8 - Somatic Symptom & Dissociative Disorders

Somatic Symptom Disorders

• Involve physical symptoms and complaints suggesting presence of medical condition

• Contain no evidence of physical pathology

Somatic Symptom Disorders

These are mental health conditions where a person has real physical symptoms (like pain, weakness, or sickness), but the main problem comes from stress, anxiety, or the mind, not a clear medical disease.

➡ The symptoms are not fake — the person truly feels them.

• Hypochondriasis

• Somatization disorder

• Pain disorder

• Conversion disorder

Somatic Symptom Disorder Patterns:

Hypochondriasis

Being extremely afraid of being sick even when doctors say you’re healthy.

• A person always thinks they have cancer because of a small headache.

Somatization Disorder

Having many physical complaints in different body parts for many years, with no clear medical cause.

• Stomach pain, headache, dizziness, fatigue — all happening repeatedly.

Pain Disorder

Feeling serious pain

• that is mainly caused or made worse by stress or emotions.

• A person feels strong back pain when stressed, even though X-rays are normal.

Conversion Disorder

When stress turns into physical problems with movement or senses.

• Suddenly can’t walk

• Becomes blind or mute

• Arm stops moving

• But doctors find no physical damage.

Hypochondriasis

Preoccupation with fears of having or getting serious disease

• People with _________ are preoccupied with fears of getting a serious disease or the idea that they already have one

Hypochondriasis

•Not a disorder in DSM-5, and about 75% of people with __________ will meet criteria for somatic symptom disorder

CBT

Effective treatment for Hypochondriasis:

Illness Anxiety Disorder

Experience high anxiety about having or developing a serious illness.

• New to DSM-5

Illness Anxiety Disorder

25% of people who met the criteria for hypochondriasis will be diagnosed with this new disorder.

Somatization disorder

Characterized by many different complaints of physical ailments

Somatization disorder characteristics

• Lasting several years

• Beginning before age 30

• Not adequately explained by independent findings of physical illness or injury

• Leading to medical treatment or to significant life impairment

• Difficult to treat

• Combination of medical management & CBT

Somatization Disorder Treatment:

Pain Disorder

Experience of persistent and severe pain in one or more areas of body

• Not intentionally produced or feigned

• Cognitive-behavioral techniques

• Used in treatment of both subtypes of pain disorder

Pain Disorder Treatment:

Conversion Disorder

Symptoms or deficits affecting sensory or voluntary motor functions

• Leads one to think patient has medical condition

• This means the person may experience: (Can’t move an arm or leg, Can’t speak, Can’t see or hear properly)

• Even though their body is actually okay.

Functional Neurological Symptom Disorder (Conversion Disorder)

• A. One or more symptoms of altered voluntary motor or sensory function.

• B. Clinical findings provide evidence of incompatibility between the symptom andrecognized neurological or medical conditions.

• C. The symptom or deficit is not better explained by another medical or mental disorder.

Freud

______ believed that the symptoms were an expression of repressed sexual energy

• Continued escape or avoidance of a stressful situation.

• Attention and financial compensation.

Gains in Conversion Disorder:

• Primary:

• Secondary:

• Sensory symptoms or deficits

• Motor symptoms or deficits

• Seizures

• Mixed presentation from first three categories

Categories of symptoms in Conversion Disorder: (4)

True

It is crucial that patients receive a thorough medical and neurological examination to rule out organic illness. True or false?

• Behavioral therapy

• CBT

• Hypnosis

Conversion Disorder TREATMENT:

Malingering

Motivated by external incentives.

• The person fakes or exaggerates illness

• Goal: To get something external (money, time off, avoiding responsibility)

• “Faking sickness to gain something you want.”

Factitious disorder

Motivated by benefits of "sick role"

• The person fakes or causes illness

• To get attention or sympathy from being a patient (“sick role”)

• “Faking sickness to be cared for or noticed.”

Dissociative Disorders

are conditions involving disruptions in normally integrated functions:

• Consciousness

• Memory

• Identity

• Perception

• Depersonalization/Derealization Disorder

• Dissociative Amnesia and Dissociative Fugue

• Dissociative Identity Disorder

Types of Dissociative Disorders: (3)

Derealization

one's sense of the reality of the outside world is temporarily lost.

Depersonalization

one's sense of one's self and reality is temporarily lost.

Dissociative Amnesia

involves a failure to recall previously stored personal information when that failure cannot be accounted for by ordinary forgetting.

• The person cannot remember important personal information.

• “Can’t remember personal stuff for no normal reason.”

Dissociative Fugue

(a subtype of dissociative amnesia)

• the person also departs from home surroundings.

Dissociative Fugue

A rare subtype where the amnesia is accompanied by purposeful travel or bewildered wandering away from home

• or one's usual surroundings, often involving confusion about identity.

Dissociative Identity Disorder (DID)

The person has two or more distinct identities or personality states

• (different ways of thinking, feeling, or behaving)

• Not separate personalities, just different identity states.

Dissociative Identity Disorder (DID)

Used to be called: Multiple Personality Disorder

• Is the disorder real or faked?

• If the disorder is not faked, how does it develop?

• Are recovered memories of abuse in the disorder real or false?

• If abuse has occurred, did it play a causal role?

Controversies about DID:

Amok

is a dissociative rage

• seen in some cultures such as Malaysia, Laos, the Philippines, Papua New Guinea, and others.

• Hypnosis

• Integration of separate alters

Treatments for DID: