8. somatic symptom and dissociative disorders

relationship between psychological and biological symptoms

• heavily intertwined

  • many physical symptoms are often a result of psychological symptoms

what is the challenge with somatic symptom disorder?

• there is a possibility that the client actually does have a real physical disorder

• doctors have not found the biological cause of somatic symptom disorder

COVID example — somatic symptom disorder

• during COVID, somatic symptoms went up

  • when individual’s had a sore throat, they became highly aware and preoccupied that they might have COVID

somatic symptom disorder

• an individual feels one or more physical symptoms + places high awareness or preoccupation on those symptoms, leading to high distress and anxiety.

  • pain in body, nausea (GI), dizziness (neurological), heart palpitations, fatigue, weakness, etc.

• place a lot of time and energy on these symptoms + seeking medical care for them

when does SSD develop?

• childhood, adolescence, or adulthood

are men or women more likely to experience SDD?

• women (10:1 ratio)

illness anxiety disorder

• individuals experience absent or mild physical symptoms

• experience large preoccupation with having or eventually obtaining a serious illness

  • e.g. an individual spots a harmless skin mark. they now are always preoccupied with the idea that they might have cancer.

of those with somatic symptom disorder and illness anxiety disorder, who are more likely to report more severe anxiety and depression?

• somatic symptom disorder

health concerns + multiple somatic symptoms are associated with:

• disability

• poor sleep

• low income

• substance and drug abuse

• obesity

• hospitalization

  • these tend to create a cycle

client buy in

• an issue in recommending those with SSD and IAD to seek therapy is that this may suggest that their physical symptoms are not real

  • for therapy to work, client must buy in.

conversion disorder

• an individual experiences neurological symptoms that are inconsistent with medical findings

  • note: the individual does not fake their symptoms— they actually do experience symptoms of paralysis, tremors, blindness, etc.

  • e.g. Sarah suddenly discovers that she cannot move her legs. She goes to the doctor, but the doctor’s findings do not match Sarah’s symptoms of paralysis.

Why is treatment difficult for those with conversion disorder?

• they tend to believe that treating their psychological symptoms will not affect their physical symptoms

which two treatment approaches are used in treating conversion disorder?

• psychoanalytic therapy

• CBT

Factitious disorder / Munchausen’s syndrome

• an individual deliberately fabricates a (psychological or physical) illness in order to receive medical attention

  • e.g. contaminating a medical sample

factitious disorder imposed on another

• an individual claims that another individual (or animal) has a medical illness

  • aim to receive medical attention

prefrontal cortex + what happens during dissociation

• the “control centre” of the brain

  • during dissociation, it has minimized activation— “autopilot”

amygdala + what happens during dissociation

• emotional regulation; increased activation during threat

  • during dissociation, it decreases in activation, even when there is a threat

hippocampus + what happens during dissociation

• responsible for memory; converting short term memory into long term memory

  • during dissociation, individuals feel they have a “foggy” memory

default mode network

• “resting state”

• we are not concentrating on a demanding task; however, we are still passively processing things.

everyday dissociation vs dissociative disorder

• everyday: driving, reading a good book, scrolling social media → temporary easily able to “snap out of it”

• disordered: occurs frequently, uncontrollable, and occurs unconsciously

dissociative disorders are common among individuals who have been exposed to _____?

• trauma

historical background of dissociative disorders

• 19th C → peaked interest in dissociation (James, Jung, + Freud)

• After 1910’s however, interest decreased

  • rise in behaviourism

  • rise in biological theories of psychology

Hilgard hidden observer phenomenon

• active mode to consciousness

• passive mode to consciousness (“autopilot”)

Dissociative identity disorder (DID)

• identity disruption; characterized by the presence of 2 or more distinct identities or “alters”

• memory gaps are common

• differences in psychological, behavioural, and physiological characteristics

Alters

• 2 distinct identies

• there tends to be a “host” or a dominant side

• the alters are unaware of the other alters

• common alters: child, persecutor, suicidal, opposite gender

  • most common: child

what circumstance is “switching” most likely to occur

• during periods of high stress and anxiety

DID tends to be diagnosed following

• traumatic event

depersonalization vs derealization

• depersonalization: detached from body

• derealization: detached from surroundings

self injurious behaviour in DID

• cuts, burns, attempted suicide, drug overdoses are common

prevalence of DID

• very uncommon

  • 5% inpatient, 2-3% outpatient, 1% general population

  • majority are adult females

issues in diagnosing DID

• DID has been recognized in the DSM since 1980; however, many individuals with DID are often misdiagnosed and obtain inefficient treatment

• many researchers and clinicians question the actual existence of this disorder