PSYC 407 1st Edition Lecture 10 Outline of Last Lecture I. What is Somatoform Disorders?II. Types of Somatoform DisordersIII. What is Hypochondriasis Disorder?IV. What is Somatization Disorder?V. What is Conversion Disorder?VI. What is Pain Disorder?VII. What is Body Dysmorphic disorder?Outline of Current Lecture II. An Overview of Dissociative DisordersIII. Depersonalization vs. Derealization DisorderIV. Introduction to Dissociative AmnesiaV. Introduction to Dissociative FugueVI. Causes of Dissociative Amnesia and Dissociative FudgeVII. Introduction to Dissociative Trance Disordera. Causes and TreatmentsVIII. Introduction to Dissociative Identity Disorder (DID):a. Causes and Treatmentsb. What is the Autohypnotic Model?Current LectureAn Overview of Dissociative Disorders• Types of DSM-IV-TR dissociative disorders– Depersonalization disorder– Dissociative amnesia– Dissociative fugue– Dissociative trance disorder– Dissociative identity disorderTwo types of unreal experiences1. Depersonalization2. DerealizationDepersonalization/Derealization DisorderThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.– Depersonalization – Perception is altered so that the person loses sense of their own reality– Derealization – losing a sense of the reality of the external world– Transient experiences occur in half the populations. Also occur in sleep deprivation, Panic Disorder and Acute Stress DisorderDepersonalization Disorder:When very severe, it may be the primary problem:– Severe and frightening feelings of unreality and detachment– Feelings dominate and interfere with life functioning– Most common dissociative statePerson substantially impairedDepersonalization Disorder: Causes and Treatment• Distinct cognitive profile– Cognitive deficits in attention, short-term memory, spatial reasoning– Deficits related to tunnel vision and mind emptiness– Such persons are easily distracted– Inhibited emotional expression• Treatment– Little is known– Anxiety and depression treatedTherapist questions:“Have you had the feeling that things around you are unreal?”“Have you found yourself somewhere and not known how you got there?”Client:“It is as if the real me is taken out and put on a shelf somewhere.”“Whatever makes me ‘me’ is not there.”Dissociative Amnesia: An Overview• Dissociative amnesia– Includes several forms of psychogenic memory loss– Generalized vs. localized or selective type• Generalized- can’t remember anything including who they are, Can be lifelong.• Localized- more common, fail to recall specific events, especially if traumatic.– Not explained by ordinary forgetfulnessDissociative Fugue: An Overview• Dissociative fugue• Memory loss around a trip– Related to dissociative amnesia– Take off and find themselves in a new place– Unable to remember the past– Unable to remember how they arrived at new location– Often assume a new identityDissociative Amnesia and Fugue: CausesStatistics– Usually begin in adulthood– Show rapid onset and dissipation– Occur most often in females• Causes– Little is known– Trauma and stress can serve as triggersDissociative Trance Disorder: An OverviewClinical description- Symptoms resemble other dissociative disorders- Dissociative symptoms and sudden changes in personality- Changes often attributed to possession by a spirit- Presentation varies across culturesDissociative Trance Disorder: Causes and Treatment• Causes– Often attributable to a life stressor or trauma– Is this culturally appropriate?• Treatment– Little is knownDissociative Identity Disorder (DID): An Overview• Clinical description– Formerly known as multiple personality disorder– Defining feature is dissociation of personality– Adoption of several new identities (as many as 100)– Identities display unique behaviors, voice, and posture– No cognitive or memory problems– Unique aspects of DID– Alters – different identities or personalities– Host – the identity that keeps other identities together and asks for treatment– Switch – quick transition from one personality to another• Statistics– Average number of identities is close to 15– Ratio of females to males is high (9:1)– Onset is almost always in childhood– High comorbidity rates & lifelong, chronic course.– Increase in dx since “Sybil” was released• Pre-1970s, several hundred cases• Post-Sybil, thousands of new cases each year, esp. in US• Some believe condition may be UNDER-diagnosed and could be quite common. Others say OVER-diagnosed and is rare.it is diagnosed because of clinician bias, faulty assessment, and therapy techniques that increase the likelihood of a DID diagnosis.Dissociative Identity Disorder (DID): Causes• Causes– Histories of horrible, unspeakable, child abuse– Closely related to PTSD– Mechanism to escape from the impact of trauma– Escape into fantasy from unremitting negative affect of abuseDissociative Identity Disorder (DID): Treatment• Treatment– Focus is on reintegration of identities– Identify and neutralize cues/triggers that provoke memories of trauma/dissociation– Prognosis guardedAutohypnotic Model• Some more suggestible, easily hypnotized.• Some have imaginary friends (corr. with above), 50% had them.• Both correlate w ability to dissociate as a defense against trauma.• People w less suggestibility get PTSD, so is DID self-hypnosis>• Is DID an extreme form of PTSD?• DID window seems to close after 9 years old.Diagnostic Considerations in Somatoform and Dissociative Disorders• Separating real problems from faking– Malingering – deliberately faking symptoms• Factitious disorderFactitious disorder by proxySummary of Somatoform and Dissociative Disorders• Features of somatoform disorders– Physical problems without on organic cause• Features of dissociative disorders– Extreme distortions in perception and memory• Well established treatments are generally lackingDSM-5 ChangesSomatic Symptom Disorders:– Complex Somatic Symptom Disordersomatic sx excessive thoughts, feelings, behaviors related to somatic sx not necessary that sx be unexplained pain is a specifier, not a specific diagnosis– Illness Anxiety Disorder (new dx.) unwarranted fears about a serious illness despite absence of significant sx.-