Somatoform & Dissociative Disorders: Psychological Conditions Mimicking Physical Issues - , Study notes of Abnormal Psychology

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Somatoform and Dissociative Disorders In addition to disorders covered earlier, two other kinds of disorders are commonly associated with stress and anxiety: Somatoform disorders Dissociative disorders Somatoform and Dissociative Disorders Somatoform disorders are problems that appear to be medical but are due to psychosocial factors Unlike psychophysiological disorders, in which psychosocial factors interact with physical ailments, somatoform disorders are psychological disorders masquerading as physical problems Somatoform and Dissociative Disorders Dissociative disorders are patterns of memory loss and identity change that are caused almost entirely by psychosocial factors rather than physical ones Somatoform and Dissociative Disorders The somatoform and dissociative disorders have much in common: Both may occur in response to severe stress Both have traditionally been viewed as forms of escape from stress A number of individuals suffer from both a somatoform and a dissociative disorder Theorists and clinicians often explain and treat the two groups of disorders in similar ways Somatoform Disorders When a physical ailment has no apparent medical cause, physicians may suspect a somatoform disorder People with a somatoform disorder do not consciously want, or purposely produce, their symptoms They believe their problems are genuinely medical There are two main types of somatoform disorders: Hysterical somatoform disorders Preoccupation somatoform disorders What Are Hysterical Somatoform Disorders? People with hysterical somatoform disorders suffer actual changes in their physical functioning These disorders are often hard to distinguish from genuine medical problems It is always possible that a diagnosis of hysterical disorder is a mistake and that the patient’s problem has an undetected organic cause What Are Hysterical Somatoform Disorders? DSM-IV-TR lists three hysterical somatoform disorders: Conversion disorder Somatization disorder Pain disorder associated with psychological factors What Are Hysterical Somatoform Disorders? Conversion disorder In this disorder, a psychosocial conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling May be called pseudoneurological Most conversion disorders begin between late childhood and young adulthood They are diagnosed in women twice as often as in men At times of extreme stress and last a matter of weeks They usually appear suddenly and are thought to be rare What Are Hysterical Somatoform Disorders? Somatization disorder People with somatization disorder have many long-lasting physical ailments that have little or no organic basis Also known as Briquet’s syndrome To receive a diagnosis, a patient must have a range of ailments, including several pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological symptom Patients usually go from doctor to doctor in search of relief What Are Hysterical Somatoform Disorders? Somatization disorder Patients often describe their symptoms in dramatic and exaggerated terms Most also feel anxious and depressed What Are Preoccupation Somatoform Disorders? Preoccupation somatoform disorders include hypochondriasis and body dysmorphic disorder People with these problems misinterpret and overreact to bodily symptoms or features Although these disorders also cause great distress, their impact on one’s life differs from that of hysterical disorders What Are Preoccupation Somatoform Disorders? Hypochondriasis People with hypochondriasis unrealistically interpret bodily symptoms as signs of serious illness Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating Although some patients recognize that their concerns are excessive, many do not What Are Preoccupation Somatoform Disorders? Hypochondriasis Patients with this disorder can present a picture very similar to that of somatization disorder If the anxiety is great and the bodily symptoms are relatively minor, a diagnosis of hypochondriasis is probably in order If the symptoms overshadow the anxiety, they may indicate somatization disorder What Are Preoccupation Somatoform Disorders? Hypochondriasis Although this disorder can begin at any age, it starts most often in early adulthood, among men and women in equal numbers Between 1% and 5% of all people experience the disorder For most patients, symptoms rise and fall over the years What Are Preoccupation Somatoform Disorders? Body dysmorphic disorder (BDD) People with this disorder, also known as dysmorphophobia, become deeply concerned over some imagined or minor defect in their appearance Most often they focus on wrinkles, spots, facial hair, swelling, or misshapen facial features (nose, jaw, or eyebrows) Most cases of the disorder begin in adolescence but are often not revealed until adulthood Up to 5% of people in the U.S. experience BDD, and it appears to be equally common among women and men Sufferers may severely limit contact with other people, be unable to look others in the eye, or go to great lengths to conceal their “defects”. As many as half of people with this disorder seek plastic surgery or dermatology treatment, and often they feel worse rather than better afterward. One study found that 30% of participants with this disorder were housebound and 17% had attempted suicide. They are also more likely to be unemployed and to have limited academic success What Causes Somatoform Disorders? Theorists typically explain the preoccupation somatoform disorders much as they do the anxiety disorders: Behaviorists: classical conditioning or modeling Cognitive theorists: oversensitivity to bodily cues people with the disorders are so sensitive to and threatened by bodily cues that they come to misinterpret them In contrast, the hysterical somatoform disorders are widely considered unique and in need of special explanation No explanation has received much research