Somatoform disorders characterized by the presence of physical symptoms that suggest a medical condition but for which no evidence of a medical cause can be found. people with this disorder BELIEVE that they have one or more medical problems, despite the fact that evidence suggests otherwise. How does it differ from psychosomatic disorders? People suffering from psychosomatic disorders clearly have a medical problem but psychological factors are presumed to have contributed to it Somatization Disorder characterized by a prevasive and recurring pattern of reports of multiple physical symptoms for which no physical cause can be found. This pattern starts before the age of 30 and typically lasts for many years At least 4 symptom domains must be included- Pain, Gastrointestinal, Sexual & Pseudoneurological symptoms. Symptoms Required for Somatization Disorder • Pain symptoms Head, abdomen, back, joints, extremities, chest, rectum and pain during menstruation, sexual intercourse or urination • Gastrointestinal symptoms Nausea, bloating, vomitting (unless it is part of pregnancy), diarrhea and intolerance of several different foods • Sexual symptoms Sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding &vomitting throughout pregnancy • Pseudoneurological symptoms Impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in the throat, loss of voice, difficulty urinating, hallucinations, loss of touch or pain sensations, double vision, blindness, deafness, seizures, amnesia and loss of consciousness CONVERSION DISORDER • “ originally known as Conversion Neurosis”. • Freud believed that an unconscious sexual or aggressive conflict was “converted” into a physical problem. • Originally known as “hysteria”. • Patients complain of physical problems or impairments of sensory or motor functions controlled by the voluntary nervous system, all suggesting a neurological disorder but with no underlying organic cause. • are not consciously faking symptoms. • Believe that there is a genuine physical problem, and it produces notable distress or impairment in social functioning. • Hypnosis used to be the cure. Most Common: • Psychogenic pain • Disturbances in Stance and Gait • Sensory symptoms • Dizziness • Psychogenic seizures *most are due to stress..(75% of the time) PAIN DISORDER Characterized by reports of severe pain that may……. • Have no physiological or neurological basis. • Be greatly in excess of that expected with an existing physical condition. • Linger long after a physical injury has healed. Patients…….. • Have numerous physical complaints. • More vague in their description of the pain and are less able to localize the area of pain. Common types………. • Recurrent abdominal pain • Reflex Sympathetic Dystrophy Hypochondriasis unrealistic and recurring fears/beliefs that one has a disease despite medical reassurance of being otherwise • unlike somatization disorders, a hypochondriac may not really suffer from any specific symptoms (DIAGNOSABLE HYPOCHONDRIASIS IS VERY RARE: a study of 1,456 patients in a certain institution found that only 3% met the diagnostic criteria for hypochondriasis) • Criterion 1 is not of delusional intensity and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder). • The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. • Duration of at least 6 months • Comorbidity with depression and anxiety makes it more of a symptom than a separate disorder in itself • The etiology of hypochondriasisCognitive-emotional perspective (thinking and feeling) • Freudian Conversion theory • Social-behavioral perspective Hypochondriasis: treatment Psychological treatment comes in two forms: psychoanalytic and cognitive approaches • Psychoanalysis: aims to help the sufferer identify feelings and thoughts behind symptoms, and to find adaptive ways of coping • Cognitive approach: aims to help clients learn to interpret their physical symptoms appropriately, and to avoid catastrophizing physical symptoms Body Dysmorphic Disorder (BDD): Symptoms • An excessive preoccupation with a part of one’s body, resulting to elaborate means to change or conceal that part of the body • If a slight physical anomaly is present, the person's concern is markedly excessive. • Tends to begin around teenage years (around 16 years old), with four or more bodily preoccupations • Sufferers are likely to repeatedly seek plastic surgery to change the “offensive” part • BDD etiologySerotonin (the lack of it is just…sad…remember SAD?) • Gene pool blues • Nurture ( values and the media, maybe even cultural norms) Body Dysmorphic Disorder: treatment Treatment has two common forms: psychodynamic and Cognitive-Behavioral (there’s a secret third technique!) • Psychodynamic approach: what repressed thoughts are you hiding inside your nose? • Cognitive-Behavioral approach: why do you keep telling yourself that your nose looks ugly? • SSRIs Causes of Somatoform Disorders No current theory explains these disorders well. Psychodynamic Perspective Psychoanalytic theories: Sigmund Freud – conversion disorders = actively seeking both the cause and effective treatments Freud: proposed that the physical symptoms were a manifestation of an underlying psychological conflict if Electra complex is not resolved, events that trigger sexual feelings in adulthood will lead to additional efforts to hide from those feelings thus creating the conditions that foster development of conversion disorders conversion symptoms were the woman’s efforts to hide, even from herself, the sexual feelings that should be abhorrent Modern psychoanalytic theorists: focused on generic unconscious conflicts that arouse such anxiety that the individual must translate them into something less threatening (such as a physical symptom) Behavioral Perspective focuses on the consequences of having a disorder secondary gain – the pathology is being maintained by the positive reinforcement it produces as a secondary effect Freud: the reduction in anxiety that resulted in anxiety that resulted from the conversion of a psychologically distressing feeling into a physical symptom was what motivated the conversion process; noted that the symptoms of conversion disorder often had secondary gain in that his clients could avoid activities that they disliked data in support of the perspective are inconclusive Cognitive Perspective Could the way one thinks affect the likelihood of somatoform symptoms? People with hypochondriasis, somatization disorder, and