somatic symptom and dissociative disorders

what are dissociative disorders?

• disrupted integration of memory, consciousness, identity, or perception

• often follow trauma

what are somatic symptom disorders?

• physical symptoms or health worries out of proportion — or without — a medical cause

• symptoms are not faked

what were dissociative disorders and somatic symptom disorders once called?

hysteria, blamed on sexual desire

what is the progression from everyday dissociation into a disorder?

everyday → under strain → occasional episodes → disorder

what are characteristics of being under strain?

sleep loss, intense emotion, substances

what are characteristics of occasional dissociative episodes?

depersonalization, experienced by 50% of people

what are characteristics of dissociative disorders?

persistent, distressing, impairing; experienced by 1-2% of people

who is charcot?

used hypnosis to induce and treat hysteria

janet vs freud theories

dissociation is an abnormal process vs dissociation is a normal defense

what does science support today regarding dissociation?

• there is no place called the unconscious or subconscious

• unconscious processes are real, such as implicit memories

• their importance and casual status are still debated

what is hypnosis?

• loss of control in response to a hypnotist’s suggestions

• central to both the trauma and the role-play views of DID

what is depersonalization-derealization disorder?

persistent or recurrent feelings of detachment with intact reality testing

what is depersonalization?

• detachment from yourself

• watching your own actions from outside; your body or thoughts feel unreal

what is derealization?

• detachment from the world

• surroundings feel unreal, dreamlike, foggy, or lifeless

what is the epidemiology of depersonalization-derealization disorder?

• about 50% of people have had an episode, but only 1-2% meet criteria

• onset in adolescence, often chronic

• linked to trauma history, anxiety, and depression

what is dissociative amnesia and fugue?

sudden loss of personal memories, usually after trauma or stress

what is localized/selective dissociative amnesia?

• a specific event or period is lost

• most common, usually the trauma itself

what is generalized dissociative amnesia?

• one’s whole life history is lost

• rare, may include one’s own identity

what is dissociative amnesia with fugue?

• unplanned travel away from home

• confused about — or adopts a new — identity

what are key features of dissociative amnesia?

• not due to substances, head injury, or a neurocognitive disorder

• rapid onset; most recover, often without treatment

• fugue is now a specifier, not a separate disorder

what is dissociative identity disorder?

• formerly multiple personality disorder

• two or more distinct personality states that take control over behavior

• in some cultures, described as possession

• recurrent gaps in memory

how does DID present?

• the “host” appears more often, carrying the person’s given name

• sudden, sometimes, dramatic switching/shifting between alters

how many possible alters are there in DID?

2 to 100+ (average about 15)

what are the two famous cases of DID?

the three faces of eve and sybil

what is the case of the three faces of eve?

• young mother treated for headaches and blackouts

• under hypnosis, “Eve Black” and “Jane” emerged

• in real life, Chris Sizemore later reported 22 personalities

what is the case of sybil?

• shirley mason had 16 personalities, linked to severe childhood abuse

• she wrote to her therapist that she had made up the personalities — the letter was treated as resistance

what affect did the case of sybil have on DID diagnoses?

diagnoses and the average number of alters rose sharply

what are reasons for doubt for surge of DID diagnoses?

• diagnoses surged after sybil

• numbers of alters grew with the publicity

• rarely diagnoses outside the U.S. and Canada

what are high correlations in who receives a DID diagnosis?

• female

• mid 30s

• past suicide attempt

• amnesia between personalities

• history of child physical/sexual abuse

what are the two explanations of DID?

trauma model and sociocognitive (iatrogenic) model

what is the trauma model of DID?

• severe, chronic childhood abuse → dissociation to escape → memories split by state → separate identity states form

• most trauma survivors never develop a dissociative disorder

what is the sociocognitive (iatrogenic) model of DID?

• suggestion: therapist expectations, hypnosis, media → patient enacts the role — comes to believe it → attention and validation reinforce alters → diagnosis; more alters

• explains the surge and clustering in North American concentration

what is the case of the Hillside Strangler (Kenneth Bianchi)?

• under hypnosis, an alter “Steve” claimed the killings

• experts disagreed; most concluded he was faking

what are Spanos’s experiments?

• students role played Bianchi’s hypnotic interview

• many produced a second personality on cue

• healthy actors can also mimic “physiological” differences between alters

what is the traditional approach in treating dissociative disorders?

• uncover and relive past trauma

• hypnosis and abreaction (emotional reliving)

• goal: integrate personalities into one

what is the evidence behind treatment of DID?

• no systematic research supports any treatment

• dropout in studies is high

• meds ease distress but do not cure

what are common factors of somatic symptom and related disorders?

• physical symptoms/health fears causing distress out of proportion to any medical problem

• patients see physicians, not mental health professionals

what is functional neurological disorder?

motor or sensory loss that makes no neurological sense

what is factitious disorder?

symptoms produced on purpose to take the sick role

what are symptoms of functional neurological symptom disorder?

paralysis, tremor, seizures, abnormal gait, “blindness”, numbness, and loss of hearing

what are the key diagnostic features for functional neurological symptom disorder?

• symptoms are incompatible with known neurology

• oddly unconcerned

what is factitious disorder?

• Munchausen syndome

• rare, repetitive pattern of factitious illness

what are the biological causes of somatic symptom disorders?

• diagnosed only after medical causes are ruled out

• real illness can be missed

what are the psychological causes of somatic symptom disorders?

• primary gain: symptom expresses an unconscious conflict

• secondary gain: attention, relief from duties

what are the cognitive causes of somatic symptom disorders?

• amplifying normal body sensations

• misattributing them to illness

• alexithymia: difficulty recognizing and naming emotions

what are social causes of somatic symptom disorders?

culture and the acceptability of emotional complaints