DISSOCIATIVE
AND SOMATIC
SYMPTOM DISORDERS
CHAPTER 9
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DISSOCIATIVE DISORDERS
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FORMS OF DISSOCIATIVE DISORDERS
• Dissociative identity disorder:
• Formerly called multiple personality disorder
• An individual develops more than one self or personality
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From October 14–26, 1977, three women around Ohio State
University were kidnapped, taken to a secluded area, robbed, and
raped. One woman claimed the man who raped her had a German
accent, while another one claimed that (despite kidnapping and raping
her) he was actually kind of a nice guy. However, one man committed
the rapes: 22-year-old Billy Milligan.
After his arrest, Milligan saw a psychiatrist, and he was diagnosed with
DID. Altogether, he had 24 different personalities. So when the
kidnapping and rapes happened, Milligan’s defense attorney said it
wasn’t Billy Milligan who was committing the crimes. Two different
personalities were in control of his body—Ragen, who was a
Yugoslavian man, and Adalana, who was a lesbian. The jury agreed,
and he was the first American found not guilty due to DID. He was
confined to a mental hospital until 1988 and released after experts
thought that all the personalities had melded together.
In 1981, Daniel Keyes, the award-winning author of Flowers for
Algernon, released a book about Milligan’s story called The Minds of
Billy Milligan. An upcoming film based on his story, The Crowded
Room, will reportedly star Leonardo DiCaprio.
Milligan died December 12, 2014 at the age of 59 from cancer.
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People with DID have distinct personalities. Instead of distinct
personalities, people with DID have different states. Brand describes it
as “having different ways of being themselves, which we all do to
some extent, but people with DID cannot always recall what they do or
say while in their different states.” And they may act quite differently in
different states.
Also, “There are many disorders that involve changes in state.” For
instance, people with borderline personality disorder may go “from
relatively calm to extremely angry with little provocation.” People with
panic disorder may go “from an even emotional state to extremely
panicked.” “However, patients with those disorders recall what they do
and say in these different states, in contrast to the occasional amnesia
that DID patients experience.”
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It’s obvious when someone has DID. Sensationalism
sells. So it’s not surprising that depictions of DID in
movies and TV are exaggerated. The more bizarre the
portrayal, the more it fascinates and tempts viewers to
tune in. Also, overstated portrayals make it obvious that
a person has DID. But “DID is much more subtle than
any Hollywood portrayal,” Brand said. In fact, people with
DID spend an average of seven years in the mental
health system before being diagnosed.
They also have comorbid disorders, making it harder to
identify DID. They often struggle with severe treatmentresistant depression, post-traumatic stress disorder
(PTSD), eating disorders and substance abuse. Because
standard treatment for these disorders doesn’t treat the
DID, these individuals don’t get much better, Brand said.
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DID is rare. Studies show that in the general
population about 1 to 3 percent meet full criteria for
DID. This makes the disorder as common as bipolar
disorder and schizophrenia. The rates in clinical
populations are even higher, Brand said.
Unfortunately, even though DID is fairly common,
research about it is grossly underfunded. Researchers
often use their own money to fund studies or
volunteer their time. (The National Institute of Mental
Health has yet to fund a single treatment study on
DID.)
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DISSOCIATIVE AMNESIA
• An inability to remember important personal details
and experiences that is associated with traumatic
or very stressful events.
• This amnesia can be diagnosed with a specifier of
dissociative fugue:
• During which they travel or wander without knowing their
identity.
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A 29-year-old female experienced the onset of dissociative
amnesia during an academic trip to China.[2] She was found
in a hotel bathroom unconscious, with no signs of structural
or neurologic abnormalities or alcohol or chemical
consumption. The woman was sent home but could not
remember her name, address, family, or any facts about her
home life. The amnesia persisted for nearly 10 months, until
the feeling of blood on the woman's fingers triggered the
recollection of events from the night of onset of dissociative
amnesia, and, subsequently, other facts and events. The
woman finally remembered having witnessed a murder that
night in China. She recalled being unable to help the victim
out of fear for her own safety. She came to remember other
aspects of her life; however, some memories remain elusive.
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DEPERSONALIZATION/
DEREALIZATION DISORDER
• A dissociative disorder in which the individual
experiences recurrent and persistent episodes of
depersonalization, derealization, or both:
• Depersonalization is the condition in which people
feel they are detached from their own body.
• Derealization is a condition in which people feel a
sense of unreality or detachment from their
surroundings
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27, single, with a university degree, sought psychiatric treatment with
complaints that she "did not feel her body". She reported that she felt
strange and empty, that her body seemed to be somewhere else and hollow,
with nothing but the skin, and it seemed to be someone else's body. She
had come to the point of wearing numerous bracelets to mark the
boundaries of her own limbs. She also suffered from affective detachment,
frequently stating "I feel like I was dead" or "I feel nothing", but complained
of intense anxiety in social situations. Reality testing was intact. Slightly
depressed mood and mitigated panic-like symptoms were also identified;
however, she did not fulfill the criteria for any other DSM axis I disorder, as
confirmed by the MINI-plus. There were no comorbid conditions or history of
drug abuse. She had a normal neurological examination, and an EEG
showed no abnormalities.
