*Somatics symptoms and DID

Chapter 16: Psychological Disorders

Somatic Symptom Disorders (formerly somatoform disorders)

  • Definition: Physical complaints suggesting a medical problem without a biological cause.

    • Symptoms are not intentionally produced by individuals.

    • Individuals experience significant preoccupation or anxiety about their health or physical sensations.

    • This category includes conditions formerly known as hypochondriasis, which is now split in DSM-5 into:

    • Illness Anxiety Disorder

    • Somatic Symptom Disorder

Types of Somatic Symptom Disorders:

  1. Pain Disorder:

    • Characterized by intense pain that is disproportionate to any medical condition present.

    • The pain is experienced as real but cannot be explained by any physical injury or medical condition.

  2. Functional Neurological Symptom Disorder (Conversion Disorder):

    • Involves neurological symptoms such as paralysis, blindness, or loss of sensation without any identifiable physical cause.

    • The brains and nerves of the patient remain intact.

    • Example of a symptom: Glove Anaesthesia - loss of sensation below the wrist which is anatomically impossible.

    • Patients often exhibit belle indifference, which is a calm indifference to their symptoms.

Prevalence & Case Studies:

  • Frequency: Rare in the general population, approximately 3 in 1000; more common during war or experienced trauma.

  • Up to 25% of hospital patients may present some functional neurological symptoms.

  • Notable case: Psychogenic blindness observed in Cambodian refugees (Cooke, 1991) - the eyes respond normally, yet the brain blocks visual input related to trauma.

Causal Factors:

  1. Psychodynamic:

    • Freud posited that symptoms symbolize unresolved unconscious conflicts.

    • Example: Paralysis may occur after repressed anger directed towards a parent.

  2. Biological:

    • Factors such as reduced pituitary gland volume and possible genetic vulnerabilities.

  3. Environmental:

    • Learned attention and sympathy reinforce a habitual focus on bodily sensations.

  4. Cultural:

    • Such disorders may be more prevalent in cultures where emotional discussion is discouraged.

  5. Psychological:

    • Traits include heightened sensitivity to bodily sensations and poor coping skills when faced with stress.

Dissociative Disorders

  • Definition: A breakdown in the integration of memory, identity, and consciousness.

  • Purpose: These disorders often manifest as a psychological escape from stress or traumatic experiences.

Major Types of Dissociative Disorders:

  1. Dissociative Amnesia:

    • Features a sudden, selective loss of memory typically following stress or trauma.

    • Other cognitive abilities, such as language and motor skills, remain intact.

  2. Dissociative Fugue:

    • A rare subtype of amnesia characterized by sudden travel and the adoption of a new identity.

    • Duration can range from hours to years; the individual may lack awareness of their original identity.

    • Usually triggered by severe stress or trauma.

  3. Dissociative Identity Disorder (DID):

    • Formerly known as Multiple Personality Disorder.

    • Involves two or more distinct personalities (commonly referred to as "alters") coexisting within a single individual.

    • Each alter may possess different memories, behaviors, and even physiological traits such as variations in voice, allergies, handedness, and menstrual cycles.

    • Often arises following severe trauma or abuse during childhood.

Trauma-Dissociation Theory:

  • Proposed by Frank Putnam in 1989, this theory suggests:

    • DID develops as a coping mechanism for enduring unbearable trauma, especially from childhood abuse.

    • The child dissociates, creating alternate identities to endure and manage the trauma and accompanying pain.

    • Dissociation operates similarly to self-hypnosis, allowing the individual to detach from the traumatic experience.

    • Protective identities are maintained separate from the host personality to prevent re-experiencing the trauma.

    • Support for this theory: Approximately 97% of patients diagnosed with DID report experiencing severe abuse in their early years.

Critique of DID Validity:

  • Controversial Diagnosis:

    • Critics suggest that DID could be a condition developed through therapist suggestion or hypnosis.

    • The diagnosis was rare prior to 1970, with about 100 cases worldwide, but surged as public awareness increased (notably through media representations like the case of Sybil).

    • Some theorists consider DID to be merely a form of role-playing or a social construction rather than a genuine disorder.

    • Allegations of therapists implanting false memories, leading to lawsuits against therapists for inducing DID through suggestion.

Scientific Debate:

  • Support for DID:

    • Research shows distinct physiological differences (such as EEG readings, brain activation, and eye muscle movements) between alters within DID patients.

    • Variations in visual cortex activity have been observed when subjects switch between personalities (Strasburger & Waldvogel, 2015).

    • Differences in voice spectral patterns recorded between alters (Putnam, 1984).

  • Criticism of Findings:

    • Many results are derived from case studies rather than being validated through controlled experiments.

    • Role-playing studies fail to replicate the same neurological differences shown in actual cases of DID.

Conclusion:

  • Current perspectives reveal mixed evidence regarding the authenticity of DID: some view it as a legitimate dissociative response to trauma, while others believe it to be behavior reinforced by social context.

Controversy Surrounding Dissociative Identity Disorder (DID)

A. Grounds for Criticism

  • Controversial Diagnosis:

    • Critics question the validity of DID, suggesting that it may not be an authentic disorder but rather a construct influenced by activities in therapeutic settings.

    • Argument that DID is created by therapists through suggestion techniques or hypnosis.

    • Prior to 1970, there were approximately 100 recorded cases of DID worldwide, but the number surged following media portrayals (e.g., the case of "Sybil").

    • Some critics propose that DID may function as a role-playing or social construction rather than a legitimate psychological disorder.

    • Additionally, there are claims that therapists may implant false memories in patients, leading to misdiagnoses.

    • Example cited: Associated Press report from 1997 highlighting instances of litigation against therapists for allegedly inducing DID through suggestive techniques.

B. Scientific Debate

  • Support for DID:

    • Research demonstrates distinct physiological differences among personality alters in individuals diagnosed with DID:

    • Specific EEG patterns.

    • Variation in brain activation levels.

    • Changes in eye muscle movement detected during personality switches.

    • Notable finding: Visual cortex activity alters when DID patients switch personalities (Strasburger & Waldvogel, 2015).

    • Voice spectral patterns reveal differences among alters (Putnam, 1984).

  • Criticism:

    • Many supporting findings originate from observational case studies rather than controlled experimental studies.

    • Role-playing research conducted has failed to consistently reproduce the neurological distinctions observed in DID patients.

C. Conclusion

  • The evidence surrounding DID remains mixed:

    • Some experts perceive DID as an authentic dissociative response to traumatic experiences.

    • Conversely, others interpret it as behavior that has been socially reinforced over time.