Somatic Disorder and Dissociative Disorders

Somatoform Assesment 

MMPI or MSPQ

• There seems to be a fullness in my head

• I have numbness in my skin

• I have a lump in my throat often

• I do not notice my ears ringing (reversed)

• Desire to pass water

• Mouth becoming dry

• Butterflies in stomach

• Muscles twitching or jumping

• Pain vs. Somatoform

  • Pain → psychical suffering 

  • Somatoform → experience of physical sensations that are disproportionate to, or unexplained by, a physical cause

• Somatoform w/ pain

  • Patient w/ fibromyalgia whose symptoms aren’t responding to/managed by typical intervention

  • Disproportionate & persistent thoughts about the seriousness of pain symptoms

  • Disproportionately excessive time & energy devoted to pain symptoms 

Functional Neurological Symptom Disorder ( Con version Disorder) 

a type of somatic disorder that is sometimes applied to patients who present neurological symptoms, such as numbness, blindness, paralysis, or fits, which are not consistent with a well-established organic cause, cause significant distress, and can be traced back to a psychological trigger. 

• DSM-V criteria removed the requirements for a psychological stressor to be present and for feigning to be disproved.

• Functional neurological symptom disorder begins with some stressor, trauma, or psychological distress. 

• Common symptoms include:

  • blindness

  • partial or total paralysis

  • inability to speak

  • deafness

  • numbness

  • difficulty swallowing

  • incontinence

  • balance problems

  • seizures

  • tremors

  • difficulty walking.

Factitious Disorder and FD Imposed on Another

Factitious disorder: a condition in which a person, without a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient's role. 

• People with a factitious disorder may produce symptoms by contaminating urine samples, taking hallucinogens, injecting fecal material to produce sickness, and similar behavior.

Factitious disorder imposed on self (also called Munchausen syndrome) was for some time the umbrella term for all such disorders. 

Factitious disorder imposed on another (also called Munchausen syndrome by proxy, Munchausen by proxy, or factitious disorder by proxy) is a condition in which a person deliberately produces, feigns, or exaggerates the symptoms of someone in their care. 

The six types of DSM- 5 Dissociative Disorder 

1. Dissociative Identity Disorder

2. Dissociative Amnesia without dissociative fugue

3. Dissociative Amnesia with dissociative fugue

4. Depersonalization/Derealization Disorder

5. Other Specified Dissociative Disorder

6. Unspecified Dissociative Disorder

Characteristics of Dissociative Disorder

Dissociative disorders are characterized by an individual becoming split off, or dissociated, from their core sense of self. Memory and identity become disturbed; these disturbances have a psychological rather than physical cause.

The five core components of dissociative disorders 

Amnesia, Depersonalization, Derealization, Identity Confusion, Identity Alteration 

Depersonalization: a feeling of detachment or estrangement from one’s self; feeling as if you are an onlooker of your own body

• Qualitative study, conducted by by Ciaunica et al., 2023, reveals lived experienced of individuals struggling with depersonalization, and found three core themes: 

• Individuals with high levels of depersonalization reported:

• Detachment from the world and one’s self – “I just feel like I’m watching myself over a distance and I don’t know who I am”

• Embodiment, denoting unusual or changing experiences of the body – “whenever I feel intimidated, I tend to lose control of my body and can’t move properly”

• Identity changes, a lack of congruence between one’s felt self and one’s words and action — “My thinking self and my speaking self feel different”

Derealization: an alteration in the perception of one’s surroundings so that a sense of reality of the external world is lost – the world you are experiencing doesn’t seem real 

• The sense that one is in a “fog”

• A see-through wall or veil is separating you from your surroundings

• The world appears lifeless, muted, or fake

• Objects or people look “wrong” – blurry,  unnaturally sharp, too big, or too small

• Sounds are distorted, too loud, or too soft

• Time seems to speed up or stand still

Dissociative amnesia: when dissociation causes memory loss

• Brief overview on how memory works: 

  • Encoding: the receival and interpretation of information

    • the act of getting info into our memory from either automatic and effortful processing

  • Storage: Maintaining information over time

    • the retention of encoded information

  • Retrieval: the ability to access information when you need it

    • act of getting information out of storage and into awareness through recall and recognition

Two types of dissociative amnesia: 

1. Retrograde: When dissociative amnesia affects finding old memories. 

2. Anterograde: When dissociative amnesia blocks the formation or storage of new memories. 

Identity confusion: thoughts and feelings of uncertainty and conflict a person has related to their identity 

• “I have a feeling that I am made up of two or more people”

• “It happens that I have the feeling that my mind is split up”

• “At times it seems as if someone else inside of me decides what I do”

• “It happens that I have the feeling that I am somebody else” 

Identity alteration: Manifestations of alters (or alternative identities) containing and expressing differing opinions, perceptions, and senses of self. 

• Individuals may notice a shift in their sense of how old they are, their gender identity, their preferences, skills, and memories. 

  • Even vocal pitch, body language, and physical reactivity to stress can change

A dissociative fugue is a temporary state where a person has memory loss (amnesia) and ends up in an unexpected place. People with this symptom can't remember who they are or details about their past. Other names for this include a "fugue” or a “fugue state".