Somatic Symptoms and Dissociative Disorders (start of final exam information)

Somatic symptom and related disorders

• Somatic symptom disorder

• Illness anxiety disorder

• Conversion disorder

• Factitious disorder

Change substantially from DSM - IV to DSM - 5

Soma = body

Somatic Symptom Disorder

• Chronically bodily sx that are distressing + dysfunctional thoughts, feelings, and/or behaviors

• Includes DSM - IV’s hypochondriasis, somatization disorder, and pain disorder

• No assumptions about cause

DSM tries to move away from the idea of misdiagnosing and no assumption of the cause.

Somatic Symptom Disorder: Causes

Psychodynamic

• Develops as a defense mechanism of unresolved conflicts

Somatic Symptom Disorder: Causes

• Cognitive-Behavioral

• - Disorder of perception/cognition or attentional bias?

• - Past experience with illness

  • - observed in self, others or media

  • “ if you don’t go to the doctor as soon as you notice something unusual, then it will be too late”

Risk Factors of Somatic Symptom Disorder

• Negative affect

• Absorption

  • some people might be able to absorb In an experience and be so focused and no one is able to distract them

• Alexithymia

  • - Emotional blindness; struggle to identify what is going on internally

Reinforcements in Somatic Symptom disorders

• Special attention and comforts but, NOT malingering

  • getting more attention and support but not intentional; feel better when they go to the doctors and and reinforces that going to the doctors is good and will go back again if they are in pain again. NOT faking the symptoms.

Somatic Symptom Disorder: Treatment

• CBT

  • Assess beliefs in illness and moidft misinterpretation of boduly sensations

  • Induce symptoms, learn selective perception can play a role

  • Response prevention (checking body, doctor visits)

• Med management

  • -Regular visits with one doctor, physical exams, and unnecessary exams

    - Need to be with CBT

Illness Anxiety Disorder

• High anxiety about having or developing in serious illness

• New to DSM - 5

Conversion Disorder

• Presence of neurological sx in absence if neurological diagnosis'

• 4 categories

  • Sensory, motor, seizure, mix

  • “La belle indifference”

    • - some people would feel indifferent when they could not feel their leg or become blind

Conversion Disorder: Causes

• Results if stress or internal conflict

• - Psychodynamic

  • repressed sexual energy

  • primary and secondary gain

• - Learning theory

  • Physical sx provide negative and positive reinforcement

• - Sociocultural

  • More socially acceptable to have phsysical disorder than anxiety

Conversion Disorder: Treatment

• Remove reinforcement of sx and provide reinforcement of wanted behaviors

• Hypnosis?

• More research is needed

Factitious Disorder

• Deliberately and consciously feign disability of illness, intentionally prodices sx to maintain benefits if sick role

• No theoretical model of why it develops

• Dangerous variant

  • Factitious disorder imposed on another

Dissociative Disorders

• Depersonalization/Derealization Disorder

• Dissociative amnesia

• Dissociative identity Disorder

Depersonalization/Derealization Disorder

• Derealization

  • sense of reality if outside world is temporarily lost

• Depersonalization

  • sense of one’s own self and one’s own reality is temporarily lost

• Different than psychosis

• Little research

Dissociative Amnesia

• Limited retrograde amnesia, often follows stress

• Subtype: dissociate fugue

  • might forget entirely who they are and live a brand new life move somewhere else and go by different identity

• Little research

Dissociative Identity Disorder

• Disruption of identity characterized by 2 or more distinct identities as well as recurrent episodes of amnesia as reported by self or others

• Name changed from earlier DSMs

Dissociative identity disorder: Controversy

• Is DID real or fake?

• If DID is not faked, how does it develop: traumatic theory or sociocognitive theory?

Are recovered memories if abuse in DID real or fake?

If abused has occurred, does It play a causal role?

Dissociative Disorders: Treatment

• No clearly effective treatments

• No systematic, controlled research exists

• YET, some psychodynamic approach to recall and process trauma?