Study Notes on Dissociative and Somatic Symptom Disorders
Overview
- This chapter discusses various disorders where psychological conflict and stress manifest physically or mentally, particularly focusing on dissociative and somatic symptom disorders.
Dissociative Disorders
- Definition: Disorders in which individuals experience a disconnection and lack of continuity between thoughts, memory, surroundings, actions, and identity.
1. Dissociative Identity Disorder (DID)
- Description: Previously known as multiple personality disorder, characterized by the presence of two or more distinct identities or personality states within a single individual.
- Alters: Distinct identities that may have their own names, ages, histories, and characteristics.
- Typically fewer than 10 identities are present.
- Host: The identity that is in control most of the time.
- Memory Gaps: Individuals often experience gaps in memory about everyday events and personal information, leading to significant distress.
- Controversy: Highly debated topic regarding its legitimacy and the validity of diagnosis.
2. Dissociative Amnesia
- Definition: A condition where an individual cannot recall important autobiographical information, often related to traumatic or stressful events.
3. Dissociative Fugue
- Definition: A dissociative disorder where a person unexpectedly travels away from home or customary work locations with an inability to recall one’s past.
- Individuals are confused about their identity or may adopt a new identity entirely.
4. Depersonalization/Derealization Disorder
- Definitions:
- Depersonalization: An altered experience of the self, such as feeling detached from one's body or mental processes.
- Derealization: Experiences of unreality or detachment from surroundings, feeling as though one is disconnected from the environment.
- Symptoms: Recurrent episodes of depersonalization and/or derealization.
5. Theories of Dissociative Disorders
- Psychological Response: Individuals may dissociate to cope with severe psychological trauma.
- Unknown Etiology: It remains unclear why some develop dissociative disorders while others do not.
6. Treatment of Dissociative Disorders
- Goals: Aim to integrate the distinct identities (alters) into one primary identity.
- **Methods:
- Hypnotherapy : Used to access memories or help integrate alters.
- Cognitive Behavioral Techniques:** Address irrational thoughts and behaviors related to their dissociative experiences.
- Associated Conditions: Often involves treating coexisting conditions such as mood disorders, anxiety disorders, and PTSD.
7. SCID-D-R (Structured Clinical Interview for DSM-IV Dissociative Disorders) Items
- This clinical assessment tool includes items that address:
- Amnesia: Gaps in memory.
- Depersonalization: Out-of-body experiences.
- Derealization: Unfamiliarity with surroundings.
- Identity Confusion: Internal struggles about identity.
- Identity Alteration: Acting as if one is a different person.
- Definition: A variety of conditions wherein psychological conflicts convert into physical complaints without physiological origins.
- Characteristics: Symptoms lead to significant distress and impairment but are not linked to physiological causes.
- Somatization Disorder: Multiple physical complaints that cannot be fully explained.
- Undifferentiated Somatoform Disorder: Symptoms not fulfilling criteria for any specific somatoform disorder.
- Conversion Disorder: Neurological symptoms that are inconsistent with medical conditions.
- Hypochondriasis: Excessive concern about having a serious illness despite medical evaluation.
- Pain Disorder: Significant pain causing distress, with psychological factors playing a key role.
- Body Dysmorphic Disorder: Preoccupation with imagined or exaggerated defects in physical appearance.
2. Somatic Symptom Disorder in DSM-5
- Definition: Characterized by excessive thoughts, feelings, or behaviors relating to physical symptoms or health concerns.
- Maladaptive Responses: Individuals with this disorder exhibit disproportionate thoughts about their symptoms and may be focused excessively on their health concerns.
- Description: Characterized by the misinterpretation of normal bodily sensations as signs of severe illness.
4. Conversion Disorder (Functional Neurological Symptom Disorder)
- Definition: A somatic symptom disorder that involves a change in body function (either sensory or motor) that does not have an underlying medical explanation.
- Example: "Glove anesthesia," where the entire hand feels numb although identified nerve injuries should not lead to this sensation.
5. Body Dysmorphic Disorder
- Definition: Individuals are obsessively preoccupied with perceived defects in their physical appearance, leading to significant distress.
- Gender Differences: Men typically focus on body build or features like genitals, while women often concern themselves with weight, breast size, or facial features.
- Behaviors: Individuals may constantly check their appearance, think about it excessively, or attempt to conceal perceived defects.
- Malingering: Intentionally producing symptoms for external gains (e.g. financial compensation).
- Factitious Disorders: Individuals feign illness not for external gain but due to an intrinsic need to maintain a sick role.
- Munchausen Syndrome by Proxy: Involves falsifying illnesses in others, often to gain attention or sympathy.
- Cognitive Behavioral Therapy (CBT): Focuses on managing health anxiety and improving realistic views on bodily sensations.
- Hypnotherapy: Addresses psychological factors and aids symptom management.
- Medications: SSRIs may be effective for certain disorders like conversion disorder.
- Interpersonal Therapy: For individuals with Body Dysmorphic Disorder, it helps them develop coping strategies.
8. Etiology of Somatic Disorders
- Psychodynamic Perspective: Symptoms arise as a defense mechanism to distract from underlying anxiety or unresolved conflicts.
- Behavioral Perspective: Symptoms are reinforced by the attention they receive from others, leading individuals to assume the ‘sick role’.
- Biological Perspective: Some individuals may be more sensitive to bodily sensations and experience them as more severe or distressing due to their heightened arousal levels.
Psychological Factors Affecting Medical Conditions
- Definition: Psychological or behavioral factors exacerbating medical disorders, including effects of stress, personality traits, and maladaptive health behaviors.
1. Examples of Psychological Factors Affecting Medical Conditions
- Hypertension: Linked to chronic occupational stress.
- Asthma: Anxiety can worsen respiratory symptoms.
- Cancer: Patients may deny surgical needs, affecting recovery.
- Diabetes: Lack of lifestyle changes can impede disease management.
- Chronic Tension Headaches: Stresses from family dynamics worsen symptoms.
2. Coping with Stress
- Coping Definition: Strategies used to reduce stress in response to perceived threats.
- Types of strategies include:
- Problem-Focused: Targeting the problem directly to alleviate stress.
- Emotion-Focused: Managing emotional responses to the stressor.
- Personality Styles:
- Type A: Competitive, impatient, hard-driving behavior.
- Type D: Distressed personality with negative emotions.
3. Behavioral Medicine
- A multidisciplinary approach to address the interaction of psychological factors with physical health.
- Focus includes:
- Psychological factors of stress
- Emotions and their effects
- Behavioral patterns influencing health
- Emerging Interventions: Increased application of strategies once deemed alternative, such as mindfulness training and meditation for health improvement.