Dissociative Disorders,Somatoform and Related

Disorders

Dissociative Disorder

Dissociative Disorder (DD)

• Are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.

Dissociative Disorder

1. Dissociative Identity Disorder (DID)2. Dissociative Amnesia3. Depersonalization/Derealization Disorder

Dissociative Identity Disorder

Dissociative Identity Disorder (DID)A dissociative disorder, formerly called multiple personality disorder, in which an individual develops more than one self or personality.• Alters• Host• Birth Person• Core Personality• Switching

Common Dissociative Identity Disorder Alter Types• Child and adolescent alters – young alters are often

the first discovered in therapy and are the most common type of alter. These alters emerge to handle the abuse that the original personality couldn't tolerate. A DID alter may be referred to as a "little" if the alter acts seven years or younger.

• Protector or rescuer alters – these alters can be of any age and were created to save the original person from intolerable situations. These DID alters are often tougher and braver than the original personality.

Common Dissociative Identity Disorder Alter Types• Persecutor alters – these DID alters are modeled after

the abuser. Persecutor alters create negative messages blaming the original identity for the abuse and telling them they need to die or pay for it. Often the host will act on these negative messages and self-harm or even attempt suicide. This is often when the person is first introduced to the mental health system.

• Perpetrator alters – also modeled after the abuser, these dissociative identity disorder alters direct their hostility outward rather than inward towards other personalities.

Common Dissociative Identity Disorder Alter Types

• Avenger alters – this dissociative identity disorder alter holds the rage from the childhood abuse and may seek retribution from the abuser. They tend to express the anger of the entire system and can be hostile.

Symptoms• Memory loss (amnesia) of certain time periods,

events and people.• Mental health problems, such as depression, anxiety,

and suicidal thoughts and attempts.• A sense of being detached from yourself.• A perception of the people and things around you as

distorted and unreal.• A blurred sense of identity.• Significant stress or problems in your relationships,

work or other important areas of your life.

Diagnostic Criteria A. Disruption of identity characterized by two or more

distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by individual.

Diagnostic Criteria B. Recurrent gaps in the recall of everyday events,

important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.

Diagnostic Criteria E. The symptoms are not attributable to the

physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Treatment for Dissociative Identity Disorder

While there's no "cure" for dissociative identity disorder, long-term treatment is very successful, if the patient stays committed. Effective treatment includes:

• Talk Therapy • Medications• Hypnotherapy

Dissociative Amnesia

Dissociative Amnesia

Inability to remember details and experiences associated with traumatic or stressful events.

Symptoms• Confusion• Emotional distress related to the amnesia.

However, not all patients with dissociative amnesia are distressed. The degree of emotional upset is usually in direct proportion to the importance of what has been forgotten, or the consequences of forgetting.

• Mild depression.

Diagnostic Criteria A. An inability to recall important

autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

NOTE: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

Diagnostic Criteria B. The symptoms cause clinically significant distress or

impairment in social, occupational, or other important areas of functioning.

C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, other neurological condition).

Diagnostic Criteria

D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.

Dissociative AmnesiaFive Patterns:

1. Localized Amnesia2. Selective Amnesia3. Generalized Amnesia4. Systematized Amnesia5. Continuous Amnesia

Five Patterns:

1. Localized Amnesia – a failure to recall events during a circumscribed period of time.

2. Selective Amnesia – the individual can recall some, but not all, of the events during circumscribed period of time.

3. Generalized Amnesia – a complete loss of memory for one’s life history. May also forget personal identity.

Five Patterns:

4. Systematized Amnesia – the individual loses memory for a specific category of information.

5. Continuous Amnesia – the individual forgets each new event as it occurs.

Treatment• Psychotherapy• Cognitive-Behavioral Therapy• Eye Movement Desensitization and

Reprocessing• Dialectic-Behavior Therapy• Clinical Hypnosis• Medication

Depersonalization/Derealization Disorder

Depersonalization/Derealization DisorderDepersonalization – one’s sense of one’s own self and one’s own reality is temporarily lost.

Derealization – one’s sense of the reality of the outside world is temporarily lost.

Symptoms (Depersonalization)

• Feelings that you're an outside observer of your thoughts, feelings, your body or parts of your body, perhaps as if you were floating in air above yourself.

• Feeling like a robot or that you're not in control of your speech or movements.

• The sense that your body, legs or arms appear distorted, enlarged or shrunken, or that your head is wrapped in cotton.

• Emotional or physical numbness of your senses or responses to the world around you.