As the patient did not respond to risperidone 2 mg/day, it was replaced with
a selective serotonin reuptake inhibitor (SSRI), which led to anxiety
improvement, but the specific symptoms of DPD grew worse. A subsequent
change to venlafaxine 225 mg/day led to a significant mood improvement
and a reduction in panic-like episodes; however, depersonalization and
derealization remained unchanged.
ed for the young man to speak with a therapist. The young man described
feeling as though he were observing the interactions of others as if it were a
film. The young man's anxiety was determined to contribute to severe sleep
deprivation, which triggered episodes of depersonalization.
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TREATMENT OF
DISSOCIATIVE DISORDERS
• Goal
• Integrate alters
• Methods
• Hypnotherapy
• Cognitive behavioral techniques
• Treatment of dissociative disorders often involves
not only these disorders themselves, but also
associated disorders of mood, anxiety, and posttraumatic stress.
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ITEMS FROM THE SCID-D-R
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THE BIOPSYCHOSOCIAL
PERSPECTIVE
• Distinctions between real and fake psychological
symptoms
• Cognitive-behavioral explanations
• How stress affects physical functioning
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written consent of McGraw-Hill Education.
SOMATIC SYMPTOM AND
RELATED DISORDERS
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written consent of McGraw-Hill Education.
SOMATOFORM DISORDERS
• Somatic symptoms involving physical problems
and/or concerns about medical symptoms.
• The term “somatic” comes from the Greek word “soma,”
meaning body.
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SOMATIC SYMPTOM DISORDER
• Somatic Symptom Disorder involves physical symptoms
that may or may not be accountable by a medical
condition.
• They also have maladaptive thoughts, feelings, and behaviors.
• People with this disorder think to a disproportionate degree
about the seriousness of their symptoms.
• They feel extremely anxious about them, and spend a great deal of
time and energy to the symptoms or their concerns about their
health.
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ILLNESS ANXIETY DISORDER
• Illness Anxiety Disorder is a somatic symptom
disorder characterized by the misinterpretation of
normal bodily functions as signs of serious illness.
• People with this disorder fear or mistakenly believe
that normal bodily reactions represent the
symptoms of a serious illness.
• Formerly called Hypocondriasis.
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CONVERSION DISORDER
(FUNCTIONAL NEUROLOGICAL
SYMPTOM DISORDER)
• A somatic symptom disorder involving the translation of
unacceptable drives or troubling conflicts into physical
symptoms.
• Clients with conversion disorder show a wide range of
physical ailments:
•
•
•
•
•
•
•
•
Pseudoseizures
Disorders of movement
Paralysis
Weakness
Disturbances of speech
Blindness and other sensory disorders
Cognitive impairment
https://www.youtube.com/watch?v=_jOuqAcgMrA
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CONDITIONS RELATED TO SOMATIC
SYMPTOM DISORDERS
• Factitious disorder imposed on self, people fake symptoms or
disorders, not for the purpose of any particular external gain but
because of an inner need to maintain a sick role.
• The individual may also feign the illness of someone else in cases of
factitious disorder imposed on another (or Munchausen’s syndrome
by proxy)
• Malingering is the fabrication of physical or psychological symptoms
for some ulterior motive.
• No longer a diagnosis in the DSM
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THEORIES AND TREATMENT OF
SOMATIC SYMPTOM
AND RELATED DISORDERS
•
•
•
•
Cognitive behavioral therapy
Hypnotherapy
Medication
Interpersonal therapy
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PSYCHOLOGICAL FACTORS AFFECTING
OTHER MEDICAL CONDITIONS
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written consent of McGraw-Hill Education.
PSYCHOLOGICAL FACTORS AFFECTING
MEDICAL CONDITIONS
• Disorder in which clients have a medical disease or
symptom that appears to be exacerbated by
psychological or behavioral factors.
• Depression, stress, denial of a diagnosis, or engaging in poor
or even dangerous health related behaviors
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written consent of McGraw-Hill Education.
PSYCHOLOGICAL FACTORS AFFECTING OTHER
MEDICAL CONDITIONS
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written consent of McGraw-Hill Education.
STRESS AND COPING
• Stress
• Coping strategies for stress
• Problem-focused
• Emotion-focused
• Emotional expression
• Personality style
• Type A behavior pattern
• Type D personality
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APPLICATIONS TO BEHAVIORAL
MEDICINE
• Behavioral medicine: An interdisciplinary approach
to medical conditions affected by psychological
factors that is rooted in learning theory
• Psychoeducation
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chapter, visit our Web site:
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