Chapter 6: Somatic Symptom and Related Disorders and Dissociative Disorders

dissociative disorders

Disorder in which individuals feel detached from themselves or their surroundings and reality, experience, and identity may disintegrate.

somatic symptom disorder

Disorder involving extreme and long-lasting focus on multiple physical symptoms for which no medical cause is evident. Previously known as somatization disorder.

illness anxiety disorder

A somatic symptom disorder (previously known as somatoform disorder) involving severe anxiety over belief in having a disease process without any evident physical cause.

psychological factors affecting medical condition

A somatic symptom disorder with the presence of a diagnosed medical condition (such as asthma, diabetes, or severe pain) clearly caused by a known medical condition (such as cancer) that is adversely affected by one or more psychological or behavioral factors.

Functional Neurological Symptom Disorders (Conversion Disorders)

Physical malfunctioning, such as blindness or paralysis, suggesting neurological impairment but with no organic pathology to account for it.

malingering

Deliberate faking of a physical or psychological disorder motivated by gain.

factitious disorder

Nonexistent physical or psychological disorder deliberately faked for no apparent gain except possibly sympathy and attention.

Munchausen syndrome

A factitious disorder suggesting that the person is faking an illness, just as the original Baron von Münchhausen lied about his adventures. The symptoms are under voluntary control, and there is no obvious reason for producing the symptoms except, possibly, to assume the sick role and receive increased attention.

derealization

Situation in which the individual loses a sense of the reality of the external world.

depersonalization-derealization disorder

A dissociative disorder in which feelings of depersonalization are so severe they dominate the client’s life and prevent normal functioning.

dissociative amnesia

A dissociative disorder featuring the inability to recall personal information, usually of a stressful or traumatic nature.

generalized amnesia

Loss of memory of all personal information, including identity.

localized or selective amnesia

Memory loss limited to specific times and events, particularly traumatic events.

dissociative fugue

Type of dissociative amnesia featuring sudden, unexpected travel away from home, along with an inability to recall the past, sometimes with assumption of a new identity.

dissociative trance

Altered state of consciousness in which people firmly believe they are possessed by spirits; considered a disorder only where there is distress and dysfunction.

dissociative identity disorder (DID)

Formerly known as multiple personality disorder; a disorder in which as many as 100 personalities or fragments of personalities coexist within one body and mind.

alters

Shorthand term for alter egos, the different personalities or identities in dissociative identity disorder.

T/F: In factitious disorder, symptoms are deliberately induced.

True. Factitious disorder involves the deliberate induction of symptoms.

T/F: People with conversion disorder experience symptoms consistent with known neurological disorders.

False. Although people with conversion disorder do experience neurological symptoms, those symptoms are not consistent with known neurological disorders.

T/F: The physical symptoms associated with illness anxiety disorder are quite severe.

False. The physical symptoms in someone with this disorder are not notably severe.

T/F: If someone has somatic symptom disorder, they are deliberately faking their symptoms.

False. Malingering involves deliberate faking of symptoms.

T/F: Dissociation is invariably a sign of severe psychopathology.

False. Dissociation is a common experience.

T/F: People with dissociative amnesia typically never recover their memories.

False. People with dissociative amnesia do recover their memories, often suddenly.

T/F: Dissociative trances are not necessarily disorders.

True. Dissociative trances play a role in religious and mystical belief systems and are only pathological if they cause significant distress or impairment.

T/F: Dissociative identity disorder is often associated with prolonged, severe trauma.

True. Dissociative identity disorder is often associated with severe and prolonged childhood abuse.

Diagnose the somatic symptom and related disorders described here by choosing one of the following: illness anxiety disorder, somatic symptom disorder, conversion disorder.

Candice constantly worries about her health. She has been to numerous doctors for her concerns about cancer and other serious diseases—even though she doesn’t report current notable physical symptoms—only to be reassured of her well-being. Candice’s anxiousness is exacerbated by each small ailment (for example, mild headaches or stomach pains) that she considers to be indications of a major illness.

illness anxiety disorder

Diagnose the somatic symptom and related disorders described here by choosing one of the following: illness anxiety disorder, somatic symptom disorder, conversion disorder.