• A sense that your memories lack emotion, and that they may or may not be your own memories.

Symptoms (Derealization)

• Feelings of being alienated from or unfamiliar with your surroundings, perhaps like you're living in a movie.

• Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall.

• Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial, or a heightened awareness and clarity of your surroundings.

• Distortions in perception of time, such as recent events feeling like distant past.

• Distortions of distance and the size and shape of objects.

Diagnostic CriteriaA. The presence of persistent or recurrent experiences of

depersonalization, derealization, or both:

1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).

2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

Diagnostic CriteriaB. During the depersonalization or derealization

experiences, reality testing remains intact.C. The symptoms cause clinically significant

distress or impairment in social, occupational or other important areas of functioning.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).

Diagnostic Criteria

E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

Treatment

• Psychotherapy• Psychodynamic therapy• Cognitive techniques• Behavioral techniques• Grounding techniques • Moment-to-moment tracking and labeling of

affect and dissociation

Somatic Symptom and Related Disorder

Somatic Symptom Disorderssoma = “body” in Greek

• A wide variety of conditions in which psychological

conflicts are translated into physical problems or

complaints.

• Impair functioning, cause distress.

• No physiological basis.

• Won’t be indicated on physical or neurological tests.

Symptoms• Having a high level of worry about potential illness.• Considering normal physical sensations as a sign of

severe physical illness.• Fearing the medical seriousness of symptoms, even

when there is no evidence to support that concern.• Appraising physical sensations as threatening,

harmful or causing problems.• Feeling that medical evaluation and treatment have

not been adequate.

Symptoms• Fearing that physical activity may cause damage to

your body.• Repeatedly checking your body for abnormalities.• Frequent health care visits that don't relieve your

concerns or that make them worse.• Being unresponsive to medical treatment or

unusually sensitive to medication side effects.• Having a more severe impairment than would

usually be expected related to a medical condition.

Diagnostic CriteriaA. One or more somatic symptoms that are distressing or

result in significant disruption of daily life.B. Excessive thoughts, feelings, or behaviors related to

the somatic symptoms or associated health concerns as manifested by at least one of the following:

1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

2. Persistently high level of anxiety about health or symptoms.

3. Excessive time and energy devoted to these symptoms or health concerns.

Diagnostic CriteriaC. Although any one somatic symptom may not be

continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Specify if:With predominant pain (previously pain disorder): This

specifier is for individuals whose somatic symptoms predominantly involve pain.Specify if:

Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).

Diagnostic CriteriaSpecify current severity:

Mild: Only one symptoms specified in Criterion B is fulfilled.

Moderate: Two or more of the symptoms specified in Criterion B is fulfilled.

Severe: Two or more of the symptoms specified in Criterion B is fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

1. Illness Anxiety Disorder2. Conversion Disorder3. Psychological Factor Affecting

Other Medical Conditions4. Factitious Disorder

Types of Somatic Symptom Disorders

Illness Anxiety Disorder

Illness Anxiety Disordermore commonly referred to as Hypochondria, or

Hypochondriasis

A type of "somatoform" disorder in which a person misinterprets their normal physical experiences as symptoms of some type of disease.

Symptoms• Thinking that a headache is indicative of a

brain tumor.• Believing that a cough must be sign of lung

cancer.• Assuming that a minor chest pain is a heart

attack.• Thinking that a minor sore is a sign of AIDS.

Symptoms• Multiple doctor visits, sometimes “doctor-hopping”

on the same day.• Multiple medical tests, often for the same alleged

condition.• Repetitive checking of the body for symptoms of an

alleged medical condition.• Repeatedly avoiding contact with objects or

situations for fear of exposure to diseases.• Habitual internet searching for information about

illnesses and their symptoms (“Cyberchondria“).

Diagnostic CriteriaA. Preoccupation with fears of having, or the idea that

one has, a serious disease based on the person’s misinterpretation of bodily symptoms.

B. The preoccupation persists despite appropriate medical evaluation and reassurance.

C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).

Diagnostic CriteriaD. The preoccupation causes clinically significant

distress or impairment in social, occupational, or other important areas of functioning.

E. The duration of the disturbance is at least 6 months. F. The preoccupation is not better accounted for by

Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

Treatment

• Exposure and Response Prevention (ERP)• Cognitive Restructuring• Imaginal Exposure

Conversion Disorder

Conversion Disorder (CD)(Functional Neurological Symptom Disorder)

A somatic symptom disorder involving the actual loss of bodily function such as blindness, paralysis, and numbness due to excessive anxiety.

