Dissociative and Somatic Symptom-Related Disorders

Dissociative Amnesia

• inability to recall important personal information

• sx not explained by a substance or medical condiiton

• causes distress or impairment

Localized Amnesia

• loses memory of events within a limited period of time

• often a major trauma is a trigger

Selective Amnesia

loses memory for certain aspects of an event

Generalized Amnesia

can’t remember things leading up to the event

Continuous Amnesia

forgetting continues into the present

• very rare

Dissociative Fugue

• loss of memory + physical flight

• typical - travel a short distance, lasts hours or days

  • atypical - travel a long distance, establish a new identity, lasts months or years

Depersonalization/Derealization Disorder

• depersonalization: detachment from one’s mental processes or body

• derealization: experiences of unreality of surroundings or detachment from surroundings

• sx. are persistent or recurrent

• the sx don’t have another explanation

Stress and Dissociative Amnesia

• usually follows a stressor

• stressors are normally

  • perceived danger you can’t fight or escape

  • loss of important objects

  • homicidal/suicidal impulses

Dissociative Identity Disorder

• aka multiple personality disorder

• a disruption of identity characterized by two or more distinct personality states (alters)

• causes gaps in memory

Mutually amnesic relationship

none of the alters know about the others

mutually cognizant pattern

each alter knows the others, can be achieved with therapy

one-way amnesic relationship

1 knows about 4 but 4 only knows 2 and 3, etc.

Increasing prevalence of DID

1. increased public appearance

2. publication in the DSM-3

3. criteria for schizophrenia was revised

4. artifact (probably not true)

Post-traumatic model

• during abuse you essentially retreat into your mind and an alter is present for the abuse

• high support, esp if abuse was before 9 or the critical period of 4-6yo

Sociocognitive model

• alters appear in response to some influence, NOT that they are faking it

• influence: therapist, media, culture

• support: DID pts are more likely to be imaginative and people pleasing + is abuse really causal?

3 main goals of DID therapy

1. recover gaps in memory: hypnosis & diary

2. recognize the extent of the disorder: hypnosis & videos

3. integrating the subpersonalities into one (may result in physiological changes)

Reasons re-integration is hard

1. willingness to integrate

   • may feel as though they are killing the alters

2. efficacy of integration

   • integration doesn’t always last and may split again after a stress

Conversion Disorder

a sudden presence of neurological sx that can’t be explained by a biological cause

CD classic sx

• paralysis

• seizures

• paresthesia → tingling

• anesthesia → numb

• vision problems

CD other sx

• aphonia

• anosmia

• false pregnancy

Decreasing prevalence of CD

1. increased medical sophistication

2. greater psychological sophistication (can cope better now)

• supported as CD is more common in rural areas, lower SES, etc.

CD difficulty to diagnose

hard to tell a true neurological disorder and a CD apart as technology can’t always differentiate

• can look for neurological nonsense where the sx don’t align with how we know the human body works (ex. legs should atrophy when paralyzed)

CD psychodynamic

• something unconscious is occurring so they are consciously telling the truth (sx) but are unaware of the cause

• 3 steps to develop

  1. person experiences unacceptable unconscious conflict

  2. person represses conflict

  3. person converts conflict into physical symptoms

• 2 psychological purposes

  1. primary gain → CD sx block the person’s awareness of the internal conflict

  2. secondary gain → CD sx excuse the person from responsibilities and help the person attract sympathy and attention

CD behavioral

• sx bring the sufferer rewards this reinforces the sx

  • similar to secondary gain in psychodynamic

CD cognitive

• sx may be a form of communication

  • use sx to express distressing emotions

treatment - insight

• CD

• psychodynamic therapy → analyst helps the pt become conscious of whatever the unconscious feeling is and to process it

treatment - suggestion

• CD

• emotional support → coping strategies, hypnosis

• suggest the sx will go away

treatment - reinforcement

• CD

• therapist arranges for the removal of rewards for any sick behavior and increase rewards for healthy behavior

treatment - confrontation

• CD

• therapist tells the pt that their sx have no medical basis and to knock it off

face saving mechanism

• plant ideas in the pt that give them an outto avoid facing reality or responsibility

Illness anxiety disorder sx

Excessive worry about having a serious illness despite minimal or no symptoms, often leading to significant distress or impairment.

somatic symptom disorder sx

Physical symptoms that cause significant distress or impairment, often involving excessive thoughts, feelings, or behaviors related to those symptoms.