Deion arrived at Dr. Blake’s office with a folder crammed full of medical records, symptom documentation, and lists of prescribed treatments and drugs. Several doctors are monitoring him for his complaints, ranging from marked chest pain to difficulty swallowing. Deion recently lost his job for using too many sick days.

somatic symptom disorder

Diagnose the somatic symptom and related disorders described here by choosing one of the following: illness anxiety disorder, somatic symptom disorder, conversion disorder.

Sixteen-year-old Russell suddenly lost the use of his arms with no medical cause. The complete paralysis slowly improved to the point that he could slightly raise them. However, Russell cannot drive, pick up objects, or perform most tasks necessary for day-to-day life.

conversion disorder

Diagnose the dissociative disorders described here by choosing one of the following: dissociative fugue, depersonalization-derealization disorder, generalized amnesia, dissociative identity disorder, and localized amnesia.

Nylah was found wandering the streets, unable to recall any important personal information. After searching her purse and finding an address, doctors were able to contact her mother. They learned that Nylah had just been in a terrible accident and was the only survivor. Nylah could not remember her mother or any details of the accident. She was distressed.

generalized amnesia

Diagnose the dissociative disorders described here by choosing one of the following: dissociative fugue, depersonalization-derealization disorder, generalized amnesia, dissociative identity disorder, and localized amnesia.

Gabriel was brought to a clinic by his mother. She was concerned because at times his behavior was strange. His speech and his way of relating to people and situations would change dramatically, almost as if he were a different person. What bothered her and Gabriel most was that he could not recall anything he did during these periods.

dissociative identity disorder

Diagnose the dissociative disorders described here by choosing one of the following: dissociative fugue, depersonalization-derealization disorder, generalized amnesia, dissociative identity disorder, and localized amnesia.

Jhené complained about feeling out of control. She said she felt sometimes as if she were floating under the ceiling and just watching things happen to her. She also experienced tunnel vision and felt uninvolved in the things that went on in the room around her. This always caused her to panic and perspire.

depersonalization-derealization disorder

Diagnose the dissociative disorders described here by choosing one of the following: dissociative fugue, depersonalization-derealization disorder, generalized amnesia, dissociative identity disorder, and localized amnesia.

Rashadis 64 and recently arrived in town. He does not know where he is from or how he got here. His driver’s license proves his name, but he is unconvinced it is his. He is in good health and not taking any medication.

dissociative fugue

Diagnose the dissociative disorders described here by choosing one of the following: dissociative fugue, depersonalization-derealization disorder, generalized amnesia, dissociative identity disorder, and localized amnesia.

Rosita cannot remember what happened last weekend. On Monday, she was admitted to a hospital, suffering from cuts, bruises, and contusions. It also appeared that she had been sexually assaulted.

localized amnesia

Possible factors contributing to illness anxiety disorder

“ First, these disorders seem to develop in the context of a stressful life event, as do many disorders, including anxiety disorders. …

Second, people who develop these disorders tend to have had a disproportionate incidence of disease in their family when they were children. Thus, even if they did not develop somatic symptom disorders until adulthood, they carry strong memories of illness that could easily become the focus of anxiety.

Third, … Some people who come from families where illness is a major issue seem to have learned that an ill person often gets a lot of attention. The “benefits” of being sick might contribute to the development of the disorder in some people.”

Treatment for illness anxiety disorder

CBT and drugs that are useful for anxiety and depression

Possible factor/cause for Functional Neurological Symptom Disorder (Conversion Disorder)

Psychosocial stressors , traumatic event

dissociative experiences

“…when individuals feel detached from themselves or their surroundings, almost as if they are dreaming or living in slow motion…”

“During an episode of depersonalization, …”

your perception alters so that you temporarily lose the sense of your own reality, as if you were in a dream and you were watching yourself.

