Somatoform & Dissociative Disorders

• All dissociative disorders are characterized by changes in a person's sense of identity, memory, or consciousness.

• Little objective data available on these disorders.

A. Dissociative Amnesia --
• Sudden inability to recall important personal information.
• Usually for a period of time surrounding a traumatic event.
• Sudden onset with sudden, complete recovery. Chance of recurrence very slight.

B. Dissociative Fugue --

• Amnestic and moves away from home and establishes new identity.
• Typically following some severe stress.
• Usually time limited with complete recovery.

C. Depersonalization Disorder --

• Experience of self is altered (no memory disturbance)

D. Dissociative Identity Disorder (formerly Multiple Personality Disorder)

• Presence of at least 2 different ego states (alters).
• Not Schizophrenia
• At least two, fully integrated, alters (ego states)
• Each alter is aware of gaps in memory (because not aware of other alter)
• Estimated at 1.3 percent of population (by large but flawed study)
• Increasingly diagnosed over last several decades
• high degree of interest may have increased diagnosis
• mistaken as schizophrenia may have resulted in underdiagnosis
• changes in diagnostic practice (DSM-III-R versus DSM-IV, memory dysfunction)
• Onset typically in Early Childhood (diagnosed in late adolescence)
 
E. Etiology
• Generally very limited or no data (mostly theory)
• By psychoanalytic theory: massive repression
• Hypnotizability, severe childhood trauma

 
F. Treatment --
• Reintegration of altered states,
• Hypnosis,
• Sodium Amytal

G. The Case for or Against Hypnosis and Other Dissociative Phenomena

• Many people believe that hypnosis provides a unique means of accessing memories
• Is hypnosis real? (hypnotic increases in pain tolerance)
• Does hypnosis uncover forgotten memories?
• The case of repressed memories
• Accuracy of memory
• Iatrogenic processes

• Complaint's of bodily symptoms that suggest a physical defect or dysfunction in the absence of a physiological basis for those symptoms.
• Not under voluntary control.

A. Body Dysmorphic Disorder

• Extreme preoccupation and concern with an imagined body defect (typically involving areas of the face).
• This concern causes significant distress and may interfere with social and occupational functioning.

B. Hypochondriasis

• Excessive and pervasive (6 months or more) concern about a nonexistent physical illness.
• Negative tests do not alleviate concern;
• Not delusional, however.

C. Somatization Disorder

• Chronic somatic complaints without physical cause;
• Typical onset in late adolescence;
• Common within families

E. Conversion Disorder

1. Historically "Hysteria" -- problems suggesting neurological damage

2. Main Types

a. Paralysis

b. Anethesias (loss or impairment of sensation)

c. Glove Paralysis

3. Onset in adolescence or early adulthood. More women than men.

4. May first appear with rapid onset under periods of stress.

5. Related Conditions

a. Malingering -- faking symptoms for some gain "la belle indifference" -- malingering versus conversion disorder

b. Factitious Disorders -- unlike malingering in that there is no apparent goal for symptom (other than to assume a patient role)

1. Mainly from a psychoanalytic perspective

- Breuer & Freud's explanation centered on experience that creates great emotional arousal in which the affect is not expressed and is cut off from conscious awareness.

2. Biology

a. Twin study (Torgerson, 1986)
-- no co-twin with same diagnosis

-- no MZ-DZ difference in concordance

b. Laboratory Findings
-- hysterical blindness (responding to items in visual field)
3. Behavioral Theory
a. Means to an end

b. Person acts as he or she thinks an afflicted person would

4. Sociocultural Factors
a. Decreasing incidence

b. Relaxing of attitudes toward sex and discussing "concerns"

c. More sophisticated medical and psychological knowledge

d. Society more tolerant of anxiety

1. Traditionally Psychoanalytic Therapy -- typically not effective

2. Behavioral Approaches (assertion, anxiety reduction, reduced secondary gain, coping)