PSYB32H3 Chapter Notes - Chapter 7: Dissociative Identity Disorder, Fugue State, Somatic Symptom Disorder
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Chapter 7
Somatoform disorder – complaints of bodily symptoms that suggest physical
defect or dysfunction, but no physiological evidence. Some types:
- Pain disorder – onset and maintenance of pain caused largely by
psychological factors.
o 3 subtypes:
Pain disorder associated psychological factors
Pain disorder associated with both psychological factors and a
general medical condition
Pain disorder associated with a general condition
o MRI showed decrease in grey matter in prefrontal, cingulated, and
insular cortex which related to modulation of subjective pain
- Body dysmorphic disorder – preoccupation with imagined or exaggerated
defects in physical appearance
o Chronic
o Related to OCD—could even pass as a subtype
o Could pass as a social phobia, mood disorder, or even an eating
disorder
- Hypochondriasis – preoccupation with fears of having a serious illness
o Chronic – 60% still have it after 5 years
o Likely to have mood or anxiety disorders
o People who experience abnormally intense sensations may be
particularly vulnerable to hypochondriasis
o “health anxiety disorder”
o hypochondriasis “I think I have this”, illness phobia “I’m afraid to get
this”
o Illness Attitude Scale (IAS)
Worry about illness and pain
Disease conviction
Health habits
Symptom interference with lifestyle
- Conversion disorder – sensory or motor symptoms without any physiological
cause
o Usually in adolescence or early adulthood after life stress
o *some people actually get this diagnosis when there is actually
something wrong. Problematic
o Psychoanalytic theory of conversion disorder
unresolved Electra complex. The daughter becomes sexually
attached to father, but this is repressed. Anxiety converted to
physical symptom
o behavioural theory of conversion disorder
to secure some kind of end. Have a motive to doing so
o social and cultural factors in conversion disorder – high in france and
Austria, more common in lower socio-economic status and rural areas
o biological factors have been proposed, but no research evidence has
been given. But there may be a relation between brain structure and
conversion disorder (right hemisphere)
- Somatization disorder – recurrent, multiple physical complaints that have no
biological basis
o 4 pain symptoms in different locations
o 2 gastrointestinal symptoms
o 1 sexual symptom
o 1 pseudoneurological symptom
o MALINGERING type – complains consciously for some clear external
incentive
o FACTITIOUS – complains consciously but with unclear external
incentive
o Culture varied
o Emotion heavy
o Happens early adulthood
o Runs in families
o High awareness and bias towards pain
o Etiology – high levels of cortisol
Somatization disorder, hypochondriasis, pain disorder, undifferentiated
somatoform disorder = all share same features (somatic symptoms and cognitive
distortions) = share common name “complex somatic symptom disorder” (CCSD).
Symptoms are:
- multiplicity of somatic complaints (somatization disorder)
- high health anxiety (hypochondriasis)
- pain disorder
Some argue that somatoform disorders should be taken out of DSM-5 because:
- the terminology is often unacceptable to patients
- the distinction between disease-based symptoms versus those that are
psychogenic may be more apparent than real
- there is great heterogeneity among the disorders—the only common link is
physical illness that is not attributable to an organic cause
- the disorders are incompatible with other cultures
- there is ambiguity in the stated exclusion criteria
- the subcategories fail to achieve accepted standards of reliability
- the disorders lack clearly defined thresholds in terms of the symptoms
needed for a diagnosis
Some want it renamed to somatic symptom disorders
The focus of the symptoms now is the extent to which it impairs the subject’s quality
of life
Treatment
- addressing secondary gain (their ends)/ iatrogenic disability
- addressing underlying anxiety and depression
- cognitive behavioural approach
o validating that the pain is real, and not just in the patient’s head
o relaxation training
o rewarding the person for behaving in ways inconsistent with the pain
Dissociative disorder – disruption of consciousness, memory and/or identity
Dissociative amnesia – memory loss following a stressful situation
Dissociative fugue – memory loss accompanied by leaving home and starting a new
identity
Depersonalization disorder – altered experience of the self (nothing is real)
Dissociative identity disorder – (split personality)
These usually follow traumatic experiences
Etiology
- stress may store trauma in a way that they are not accessible to awareness.
Possible outcomes are amnesia or fugue
DID (split personality) – theory is physical or sexual abuse as a child
Treatment of DID – hypnosis to enter different personalities. NO CONTROLLED
OUTCOME STUDIES