“…participants with ??? showed a distinct cognitive profile, reflecting some specific cognitive deficits on measures of attention, processing of information, short-term memory, and spatial reasoning.”

also “…showed greatly reduced emotional responding compared with other groups, reflecting a tendency to selectively inhibit emotional expression. ”

depersonalization disorder

Max and average number of alters

Max 100, avg 15

“host” in DID

patient’s identity

what is it called to go from one alter to another simultaneously

switch

Gender ratio for DID

women (9) : men (1)

possible cause/factors contributing to DID

trauma

After what age is DID unlikely to develop?

9

“According to the ??, people who are suggestible may be able to use dissociation as a defense against extreme trauma…”

autohypnotic model

A person experiencing a conversion symptom called globus hystericus would experience which of the following?

Feeling a lump in the throat that interferes with swallowing, eating, or talking

Raina was recently diagnosed with factitious disorder imposed on her after she was found to have been deliberately causing her 3-year-old daughter to vomit and experience other symptoms of gastrointestinal disorders. What personality disorder might Raina also have been diagnosed with?

Borderline

During an episode of which of the following may an individual feel that things seem to change shape or size or that people seem dead or mechanical?

Derealization

What is the hallmark of somatic symptoms and related disorders?

The individual becomes disproportionately distressed about their physical health.

Which of the following is considered most important if an individual with dissociative identity disorder is to experience improvement?

Confronting and gaining control over the trauma

An individual who finds themselves in an unfamiliar new town, with no idea of who they are or where they have been, is displaying symptoms most consistent with which of the following disorder?

Dissociative fugue

When feelings of dissociation are so severe and frightening that they dominate an individual's life and prevent normal functioning, clinicians may diagnose which disorder?

Depersonalization-derealization disorder

A person who reports a sudden loss of vision that is inconsistent with recognized conditions affecting vision is displaying symptoms consistent with which of the following disorders?

Conversion disorder

The symptoms and etiology of dissociative identity disorder are similar to the symptoms of which other disorder?

a. Post-traumatic stress disorder

b. Generalized anxiety disorder

c. Obsessive-compulsive disorder

d. Antisocial personality disorder

a. Post-traumatic stress disorder

Which of the following statements is true regarding sex differences in the diagnosis of somatic symptom disorder?

a. Females are more likely than males to be diagnosed.

b. Males and females are equally likely to be diagnosed.

c. Females are more likely than males to be diagnosed in adolescence or young adulthood, while males are more likely than females to be diagnosed in middle adulthood and old age.

d. Males are more likely than women to be diagnosed.

a. Females are more likely than males to be diagnosed.

An individual who is unable to remember witnessing a brutal physical attack although they can remember what they were doing before the attack and can remember talking to the police after the attack is displaying symptoms most consistent with which of the following disorders?

Dissociative amnesia

Vanessa just turned 40 and finds that she often has blanks in her memory—time periods she cannot recall at all. Friends tell her stories about her behavior during these periods, and they claim that she may use a different name or give her age as much younger than she actually is. They tell her that her behavior may also be much different, and that, while normally reserved and soft-spoken, she may be outspoken and aggressive or loud and sexually provocative. Vanessa is displaying symptoms most consistent with which of the following disorders?

Dissociative identity disorder

Individuals with which disorder often present with a history of severe, prolonged abuse that they suffered in childhood?

DID

Which type of treatment has been shown to be somewhat effective with both somatic symptom and illness anxiety disorder?

CBT

An important concern in the diagnosis and treatment of dissociative disorders is whether well-meaning therapists can somehow suggest to clients that abuse occurred and, in doing so, create false memories of abuse. Is it possible to create such false memories?

Yes, it is possible and the ways in which false memories occur are fairly well understood.

A principal strategy in treating conversion disorder is to do which of the following?

Identify and tend to the precipitating event

Maria is terrified of having cancer and is so preoccupied with the fear of having cancer, despite having no signs or symptoms of it, that her ability to function is impaired. Maria is displaying symptoms consistent with which of the following disorders?

Illness anxiety disorder

A person who fakes symptoms of a disorder by, for example, deliberately contaminating a urine test with blood, is displaying symptoms consistent with which of the following disorders?

Factitious disorder