcersGlove Anesthesia

Body Dysmorphic Disorder

Dysfunctional preoccupation about imagined physical defects Ideas of reference Successive changes

& surgeries With insight Without insight

Delusional Disorder

0

10

20

30

40

50

60

70

%

Hair

Nose

Skin

Eyes

Stomach

Breasts

Penis

Causes & Treatment

Contributors Societal beauty images High comorbidity with OCD

Treatment Drugs

Same ones for OCD Behavioural Therapy

Exposure and Response Prevention

Same therapy as for OCD

General Considerations

Psychodynamic Neurosis

Primary gain Secondary gain

Behavioural Sick role Modeling

Stress & Trauma High incidences

of child abuse History of illness

Cognitive Faulty

interpretations Biological

History of illness Sensitivity to

bodily sensations Cultural Factors

More prevalent in cultures that stigmatize mental disorders

Dissociative Disorders

Disruptions of consciousness, memory, and identityMissing time

No memory for a period Weren’t conscious when it happened

Don’t know who you are Lost memories Don’t identify with self Multiple identities

Don’t feel real

Dissociative Experiences Scale

1. Able to ignore pain2. Missing part of a conversation3. Usually difficult things can be done with

ease and spontaneity4. Not sure whether you have done

something or only thought about it5. Absorption in TV program or movie6. Remembering past so vividly you seem to

be reliving it7. Staring into space8. Talking out loud to yourself when alone9. Finding evidence of having done things you

can’t remember doing

10. Not sure if remembered event happened or was a dream

11. Being approached by people you doesn’t know who call you by a different name

12. Feeling as though you were two different people

13. So involved in fantasy that it seems real14. Driving a car and realizing you don’t remember

part of the trip15. Not remembering important events in your life16. Being in a familiar place but finding it

unfamiliar17. Being accused of lying when you are telling the

truth18. Finding notes or drawings that you must have

done but don’t remember doing

19. Seeing yourself as if looking at another

person20. Hearing voices inside your head21. Not recognizing friends or family members22. Other people and objects do not seem real23. Looking at the world through a fog24. Finding unfamiliar things among your

belongings25. Feeling as though your body is not your

own26. Finding yourself in a place but unaware of

how you got there27. Finding yourself dressed in clothes that you

don’t remember putting on28. Not recognizing your own reflection in a

mirror

Dissociative Amnesia

Person is unable to recall important personal information Usually related to a

traumatic or stressful event

Variations Generalized Localized Selective

24

Dissociative Fugue

Person suddenly leaves home and work and assumes a new identity Usually triggered by

stress or trauma

Depersonalization Disorder

Person’s perception or experience of the self is disconcertingly and disruptively altered Frequent episodes Reality does remain

intact during episodes No amnesia or new

identities

Causes & Treatment

Dissociative Identity Disorder (DID)

Causes & Treatment

Is DID A Real Disorder?

Yes It IsMany symptoms

of PTSD are similar to those of DID

Alters show several physiological and / or behavioural differences

No It Isn’tThe use of hypnosis

may be a source of therapist contamination

Physiological changes are also seen in subjects asked to fake DID