Dissociative & Somatoform Disorders DISORDER V. FAKING Malingering = faking bad - symptoms...

Dissociative & Somatoform Disorders

DISORDER V. FAKING

Malingering = faking bad

- symptoms deliberate

- for gain

- not a disorder

Factitious Disorder

= psychological need to lie

- only for psychological gain

- symptoms deliberate

- a mental disorder

Ex. Munchausen’s Syndrome

- lies for medical attention

Munchausen by proxy

- creating physical problems in another for medical attention

Somatoform Disorders

= physical symptoms without physical basis

- psychological disorder

- may be gain

- symptoms not deliberate**

Undiagnosed physical illness

Somatoform Disorders

Physical complaints with no physical cause

1. Conversion Disorder

Freud: conflicts converted into sxs

- women

Description

• Affects voluntary movement/sensation

• Identifiable stressors

• Not explained medically

• Not intentional

• Distress/impairment

• Decreasing incidence

Signs of conversion

• Sudden onset after stress

• La belle indifference

• Selective symptoms

Possible Causes

Psychodynamic: 4 processes:

1) traumatic event--> impulse emerges

2) conflict is repressed

3) anxiety increases, is “converted” into physical symptom

- avoid anxiety (primary gain)

4) attention/sympathy & avoid tasks (secondary gain)

Learning Theory

1) traumatic event => escape/avoid

2) symptom develops

3) environment reinforces symptoms

Other: Personality type

- histrionic

Treatment

1) Deal with stressor

2) Remove secondary gain

3) Teach reuse of body part

2. Hypochondriasis

Description

- belief of serious illness (anxiety)

- illness is long-term

- misinterpret body symptoms

- symptoms are wide-ranging

- agree that reaction is excessive

• “doctor shopping”

• distress/impairment

• men & women

Possible Causes

Theoretical agreement

• faulty interpretation of sensations

• biological hypersensitivity

• learned focus on illness

Treatment

• Uncover unconscious conflicts

• Attack illness beliefs

via cognitive-behavioral

• Support groups

3. Somatization Disorder

Description

• Multiple somatic complaints

• Most major body systems

• No physical basis

• Concern = symptoms themselves, not illness

• Life revolves around symptoms

• Relating to others = symptoms

• Lengthy medical history

• Severe impairment

• Very rare - women

Possible Causes

• Childhood learning

• Identifiable stressor

• Personality traits

- insensitive to punishment

- impulsive (short-term gains)

- irresponsible

- aggressive

• Women

- socialization

Treatment

• Very difficult

• Reduce help-seeking behavior

• Increase independence

• No reinforcement for symptoms

• Teach more appropriate behavior

4. Body Dysmorphic Disorder

Description

• Perceived defect in appearance

• Imagined/exaggerated

• Face/head flaws

• Difficulty controlling obsession

• Frequently check appearance

• Requests reassurance

• Plastic surgery

• Distress & life impairment

• Prevalence unknownbut probably common

• Men & women

Causes & Treatment

• Little known

• Related to OCD?

- anxiety

• Surgery increases complaints

Dissociative Disorders

Splitting off of a psychological function from rest of conscious mind

1. Dissociative Identity Disorder (DID)

Description

• 2+ distinct personalities

• Alternate control of body

—> NOT INTEGRATED

• “Core” has amnesia

• DID vs. Schizophrenia

• Does DID exist?

(iatrogenic effects)

Indications of DID

• Amnestic periods

• Childhood abuse or trauma

• Unsuitable nickname

• Hypnotizability

2. Dissociative Amnesia

• Loss of memory

• Traumatic event

• Lack of distress

3. Dissociative Fugue

• Amnesia for identity

• Flight

• New life & identity

• Brief duration

4. Depersonalization Disorder

• Recurrent detachment from self/body

• Observing self

• Good reality perception

• Distress

Possible Causes

• Childhood sexual abuse/trauma

• Self-hypnosis

• Biological vulnerability

Treatment

• Amnesia & fugue get better on own

• Resolve trauma

• Improve coping

Tx for DID

• Uncover & deal with trauma

• Hypnosis to remember

• Goal: integrate personalities