Four categories of symptoms:

1. Motor symptoms or deficits2. Sensory symptoms or deficits3. Seizures or convulsions4. Mixed presentations

Conversion Disorder (CD)

Diagnostic Criteria A. One or more symptoms of altered voluntary motor or

sensory function.B. Physical findings provide evidence of incompatibility

between the symptom and recognized neurological or medical conditions.

C. The symptom or deficit is not better explained by another medical or mental disorder.

D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Treatment

• Counseling (psychotherapy)• Physical therapy• Treating related stress and other conditions

Psychological Factor Affecting Other Medical

Conditions

Psychological Factor Affecting Other Medical Conditions

Psychological factors affecting other medical conditions (PFAOMC) is a disorder that is diagnosed when a general medical condition is adversely affected by psychological or behavioral factors; the factors may precipitate or exacerbate the medical condition, interfere with treatment, or contribute to morbidity and mortality. In addition, the factors are not part of another mental disorder (e.g., unipolar major depression).

Diagnostic CriteriaA. A medical symptom or condition (other than

a mental disorder) is present.B. Psychological or behavioral factors adversely

affect the medical condition in one of the following ways:

1. The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.

Diagnostic Criteria2. The factors interfere with the treatment of the medical condition (e.g., poor

adherence).3. the factors constitute additional well-established health risks for the individual.4. The factors influence the underlying pathophysiology, precipitating or

exacerbating symptoms or necessitating medical attention.

Diagnostic CriteriaC. The psychological and behavioral factors in Criterion B are not

better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder).

Specify current severity:

Mild: Increases medical risk (e.g., inconsistent adherence with antihypertension treatment).

Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating asthma).

Severe: Results in medical hospitalization or emergency room visit.

Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attack symptoms).

Factitious Disorder

Factitious Disorder

Is a condition in which a person acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder imposed on another is a condition in which a person deliberately produces, feigns, or exaggerates the symptoms of someone in his or her care.

Symptoms• Clever and convincing medical problems• Frequent hospitalizations• Vague or inconsistent symptoms• Conditions that get worse for no apparent

reason• Conditions that don't respond as expected to

standard therapies• Eagerness to have frequent testing or risky

operations

Symptoms• Extensive knowledge of medical terms and diseases• Seeking treatment from many different doctors or

hospitals, which may include using a fake name• Having few visitors when hospitalized• Reluctance to allow health professionals to talk to

family or friends or to other health care providers• Arguing with hospital staff• Frequent requests for pain relievers or other

medications

Diagnostic CriteriaFactitious Disorder Imposed on SelfA. Falsification of physical or psychological signs or

symptoms, or induction of injury or disease, associated with identified deception.

B. The individual presents himself or herself to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Diagnostic CriteriaSpecify:• Single Episode• Recurrent Episode (two or more events of falsification of

illness and/or induction of injury)

Factitious Disorder Imposed on Another (Previously Factitious Disorder by Proxy)A. Falsification of physical or psychological signs or symptoms,

or induction of injury or disease, associated with identified deception.

B. The individual presents another individual (victim) to others as ill, impaired, or injured.

Diagnostic CriteriaC. The deceptive behavior is evident even in the

absence of obvious external rewards.D. The behavior is not better explained by another

mental disorder, such as delusional disorder or another psychotic disorder.

NOTE: The perpetrator, not the victim, receives this diagnosis.

Specify:• Single Episode• Recurrent Episode (two or more events of falsification of

illness and/or induction of injury)

Treatment

• Talk Therapy (psychotherapy) • Behavior Counseling• Family Therapy

Other Specified Somatic Symptom and Related Disorder

This category applies to presentations in which symptoms characteristic of a somatic symptom and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the somatic symptom and related disorders diagnostic class.

Other Specified Somatic Symptom and Related Disorder

Examples of presentations that can be specified using the “other specified” designation include the following:1. Brief somatic symptom disorder: Duration of symptoms is

less than 6 months. 2. Brief illness anxiety disorder: Duration of symptoms is less

than 6 months.3. Illness anxiety disorder without excessive health-related

behaviors: Criterion D for illness anxiety disorder is not met. 4. Pseudocyesis: A false belief of being pregnant that is

associated with objective signs and reported symptoms of pregnancy.

Unspecified Somatic Symptom and Related Disorder

This category applies to presentations in which symptoms characteristic of a somatic symptom and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the somatic symptom and related disorders diagnostic class. The unspecified somatic symptom and related disorder category should not be used unless there are decidedly unusual situations where there is insufficient information to make a more specific diagnosis.

Thank You =)