Somatoform and dissociative disorders

Dr. Hassan Sarsak, PhD, OT

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Introduction• Psychophysiological response to anxiety, are those in which it has been determined that psychological factors contribute to the initiation or exacerbation of the physical condition. These responses have pathophysiological evidence. • Some of the psychological factors can influence the development of medical conditions. • Four general types of reaction to stress occur and include: Normal reaction, Psychophysiological reaction, Neurotic reaction, Psychotic reaction

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First: Somatoform disorders (SD) SD are characterized by physical symptoms that

suggest medical disease, but that do not have demonstrable organic pathology or known pathophysiological mechanism to account for them (not caused by organic disease).

There is evidence or presumption that psychological factors are the major cause of the symptom of the SD.

Somatization: those mechanisms by which anxiety is translated (converted) into physical illnesses or body complaints.

There are five types of SD

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1. Somatization disorder It is a syndrome of multiple somatic symptoms

that cannot be explained medically and that are associated with psychosocial distress and long term seeking of assistance from health care professionals.

Symptoms are identified as pain in several sites like GI symptoms ,sexual symptoms and pseudoneurological symptoms*.

Other symptoms are: anxiety, depression, suicidal attempts, substance abuse.

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2. Pain disorder This disorder is characterized by severe and

prolonged pain that causes clinically significant distress or impairment in social, occupational, and other important areas of functioning.

Etiology of the pain may be evidenced by occurrence of stressful situations with the onset of the symptoms e.g., chronic headache, earache.

Characteristics behavior include frequent visits to physicians in an attempt to obtain relief pain and request surgery.

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3. Hypochondriasis It is the person’s preoccupation with the fear of

contracting, or the belief of having, a serious disease. The preoccupation may be with specific organ or disease (body structures), or with bodily functions. Their response to slight signs is usually unrealistic and exaggerated.

Anxiety and depression are common. Impaired social and occupational function.

Those people have a long history of “doctor shopping”.

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4. Conversion disorder

Loss or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder.

Examples of conversion disorders are: paralysis, aphonia الصوت ,difficulty swallowing , فقدانurinary retention, blindness, deafness, pseudocyesis (false pregnancy).

Conversion symptoms serve to prevent internal conflicts or painful issues from attaining awareness.

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5. Body dysmorphic disorder. Exaggerated belief that the body is deformed or

defective in some specific way. Example: imagined or slight flaws of the face or head (thinning hair, acne, wrinkles, scares, facial swelling). Some times includes nose, ears, and eyes.

Symptoms of depression and obsessive-compulsion are common. Impairment in functions is also common.

Those people have history of visiting plastic surgeons and dermatologists.

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Second: Dissociative disorders (D.D.) D.D. is a disruption in the usually integrated

functions of consciousness, memory, identity, or perception of the environment. It can refer to feeling, thoughts, information, or mental functioning that cannot be accessed consciously by a person for a certain period of time.

Dissociative responses occur when anxiety becomes overwhelming and the personality becomes disorganized.

In D.D., there is a break down in the defense mechanisms that usually govern consciousness, identity, and memory, and behavior occur with little or no participation on the part of the conscious personality..

Dissociative disorders (D.D.)

Dissociation refers to as a confusion with function that serves to protect the individual against awareness of intense pain. Other protective functions of D. include: Escape from conflict Performing actions by rote without needing to focus

conscious awareness on them Soothing pain Defying the constraints of reality Altering one’s self-concept

According to the DSMIV there are five types of DD as follow:

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1. Dissociative Identity Disorder (DID)

Previously known as multiple personality disorder (MPD),

See table 13-1 Pg., 409 for DSM-IV criteria for Dx*. Common among women, it affects five times the women

than men. Most cases diagnosed between the age of 29-40 years old

DID represents the existence of two or more personalities within a single individual. Only one of the personalities is evident at any given moment (host personality), and one of them is evident most of the time over the course of the disorder (alter personality).

Each personality is unique, responds to stress differently.

Those people are missed diagnosed with borderline, antisocial personalities or depression and schizophrenia.

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2. Depersonalization disorder See table 13-2, Pg., 410 for the DSM-IV Dx. criteria It represents the occurrence of persistent feelings

of unreality, detachment from oneself or one’s body, or the feeling that one is observing oneself from outside the body (e.g., feeling like one is in a dream).

This disorder is more common in women and young people (onset at adolescent).

It is common in all psychiatric disorders and is seldom to be seen as an isolated disorder.

It is estimated that half of the adults experience a transient episodes.

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3. Dissociative Amnesia See table 13-3, Pg., 411 for the DSM-IV Dx. criteria Criteria: one or more episodes of inability to recall

important personal info., usually of traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. Not related to substance abuse or medical conditions. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It is not common and temporary in nature. There are five types of recall disturbance: localized

(short period if time), selective, generalized, continuous, and systamized amnesia.

Onset of amnesia usually follows a psychological stress, termination is abrupt حاد and followed byمفاجئcomplete recovery. Recurrences are unusual.

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4. Dissociative Fugue

See table 13-4, Pg., 412 for the DSM-IV Dx. criteria

Is a sudden, unexpected travel away from home or customary place of daily activities, with inability to recall some or all of one’s past

They cannot recall personal identity and often assume a new identity.

They can provide details of their earlier life but cannot recall things after the fugue state.

Duration is usually brief. Recovery is rapid and complete. Recurrences are unusual.