Module 14: Somatic Symptoms & Dissociative Disorders

somatic symptom disorders

•characterized by physical symptoms suggesting medical disease but without demonstrable organic pathology or a known pathophysiological mechanism to account for them.

•Related disorders: illness anxiety, conversion disorder, factitious disorder, and psychological disorders affecting other medical conditions

•have been identified as hysterical neuroses and were thought to occur in response to repressed severe anxiety.

dissociative disorders

•defined by a disruption in the usually integrated functions of consciousness, memory, and identity.

•memory breakdown, conscious personality (no participation)

•Depersonalization-derealization, dissociative amnesia, dissociative identity disorder (DID)

•Freud: type of repression, an active defense mechanism used to remove threatening or unacceptable mental contents from conscious awareness.

•Women more than men & in adolescents and young adults

illness anxiety disorder

excessive health anxiety with little or no symptoms

•Unrealistic or inaccurate interpretation of symptoms/sensations

•Leads to preoccupation and fear of disease

•May become disabling

•Equally common among men and women

•Most commonly occurs in early adulthood

•Leads to drug use (to cure all the things wrong or

escape

•OCD and depression may be present

•Depression/Anxiety usually present

conversion disorder

unexplained neurological symptoms without medical cause

•A loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism.

•The most obvious and "classic" conversion symptoms are those that suggest neurological disease.

•Some instances of conversion disorder may be precipitated by psychological stress.

•(Example): Client experiences paralysis of legs after witnessing a car accident. Tests are all negative, but still cannot walk

•Other examples: seizure, tremor, blindness, difficulty speaking

In other words: brain has a psychological crisis and converts it into physical problem!

factitious disorder

faking symptoms for attention or care

•Conscious, intentional feigning of physical and/or psychological symptoms (falsifies physical or psychological symptoms or induces injury to self or others to receive attention

•Individual pretends to be ill to receive emotional care and support commonly associated with the role of "patient."

•The disorder may also be identified as Munchausen syndrome.

•The disorder may be imposed on another person under the care of the perpetrator (formerly called Factitious Disorder by Proxy).

dissociative amnesia

partial or total loss of memory which may be temporary or permanent from emotional/physical trauma

localized amnesia

•unable to recall all things associated with stressful event

selective amnesia

•can recall only certain incidents associated with the event for a specific period afterwards

generalized amnesia

has amnesia for both identity and total life history

dissociative fugue

•sudden travel away from customary place and unable to recall where they came from or where they live or past life. May assume a new identity (rare)

dissociative identity disorder (DID) (multiple personality disorder: former namer)

•Two or more personalities in a single individual

•Alter identities. One is evident at any moment while one is always dominant

•Each personality is unique with complex memories and behaviors

•Transition between may be sudden or gradual and may be dramatic.

•Controversial disorder (1976 move Sybil) 16 personalities

•Identity is fragmented and most with childhood abuse and may have amnesia of the event when another personality is manifested.

•May have "lost time"

•May be accused of lying as they deny events

depersonalization derealization disorder

•May sense themselves outside their own body (soldier recalling experience in combat and saw himself observing himself from a distance and wonders what he would do if he were in that situation.

•May occur in schizophrenia, depression, anxiety, and other neurocognitive disorders (is more frequent especially when transient) Third most reported psychiatric symptom after depression and anxiety.

•Brief episodes of depersonalization symptoms appear to be common in young adults, particularly in times of severe stress, sleep depravation, travel to unfamiliar places, or when under the influence of substances.

depersonalization

disturbance in the perception of oneself. detached or being outside observer (may have distorted time, emotional numbing)

derealization

alteration in the perception of the external environment. unreal dreamlike, foggy, lifeless or visually distorted.

psychodynamic theory: somatic symptom d/o

•Illness associated with anxiety disorder is an ego defense mechanism. Physical complaints are the expression of low self-esteem and feelings of worthlessness.

•Conversion disorder may represent emotions associated with a traumatic event that are too unacceptable to express and so are acceptably "converted" into physical symptoms.

family dynamics: somatic symptom d/o

•In dysfunctional families, when a child becomes ill, focus shifts from the open conflict to the child's illness and leaves unresolved underlying issues that the family is unable to confront openly.

•Somatization brings some stability to the family and positive reinforcement to the child (called tertiary gain).

learning theory: somatic symptom d/o

•Somatic complaints are often reinforced when the sick person learns that they

•May avoid stressful obligations or be excused from troublesome duties (primary gain)

•May become the prominent focus of attention because of the illness (secondary gain)

•May relieve conflict within the family because concern is shifted to the ill person and away from the real issue (tertiary gain)

•Past experience with serious or life-threatening physical illness, either personal or that of close relatives, can predispose the person to illness anxiety disorder.

psychodynamic theory: dissociative d/o

•Freud described dissociation as repression of distressing mental contents from conscious awareness.

•Current psychodynamic explanations reflect Freud's concepts that dissociative behaviors are a defense against unresolved painful issues.

psychological trauma: dissociative d/o

•Dissociative identity disorder (DID) as a set of traumatic experiences that overwhelm the individual's capacity to cope by any means other than dissociation.

•Experiences usually take the form of severe physical, sexual, or psychological abuse by a significant other in the child's life.

•DID is thought to serve as a survival strategy for the child in this traumatic environment.