Psychopathology (Final) Somatoform and Dissociative Disorders

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1

somatoform disorders

prominence of somatic symptoms (physical symptoms) associated with significant distress and impairment.

  1. somatic symptom disorder,
  2. illness anxiety disorder (hypochondriasis in DSM IV)
  3. conversion disorder,
  4. factitious disorder
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Dissociative disorders

  • disruption of and/ or discontinuity in the normal integration of consciousness memory, identity, emotion, perception, body representation, motor control, behavior
    • Depersonalization/ derealization dx
    • Dissociative amnesia
    • Dissociative fugue
    • Dissociative identity disorder
  • Little empirical attention given to dissociative dx
  • Notoriously difficult to treat with pharmacotherapies
    • Little research on response in patients with DID
    • Research shows that medication for dissociative amnesia is nonexistent
  • Psychotherapy is helpful
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Hypochondriasis

  • now called illness anxiety disorder in DSM5)
    • Types of somatic dx
    • preoccupation with fear of having serious disease beyond appropriate medical assessment. Belief that you have the disease**
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Somatization dx

  • Types of somatic dx
  • A history of many physical complains w significant impairment
  • Pain, GI, sexual, and neurological symptoms
  • Series of physical complaints and as a result takes on a sense of always being ill**
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Conversion dx

  • Type of somatic dx
  • Refers to physical malfunctioning such as paralysis, blindness but there is no medical etiology (happening in their head pretty much)
  • Differing from malingering or factitious disorders and getting benefits of attention
  • Includes
    • Indifference
    • Precipitating stress
    • can function normally but are unaware of nature of the disorder
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Pain dx

  • Types of somatic disorder
  • Client is exhibiting real pain which is the focus of clinical attention
  • Psych factors impact onset and intensity of pain
  • Not feigned
  • Effective treatment methods include biofeedback, cognitive behavioral, alternative medicines, and groups
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Body dysmorphic disorders

  • Types of somatic dx
  • Fear of ugliness, desiring changes in appearance based on this fear (goes beyond discomfort)
  • Often described as a social disorder
  • Clients afraid to disclose defeat so it will not become more noticeable
  • Usually seek help from dermatologists, plastic surgeons, but not mental health providers
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Depersonalization/ derealization dx

  • Type of dissociative dx
  • Persistent recurrent experiences of feeling detached from one’s own mental body.
  • Reality testing remains intact
  • Impact on functioning
  • Can present as depersonalization and derealization
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Dissociative amnesia

  • Most severe of dissociative disorders
  • One or more episodes of inability to recall personal information of a traumatic/ stressful nature
  • Generalized amnesia- unable to remember anything, including who they are
  • Localized amnesia- failure to recall specific events that occur during a specific time
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Dissociative fugue

  • Type of dissociative disorder
  • Unexpected travel away from home/ work and inability to recall one’s past
  • Usually leaving behind a difficult situations
  • Assumption of a new identity (partial or complete)
  • Not substance induced or DID
  • Ends abruptly
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Trance and possession Dx

  • Only if it is undesirable is it considered pathological
  • Under consideration but not in the DSM now
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Dissociative Identity Disorder

  • Type of dissociative dx
  • Presence of 2+ distinct identity states
  • At least 2 states recurrently take control
  • Inability to recall personal information
  • Not due to substances
  • Host identity is holding fragments together
  • Switching- instantaneous change, come cues
  • Score differently on psych tests
  • Can be faked

Comorbid with abuse, depression, somatization, panic attacks

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Depersonalization

  • I am not real
  • Altered sense of selfhood
  • Feeling outside of one’s body; emotional or physical numbing; time distortion; absent sense of self
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Derealization

  • The world is not real
  • Feels of unreality with regard to one’s surroundings
  • Object or people appear to be visually distorted or foggy/ dreamlike/ robotic/ lifeless
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Treatment of BDD

  • refers to body dysmorphic disorder
  • Treatments
    • SSRIs
    • CBT
    • Exposure and response prevention
    • family therapy
    • Insight-oriented therapy
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Treatments that do not work for BDD

  • Contraindicated tx
    • Surgery= do not relieve symptoms