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Relation between Dissociative, Somatoform and Anxiety disorders
Used to be classified together in DSM as neuroses.
Dissociative and Somatoform Disorders Similarities
- Onset is both related to a stressful experience.
- Least understood and most controversial of disorders.
- People rarely given these diagnoses.
Dissociative Disorder is sudden disruption in continuity of:
- Some aspect of cognition or experience becomes inaccessible to consciousness.
- Repression and avoidance.
- Memory loss, typically of a stressful experience.
- Not due to physical injury and may last hours or years.
- Usually returns spontaneously and in spurts.
The number of people who currently have a condition.
The annual number of people who are diagnosed with a condition.
Problems with prevalence vs. incidence:
- An incurable disease can have low incidence, but high prevalence.
- A short-lived curable condition like a cold can have a high incidence, but low prevalence.
Memory recall deficits of trauma:
- People focus on weapon and not the face of the person giving them trauma.
- High levels of stress hormones might interfere with memory formation.
- Emotional content might have vividness, but not accuracy.
- Deficits are in explicit memory.
Involves conscious recall of experiences.
Underlies behaviors based on experiences that cannot be consciously recalled. (riding a bike)
Two other causes of memory loss from dissociation:
- Degenerative brain disorders
- Substance abuse
Degenerative Brain Disorders
- Alzheimer's Disease
- Not linked to stress
- Involves gradual decline over time
- Accompanied by other cognitive deficits - can't learn new info
- Memory loss accompanied by leaving home and making new identity.
- Sudden, unexpected travel with inability to recall one�s past and create a new identity.
- Memory comes back spontaneously and in spurts.
- 0.2% prevalence rate.
- Alteration in experience of self.
- Feelings of detachment or disconnection from self.
- Unusual sensory experiences - limbs enlarged or voice distant.
- No psychosis or loss of memory.
- Based on one symptom - criticized for this.
Dissociative Identity Disorder
- At least two distinct personalities that act independently of each other.
- Other symptoms: headaches, hallucinations, self harm, suicide attempts.
- Most severe dissociative disorder and more common in women.
Two Major Theories of Causes of DID
- Posttraumatic Model - results from severe psychological and/or sexual abuse in childhood.
- Sociocognitive Model - a form of role-play in suggestible individuals. Response to therapists or media.
Evidence raised in theory debate
- DID can be role-played.
- DID patients show only partial implicit memory deficits.
- DID diagnosis differs by clinician.
- For many, symptoms emerge after therapy begins.
- Empathic and supportive therapist.
- Integration of alters into one individual.
- Improvement of coping skills.
- Psychoanalytic - reexperience traumatic event
- Poor outcomes.
- Psychological problems take a physiological form.
- Bodily symptoms have no cause and are involuntary.
- Individuals seek medical treatment.
- Severe, prolonged pain.
- Can't be accounted for by organic pathology.
- Caused by conflict and stress.
- Individual unaware of psychological origins.
Body Dysmorphic Disorder
- Preoccupation with and extreme distress over imagined or exaggerated defect in appearance.
- Constant examination of self in mirror or avoids mirrors.
- Housebound or plastic surgery or suicidal thoughts.
- Women. Late adolescence. High comorbidity.
- Fears of having a serious disease.
- Critical of medical professionals.
- Early adulthood.
Somatization Disorder or Briquet's Syndrome
- Multiple, recurrent pain complaints with no apparent physical cause.
- Seeks treatment from multiple physicians.
- Exaggerated presentation of symptoms and complaints.
- Higher in South Am. and Puerto Rico.
- Sensory or motor function impaired but no neurological cause.
- Vision impairment, paralysis of arms/legs, seizures or coordination problems. Anesthesia, aphonia, anosmia.
- Can't be explained by medical condition.
Loss of sensation.
Hippocrates & Conversion Disorder
Believed it only occured in women and attributed to wandering uterus. Hysteria.
Freud & Conversion Disorder
- Coined term conversion.
- Thought that anxiety and conflict converted into physical symptoms.
Conversion Disorder Onset
- Adolescence to early adulthood.
- Prevalence less than 1%.
- Comorbid with depressive disorder, substance abuse, personality disorders.
Conversion Disorder Cause
- Distressing event that is unexpressed and pushed to unconscious.
- In women, linked to sexual Electra Complex.
Conversion Disorder Cause: Social and Cultural Factors
- Decrease in incidence since last half of 19th century. Less repressed sexual attitudes and higher tolerance for anxiety symptoms.
- Prevalent in rural areas, people of lower SES, non-western.
Body Dysmorphic Disorder co-occurs with:
Treatment of Somatoform Disorders
- Cognitive Behavioral Treatment
- Not many studies about this.
Cognitive Behavioral Treatment - Somatoform Disorders (3)
- Identify & change triggering emotions.
- Change thinking about symptoms.
- Replace sick role behaviors with more appropriate social interactions.
Treatment of Pain Disorder
- Antidepressants (Tofranil)
- Components of psychotherapy for pain disorder
Four Components of psychotherapy for pain disorder
- Validation of patient�s pain
- Relaxation training
- Reinforce shift of focus away from pain
- Help patient develop ability to cope with stress and gain sense of control over pain
Treatment of Body Dysmorphic Disorder
- Cognitive Behavioral Therapy
- Exposure plus response prevention (Prevent individual from checking appearance)
- Antidepressants (Fluoxetine & Clomipramine)
Treatment of Hypochondriasis
- Cognitive Behavioral Therapy:
- Reduce attention to bodily sensations.
- Challenge negative perceptions about sensations.
- Discourage reassurance seeking from medical professionals.
Treatment of Somatization Disorder
- Medical professionals don�t dismiss physical complaints.
- Minimize use of diagnostic tests and medication.
- Avoid providing attention only when patient is complaining (reinforcing symptoms).
- Treat underlying depression and anxiety when present.
Treatment of Conversion Disorder
- No controlled studies to date.
- Psychoanalytic treatments have not demonstrated usefulness.
- Reinforcement of high functioning behavior may help.