Psyc363 Week 5: Dissociative and Somatic Symptom Disorders

The course material for PSYC363 Psychopathology, presented by Dr Hamish Love (PhD) at the University of New England, covers two primary learning outcomes for this module: - Outcome 5.1: Summarise the symptoms, aetiological models, and available treatments for Dissociative Disorders. - Outcome 5.2: Summarise the symptoms, aetiology, and available treatments for Somatic Symptom and Related Disorders.
The lecture framework employs the 5 Ps of Case Conceptualisation to assess these disorders: - Presenting Problem (What?): Identifying the primary symptoms and current issues. - Predisposing factors (Who? / Why?): Factors that make the individual more vulnerable to the disorder before it starts. - Precipitating factors (When? / Why?): The triggers or specific events that caused the onset of symptoms. - Perpetuating factors (How do we treat it?): Factors that keep the problem going. - Protective/Positive factors (How do we treat it?): Strengths or environmental supports that aid in recovery.

Definition: According to the Oxford Dictionary, dissociation is disconnecting or separating, or the state of being disconnected.
Dissociation as a Normal Experience: - It can be a non-pathological experience, such as being ‘off your face’ or certain religious experiences. - It serves as a normal response to stress and trauma. It is a mechanism to handle frightening experiences where an individual simply does not want to be present, achieved by changing focus or ‘pulling oneself together’.
Psychological Disorders as Continua: - Dissociation is viewed as a functional purpose existing on a spectrum. - In terms of probability density and standard normal distribution, pathological states represent the extremes of these functional purposes.
The Dissociation Spectrum (from Mild to Severe): - 'Normal' dissociation: Checking out or zoning out. - Everyday dissociation: Common instances of mental wandering. - Depersonalization & derealization: Feeling detached from self or surroundings. - PTSD/Trauma/Dissociative Amnesia: Memory loss related to trauma. - Dissociative Identity Disorder: The most complex end of the spectrum.

Dissociative Experiences Scale – II (DES-II): A tool used to measure the percentage of time a person experiences various dissociative states.
Sample Questions from DES-II: - Suddenly realizing they don’t remember part or all of a trip taken by car, bus, or subway. - Realizing they did not hear part or all of what someone just said while listening to them. - Finding themselves in a place with no idea how they got there.
Scoring: Measured on a scale from $0\%$ (Never) to $100\%$ (Always).
Average DES Scores in Research: - General Adult Population: $5.4$ - Anxiety Disorders: $7.0$ - Affective Disorders: $9.35$ - Eating Disorders: $15.8$ - Late Adolescence: $16.6$ - Schizophrenia: $15.4$ - Borderline Personality Disorder: $19.2$ - Posttraumatic Stress Disorder (PTSD): $31$ - Dissociative Disorder Not Otherwise Specified (DDNOS): $36$ - Dissociative Identity Disorder (DID) / Multiple Personality Disorder (MPD): $48$ to $49$
Clinical Diagnostic Tools: - Dissociative Disorders Interview Schedule. - Structured Clinical Interview for DSM-V (SCID-V). - A dissociative disorder is likely present if a person reports dissociative experiences $30\%$ of the time or more on the DES.

What? (Presenting Problem): - It involves a disconcerting and disruptive sense of detachment from one's self or one's surroundings. - Depersonalization: Defined by a sense of being detached from one’s self. - Derealization: Defined by a sense of detachment from surroundings, where things seem unreal.
Why? When? Who? (Predisposing + Precipitating Factors): - Symptoms are usually triggered by stress.
How to Treat? (Perpetuating + Protective Factors): - MBCBT: Mindfulness-Based Cognitive Behavioral Therapy. - DBT: Dialectical Behavior Therapy. - Somatic: Body-focused therapies. - EMDR: Eye Movement Desensitization and Reprocessing.

What? (Presenting Problem): - The inability to recall important personal information, usually concerning a traumatic experience. - Information is not permanently lost but is inaccessible during the episode. - Episodes can last from minutes to several decades. - Fugue: A more severe subtype involving more extensive memory loss. - Differential Diagnosis: It is distinguished from dementia fairly easily.
Four Types of Dissociative Amnesia: 1. Localized: Failure to remember an event or a specific period of time (the most common type). 2. Selective (Patchy): Failure to remember specific aspects of an event or some events within a timeframe but not others. 3. Continuous (Anterograde): The inability to form new memories as events occur. 4. Generalized: Complete loss of identity and life history (rare), covering a long period (months or years).
Treatment Modalities: - MBCBT, DBT, Somatic, EMDR, and a Trauma-Informed approach.

OSDD is a category for dissociative presentations that do not meet the full criteria for DID, amnesia, or depersonalization/derealization disorder.
Four Types of OSDD: - OSDD-1: Sub-threshold Dissociative Identity Disorder (DID). - OSDD-2: Coercive persuasion resulting in a loss of identity. - OSDD-3: Acute dissociation resulting from stressful events. - OSDD-4: Dissociative trance.
Treatment: MBCBT, DBT, Somatic therapy, EMDR, and Trauma-Informed care.

What? (Presenting Problem): - Formerly known as Multiple Personality Disorder. - Requires at least two separate personalities or "alters." - Alters: Different modes of being, thinking, feeling, and acting that exist independently and emerge at different times. - Usually features one primary personality, which is typically the one seeking treatment.
Aetiology and Demographics: - Prevalence: Research indicates between $1\%$ and $3\%$ of the general population meet diagnostic criteria. - Often diagnosed only in adulthood, though patients report symptoms dating back to childhood post-diagnosis.
Treatment (Perpetuating + Protective Factors): - Empathy and safety are critical. - 3-Stage Treatment Model: 1. Safety and stabilization. 2. Working through traumatic memories. 3. Reintegrating identities and rehabilitation.

General Features: - Involves distress and excessive energy expenditure regarding health concerns. - Tendency to seek frequent medical treatment, often at great expense. - Patterns include Somatic Symptom Disorder and Illness Anxiety Disorder.
Aetiology: - Symptoms often begin or intensify following trauma, conflict, or stress. - These disorders appear more commonly in women than in men.