support, and the disorders are still poorly understood in the late nineteenth century thought that psychosocial factors cause hysterical disorders. What Causes Somatoform Disorders? The psychodynamic view Freud believed that hysterical disorders represented a conversion of underlying emotional conflicts into physical symptoms Because most of his patients were women, Freud centered his explanation on the psychosexual development of girls and focused on the phallic stage (ages 3 to 5) … What Causes Somatoform Disorders? The psychodynamic view During this stage, girls develop a pattern of sexual desires for their fathers (the Electra complex) and recognize that they must compete with their mothers for his attention Because of the mother’s more powerful position, however, girls repress these sexual feelings Freud believed that if parents overreact to such feelings, the Electra complex would remain unresolved and the child might re-experience sexual anxiety throughout her life Freud concluded that some women hide their sexual feelings in adulthood by converting them into physical symptoms What Causes Somatoform Disorders? The psychodynamic view Today’s psychodynamic theorists take issues with Freud’s explanation of the Electra conflict They continue to believe that sufferers of these disorders have unconscious conflicts carried from childhood What Causes Somatoform Disorders? The psychodynamic view Psychodynamic theorists propose that two mechanisms are at work in the hysterical disorders: Primary gain: hysterical symptoms keep internal conflicts out of conscious awareness Secondary gain: hysterical symptoms further enable people to avoid unpleasant activities or receive sympathy from others What Causes Somatoform Disorders? The behavioral view Behavioral theorists propose that the physical symptoms of hysterical disorders bring rewards to sufferers May remove individual from an unpleasant situation May bring attention from other people In response to such rewards, people learn to display symptoms more and more This focus on rewards is similar to the psychodynamic idea of secondary gain, but behaviorists view the gains as the primary cause of the development of the disorder What Causes Somatoform Disorders? The cognitive view Some cognitive theorists propose that hysterical disorders are a form of communication, providing a means for people to express difficult emotions Dissociative Disorders Keep in mind that dissociative symptoms are often found in cases of acute or posttraumatic stress disorders When such symptoms occur as part of a stress disorder, they do not necessarily indicate a dissociative disorder (a pattern in which dissociative symptoms dominate) On the other hand, research suggests that people with one of these disorders also develop the other as well Dissociative Amnesia People with dissociative amnesia are unable to recall important information, usually of an upsetting nature, about their lives The loss of memory is much more extensive than normal forgetting and is not caused by organic factors Often an episode of amnesia is directly triggered by a specific upsetting event Dissociative Amnesia Dissociative amnesia may be: Localized (circumscribed) – most common type; loss of all memory of events occurring within a limited period Selective – loss of memory for some, but not all, events occurring within a period Generalized – loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends Continuous – forgetting of both old and new information and events; quite rare in cases of dissociative amnesia Dissociative Amnesia All forms of the disorder are similar in that the amnesia interferes primarily with episodic memory (one’s autobiographical memory of personal material) Semantic memory – memory for abstract or encyclopedic information – usually remains intact Clinicians do not known how common dissociative amnesia is, but many cases seem to begin during times of serious threat to health and safety Dissociative Fugue People with dissociative fugue not only forget their personal identities and details of their past, but also flee to an entirely different location For some, the fugue is brief – a matter of hours or days – and ends suddenly For others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics Dissociative Fugue ~0.2% of the population experience dissociative fugue It usually follows a severely stressful event Fugues tend to end abruptly When people are found before their fugue has ended, therapists may find it necessary to continually remind them of their own identity The majority of people regain most or all of their memories and never have a recurrence Dissociative Identity Disorder (Multiple Personality Disorder) A person with dissociative identity disorder (DID; formerly multiple personality disorder) develops two or more distinct personalities (subpersonalities) each with a unique set of memories, behaviors, thoughts, and emotions Dissociative Identity Disorder (Multiple Personality Disorder) At any given time, one of the subpersonalities dominates the person’s functioning Usually one of these subpersonalities – called the primary, or host, personality – appears more often than the others The transition from one subpersonality to the next (“switching”) is usually sudden and may be dramatic Dissociative Identity Disorder (Multiple Personality Disorder) Cases of this disorder were first reported almost three centuries ago Many clinicians consider the disorder to be rare, but some reports suggest that it may be more common than once thought Dissociative Identity Disorder (Multiple Personality Disorder) Most cases are first diagnosed in late adolescence or early adulthood Symptoms generally begin in childhood after episodes of abuse Typical onset is before age 5 Women receive the diagnosis three times as often as men Dissociative Identity Disorder (Multiple Personality Disorder) How do subpersonalities interact? The relationship between or among subpersonalities varies from case to case Generally there are