Somatoform and Dissociative Disorders

• Severe anxiety over possibility of having serious illness
• Not alleviated by medical reasurrance
• Causes significant distress or interference with functioning, make changes to behavour and life choiced based on erronous hypothesis about health.
• For at least 6 months

Overlap with panic disorder but more concern with implications and longterm outcome of perceived illenss.

Differentiated from phobia by disease conviction

Differentiated from delusion as they can entertain the possibility of ot having the perceived illess

Cgntive and erceptual distrbances amplify sysmomes and emtionalality/mood.

They misinterpret ambiguous stimuli as threatening-anxiety - preccuation with body -back to physical symtoms.

Past reinforcement of poor health makes it worse

• Rule out physical illness
• Regular appointments for GP that are planned and have clear conditions/boundaries to change pattern
• CBT

• Peaks in Adolescence, and between 40-60yrs
• Culturally specific: Kovo in China (genitals retract into abdoment), Dart in India (loosing semen)

• History of many physical complaints
• Focus o sysmptoms rather than feared underlying illness
• Meet 4 criteria
• 1.Pain (in 4 sites or functioning)
• 2.Gastrointestinal
• 3.Sexual (irregular periods)
• 4.Psuedoneurological (sensory loss, double vision etc

• Before the age of 30
• Seeking treatment over several yrs

Help them adapt to symptoms and shift focus to life stressors

• 1.Symptoms or deficits affecting voluntary motor or sensory function without identifyable organic cause
• 2. Assciated psychological factores (identifable life stressor at time of onset & maint)
• 3. Not intensionally feigned
• 4.Can be diffcult to distinguish from genuine or faked illness (difference is a focus on symptoms but indifferent/not stressed by it)

eg. Blindness, psuedo seizures

• 1.Malingerig: Faking for material or legal gain (often get details and pattern of proposed illness wrong)
• 2. Fictitious: Faking for benifts of sick role (culturally sanctioned)
• 3.Muncheusen syndrome is factitious disorder by proxy (often underlying personality disorder common & should be focus of treatment)

• 1. Pain has clear organic orgins but maintenance is psychological (pain is real)
• 2. Can be difficult to distiinguish because all pain is psychological expereince
• 3. Pain response best to psychological treatment

eg dsyprenea

• CBT (cogntive restructuring)
• Relaxation
• Behavioural activation
• Anti depressents

• 1. Preoccupation with imagiined defect in normal appearance
• 2. Causes significant distress or impairment
• 3. Not delusional
• 4. Often seek plastic/cosmetic surgery (often not satisfied with outcome)

Underdiagnosed as people often too ashamed to disclose or bring attention to it

• CBT
• Anti-depressents (SSRI's) if phobic/obsessive
• Anxiety managment

• Relatively rare conditions
• -Conversion: 50/100 000
• -BDD: 0.7%
• -Somatoform: 0.13% (lifetime prev)
• -Symptoms not warranting full diagnosis: 11.6%

• 1.All more common in women except hyochondriasis
• 2.Feminist view- suppression/abuse of women
• 3.All more common in low SES less educated grous
• 4.Co-occurrence with depression and anxiety high
• 5.Less tolerence or knowledge of phyical/psychologcal health issues.

• Biological factors: Diagnosis by exclusion
• Psychological factors:
• 1. Early traumatic experiences
• 2. Early theory vs contemporary evidece
• 3. Secondary gain/reinforement
• 4. Cognitve factors -negative memory bias
• 5. Alexathymia: difficulty recognising, verbalising and expressing emotions = amplifies symatic complaints, or misattributes emotions as somatic

CBT for reducing physical symptoms in Somatoform, Hypochondriasis, and Body Dysmorphic disorder.

Anti-depressents (prozac) SSRI's

Hypochondriasis: regular medical appointments

• 1. Losing touch wth reality
• 2. Depersonalisation; losing sense of your own reality
• 3. Derealisation; losing sense of reality of external world
• 4. Often occurs under stressful conditions

• 1. Feeling detached from yourself
• 2. Causing serious distress or impairment

• Psychogenic
• Generalised
• Localised or selective (before, during and/or after trauma)
• Memories aren't yet intergrated

• 1. Escape from unbearable stress
• 2. Usually amnestic for what has happened during fugue
• 3. Start or establish new identity, often retur to normal functioning after fugue state

• 1. Trance without alternate identity OR
• 2. Possession trance with alternate identity (culturally santioned trance distinguised by distress)
• 3. Causes significant distress or impairment

• 1. Person has 2 or more distinct personality states
• 2. At least 2 of which recurrently controlling persons behaviour
• 3 Extensive gaps in personal memory

• 1.Fugue and psychogenic amnesia usualy preciitated by trauma
• 2. DID linked to early past trauma (very controversial)

• DID: very rare 200 cases in history to 1980
• -by 1986 6000 cases in America
• -Higher in psychiatric hospitals (40%)
• Issues of misdiagnosis
• Issues of existence of DID

Psychological Factors: Trauma past (DID?) present (fugue)

• Biological Factors:
• -Orbital-frontal cortex: speculation
• -Twin studies: no genetic contribution
• -Can stem from substance use and cognitive disorders of aging

Social Factors: iatrogenesis (made up by therapist)

• DID: goal is reintergration of personalities
• Antianxiety. antidepressents, antipsychotic meds
• Await a more accurate decriptions of the disorders.