Dissociative and somatic symptom disorders Chapter 9 Dissociative Disorders Forms of Dissociative disorders Dissociative identity disorder Dissociative amnesia Specify if Dissociative fugue Depersonalization Derealization disorder DSM V combined dissociative amnesia with fugue and depersonalization with derealization disorder Symptoms of DID Dissociative identity disorder DID Formerly called multiple personality disorder An individual develops more than one self or personality DSM V criteria A Disruption of identity with 2 or more distinct personalities B Recurrent gaps in memory A Symptoms cause clinically significant distress or impairment B The disturbance is not a normal part of accepted cultural or religious practice C Symptoms are not attributable to the physiological effects of a substance or another medical condition Risk factors Traumatic events can lead to splitting of sense of self Interpersonal physical and sexual abuse associated with increased risk Prevalence of childhood abuse neglect is 90 People with DID have learned to cope by creating alters or other personalities that unconsciously control thinking and behavior treatment Goal Integrate alters Integrate the disparate parts within the person s consciousness of self memory and time Methods Hypnotherapy Help recall traumatic experiences Cognitive behavioral techniques Help client develop a coherent sense of themselves and their experiences Dissociative Amnesia An inability to remember important personal details and experiences With dissociative fugue A person confused about personal identity suddenly and unexpectedly travels to another place and is unable to recall past history or identity Dissociative amnesia Dissociative amnesia Localized amnesia most common Selective amnesia Generalized amnesia Depersonalization DEREALIZATION Disorder A dissociative disorder in which the individual experiences one or both of the experiences of depersonalization derealization Depersonalization Experiences of unreality detachment or being an outside observer of one s thoughts feelings sensations body or actions Derealization Experiences of unreality or detachment with respect to surroundings Things may seem to change shape or size or appear dreamlike or foggy Somatoform Disorders SOMATic symptom and related disorders soma body in Greek Symptoms involving physical problems and or concerns about medical symptoms Common feature is the presence of somatic symptoms associated with distress impairment Psychological in nature Account 23 of people with medically unexplained symptoms Previous criteria overemphasized medically unexplained symptoms Somatic symptoms can accompany medical problems Prominently found in medical settings rather than mental health Somatic symptom Disorder A disorder involving physical symptoms that may or mat not be accountable by a medical condition accompanied by maladaptive thoughts feelings and behaviors One or more somatic symptoms that are distressing or result in significant impairment in daily life Excessive thoughts feelings behaviors related to the somatic symptoms for at least six months Somatic symptoms can be specific i e localized pain or relatively nonspecific i e fatigue Illness anxiety disorder Preoccupation with having or acquiring a serious undiagnosed medical illness Somatic symptoms are not present or if present are mild Person is easily alarmed about personal health Characterized by the misinterpretation of normal bodily functions as signs of serious illness Conversion Disorder Functional Neurological Disorder Individual experiences a change in a bodily function not due to an underlying medical condition One or more symptoms of altered voluntary motor or sensory function Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions Symptoms are not intentionally produced Symptoms are related to motor sensory or seizure symptoms deficits Conditions Related to somatic symptom Disorders Malingering Factitious Disorder imposed on self Factitious Disorder imposed on another Munchausen s Syndrome by proxy Primary gain Direct benefits such as paid time off from work insurance payments or some other tangible rewards of occupying the sick role Secondary gain Sympathy and attention they receive from other people when they are ill they exaggerate symptoms Theories and Treatment of somatic symptom and related Disorders Psychoanalysis psychodynamic therapy Cognitive Behavioral therapy Help change and identify client s thoughts linked to their physical symptom Treating illness anxiety disorder Hypnotherapy Therapist instructs the hypnotized client to move the paralyzed limb for example then makes the post hypnotic suggestion to enable the client the sustain the movement after he is out of hypnosis Medication SSRI What s new in dsm 5 Somatic symptom and related disorder Authors of DSM 5 acknowledge that the term somatoform in DSM 4 was confusing Recognized somatic symptom disorders psychological factors affecting other medical conditions and factitious disorders all involve the presence of physical symptoms and or concern about medical illness Mind and body interact so physical and psychological interact Term illness anxiety disorder replaced hypochondriasis Psychological Factors Affecting Medical Conditions Psychological Factors Affecting Medical Conditions Conditions in which a client s physical illness is adversely affected by one or more psychological states Depression stress denial of a diagnosis or engaging in poor or even dangerous health related behaviors Psychological factors affecting other medical conditions Hypertension high blood pressure Asthma Cancer Diabetes Chronic tension headache Cardiovascular disease Theories of Mind body Interaction Stress Coping strategies for stress Problem focused Emotion focused Emotional expression Application to Behavioral Medicine An interdisciplinary approach to medical conditions affected by psychological factors that is rooted in learning theory