three kinds of relationships: Mutually amnesic relationships – subpersonalities have no awareness of one another Mutually cognizant patterns – each subpersonality is well aware of the rest One-way amnesic relationships – most common pattern; some personalities are aware of others, but the awareness is not mutual Those who are aware (“co-conscious subpersonalities”) are “quiet observers” Dissociative Identity Disorder (Multiple Personality Disorder) How do subpersonalities interact? Investigators used to believe that most cases of the disorder involved two or three subpersonalities Studies now suggest that the average number is much higher – 15 for women, 8 for men There have been cases of more than 100! Dissociative Identity Disorder (Multiple Personality Disorder) How do subpersonalities differ? Subpersonalities often display dramatically different characteristics, including: Vital statistics Subpersonalities may differ in features as basic as age, sex, race, and family history Abilities and preferences Although encyclopedic knowledge is unaffected by dissociative amnesia or fugue, in DID it is often disturbed It is not uncommon for different subpersonalities to have different abilities, including being able to drive, speak a foreign language, or play an instrument Dissociative Identity Disorder (Multiple Personality Disorder) How do subpersonalities differ? Subpersonalities often display dramatically different characteristics, including: Physiological responses Researchers have discovered that subpersonalities may have physiological differences, such as differences in autonomic nervous system activity, blood pressure levels, and allergies Dissociative Identity Disorder (Multiple Personality Disorder) studies with word lists The parallels between hypnotic amnesia and dissociative disorders are striking and have led researchers to conclude that dissociative disorders may be a form of self-hypnosis How Are Dissociative Disorders Treated? People with dissociative amnesia and fugue often recover on their own Only sometimes do their memory problems linger and require treatment In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality Treatment for dissociative amnesia and fugue tends to be more successful than treatment for DID How Are Dissociative Disorders Treated? How do therapists help people with dissociative amnesia and fugue? The leading treatments for these disorders are psychodynamic therapy, hypnotic therapy, and drug therapy Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness In hypnotic therapy, patients are hypnotized and guided to recall forgotten events Sometimes intravenous injections of barbiturates are used to help patients regain lost memories Often called “truth serums,” the key to the drugs’ success is their ability to sedate people and free their inhibitions How Are Dissociative Disorders Treated? How do therapists help individuals with DID? Unlike victims of dissociative amnesia or fugue, people with DID do not typically recover without treatment Treatment for this pattern, like the disorder itself, is complex and difficult How Are Dissociative Disorders Treated? How do therapists help individuals with DID? Therapists usually try to help the client by: Recognizing the disorder Once a diagnosis of DID has been made, therapists try to bond with the primary personality and with each of the subpersonalities As bonds are forged, therapists try to educate the patients and help them recognize the nature of the disorder Some use hypnosis or video as a means of presenting other subpersonalities Many therapists recommend group therapy How Are Dissociative Disorders Treated? How do therapists help individuals with DID? Therapists usually try to help the client by: Recovering memories To help patients recover missing memories, therapists use many of the approaches applied in other dissociative disorders, including psychodynamic therapy, hypnotherapy, and drug treatment These techniques tend to work slowly in cases of DID How Are Dissociative Disorders Treated? How do therapists help individuals with DID? Therapists usually try to help the client by: Integrating the subpersonalities The final goal of therapy is to merge the different subpersonalities into a single, integrated entity Integration is a continuous process; fusion is the final merging Many patients distrust this final treatment goal and many subpersonalities see integration as a form of death Once the subpersonalities are integrated, further therapy is typically needed to maintain the complete personality and to teach social and coping skills to prevent later dissociations Depersonalization Disorder DSM-IV-TR categorizes depersonalization disorder as a dissociative disorder, even though it is different from the other dissociative patterns The central symptom is persistent and recurrent episodes of depersonalization, which is a change in one’s experience of the self in which one’s mental functioning or body feels unreal or foreign Depersonalization Disorder People with depersonalization disorder feel as though they have become separated from their body and are observing themselves from outside This sense of unreality can extend to other sensory experiences and behavior Depersonalization is often accompanied by derealization – the feeling that the external world, too, is unreal and strange Depersonalization Disorder Depersonalization experiences by themselves do not indicate a depersonalization disorder Transient depersonalization reactions are fairly common The symptoms of a depersonalization disorder, in contrast, are persistent or recurrent, cause considerable distress, and interfere with social relationships and job performance Depersonalization Disorder The disorder occurs most frequently in adolescents and young adults, hardly ever in people older than 40 The disorder comes on suddenly and tends to be long-lasting Relatively few theories have been offered to explain depersonalization disorder and little research has been conducted on the problem