Dissociative Disorders

Persistent, maladaptive disruptions in memory, consciousness, or identity

Dissociative Identity Disorder

A. presence of two or more distinct identities or personality states

B. at least two of these identities recurrently take control

C. inability to recall important personal information

Possible Causes:Biological vulnerability

Severe abuse/trauma history

Suggestibility

Treatment: identify cues or triggers that provoke

memories or dissociation

try to help person integrate personalities

hypnosis sometimes used

antidepressants may be helpful

Depersonalization Disorder

depersonalization disorder: severe feelings of unreality - dominates the person’s life

depersonalizationderealization

Depersonalization Disorder: Causes

Causes Cognitive deficits

AttentionShort-term memorySpatial reasoningEasily distracted

Decreased emotional response

Dissociative Amnesia:

generalized amnesia: can’t remember

anything- even identity

localized or selective amnesia: failure to recall specific events (often traumatic)

dissociative fugue: memory loss combined with flight

dissociative trance disorder: dissociative phenomena that appears as a trance or “possession”

Somatic Symptom and Related Disorders

Historical Roots hysteria: “wandering uterus”

physical symptoms without a known cause term dates back to Hippocrates and Egyptians

neurosis: emotional distress due to underlying unconscious conflicts, anxiety, and implementation of defense mechanisms

Illness Anxiety Disorder

Preoccupation with fears of having a serious disease based on a misinterpretation of bodily symptoms Persists despite appropriate medical

evaluation and reassurance

Causes distress or impairment in functioning

Disturbance lasts at least 6 months

Cultural Variations

Africa Sensation of something crawling in one’s head

India and Pakistan Sensation of burning in hands or feet dhat – concern about losing semen accompanied

by feelings of weakness and exhaustion

China, East Asia koro – sudden intense anxiety that one’s genitals

will recede into one’s body and possibly cause death

Somatic Symptom Disorder

A disorder in which persons become excessively distressed, concerned, and anxious about the bodily symptoms that they are experiencing.

Their lives are greatly and disproportionately disrupted by the symptoms.

Somatic Symptom Disorderand Antisocial Personality Disorder

Run in the same families

Gender differences

Common features

• Presence of one or more symptoms or deficits that affect voluntary or sensory functioning• paralysis• blindness• difficulty speaking • loss of sense of touch

Conversion Disorder

Cognitive behavioral view

Psychodynamic view

Tends to run in families (genetic and environmental contributions)

Often develops in context of stressful life event

Causes of Somatic Symptom and Related Disorders

Treatment(Kroenke, 2007)

Reviewed 34 randomized controlled studies of treatment of somotaform disorders (3,922 patients)

Concluded that the most effective treatment for somatoform disorders was cognitive-behavioral therapy (CBT).

some evidence that antidepressants and a consultation letter to primary care physician can help.

Factitious Disorder A disorder in which an individual feigns or

induces physical symptoms, typically for the purpose of assuming the role of a sick person.

Different from Malingering

Specifiers of imposed on self vs. imposed on another (formerly factitious disorder by proxy)

http://abcnews.go.com/Health/arizona-mother-accused-poisoning-baby-munchausen-syndrome-proxy/story?id=13308998