conversion disorder all experience physical sensations that they misinterpret as signs of one or more physical disorders If one focuses on the symptoms, the perceived intensity of the symptom increases If one is convinced that the feelings are signs of illness, anxiety increases, which intensifies the whole experience Is there independent evidence that people with somatoform disorders are especially sensitive to illness – related material? can be evaluated using the Emotional Stroop Test result suggests that these people are especially sensitive to the target words Sociocultural Perspective focuses on both family and cultural influences Individuals with hypochondriasis or somatization disorder have histories that include excessive illness in their families while they were growing up, which may have sensitized these individuals to health issues People with somatoform disorders often report the same symptoms reported by family members Excessive concern can lead to vicious circle This family pattern suggests the possibility that individuals learn to be afraid of illnesses and thus show these exaggerated health concerns Biological Perspective No studies of genetic influences on either hypochondriasis or conversion disorder There is evidence that pain disorders run in families, but this does not establish that genes are responsible. Family, twin, and adoption studies all suggest that somatization disorder has a genetic component, which appears to be shared with antisocial personality disorder 2 disorders may share a neurologically based disinhibition – both groups tend to be behaviorally impulsive Brain mechanisms associated: orbital frontal cortex, hippocampus, septal area of the brain – disrupted in both somatization disorder & antisocial personality disorder suggests that there might be a biological underpinning for these disorders TREATING SOMATOFORM DISORDERS Treatment approaches differ by condition, but share many features RULING OUT PHYSICAL DISORDERS o looking for a physical cause when the presenting complaint includes physical symptoms should always be the first step o the only way to rule out a physical cause is to test for it and have the test come back to negative PROVIDING CLIENTS WITH ALTERNATIVES o All of the treatment approaches have one thing in common: They attempt to give clients alternative ways of looking at their symptoms o If somatoform symptoms appear to be related to a traumatic event = help clients to develop insight into their response to the trauma, alternative ways of dealing with distress, provide support during the normal healing process (matter of faith) o CBT: alternative exploration for their symptoms – the symptoms were partly controlled by the amount of attention paid to them FAMILY THERAPY: focus on how family members respond to the person with the somatoform disorder and on what benefits, if any, derives from the symptoms Hypnosis: treatment of conversion disorder Most treatments of somatoform disorders attempt to reduce this excessive seeking of reassurance and medical care MEDICATIONS o not often used as a major treatment of somatoform disorder o use to treat symptomatically the anxiety and depresson that are often present o Tofranil: low doses of the antidepressant imipramine; reduce the pain and distress often reported by individuals with somatoform disorders Dissociative Amnesia -formerly called psychogenic amnesia, -occurs when a person blocks out certain information, usually associated with a stressful or traumatic event, leaving him or her unable to remember important personal information. - the degree of memory loss goes beyond normal forgetfulness and includes gaps in memory for long periods of time or of memories involving the traumatic event. - Dissociative amnesia is not the same as simple amnesia, which involves a loss of information from the memory, usually as the result of disease or injury to the brain. With dissociative amnesia, the memories still exist but are deeply buried within the person’s mind and cannot be recalled. However, the memories might resurface on their own or after being triggered by something in the person’s surroundings. What causes dissociative amnesia? o Linked to overwhelming stress Traumatic events- war, physical abuse, accidents or disasters that the person have witnessed o Genetic Link o One is predisposed to amnesia o Symptoms o The primary symptom of dissociative amnesia is the sudden inability to remember past experiences or personal information o Some people with this disorder also might appear confused and suffer from depression and/or anxiety. Five Types of Amnesia o Localised amnesia: is present in a individual who has no memory of specific events that took place, usually traumatic. The loss of memory is localised within a specific window of time. For example, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localised amnesia. o Selective Amnesia: happens when a person can recall only small parts of events that took place in a defined period of time. For example, and abuse victim may recall only some parts of the series of events around his or her abuse. o Generalised Amnesia: is diagnosed when a person's amnesia encompasses this entire life. o Continuous Amnesia: occurs when the individual has no memory for events beginning from a certain point in the past continuing up to the present. o Systematised Amnesia: is characterised by a loss of memory for a specific category of information. A person with this disorder might, for example, be missing all memories about one specific family member. How is Dissociative Amnesia diagnosed? If symptoms are present, o complete medical history and physical examination. o various diagnostic are done to rule out physical illness or medication side effects as the cause of the symptoms. o If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a dissociative disorder. How is Dissociative Amnesia treated? Psychotherapy o This kind of therapy for mental and emotional disorders uses psychological techniques designed to encourage communication of conflicts and increase insight into problems. o Cognitive therapy o This type of therapy focuses on changing dysfunctional thinking patterns and the resulting feelings and behaviors. o Medication o There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or antianxiety medicine. o Family therapy o This kind of therapy helps to teach the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence. o Creative therapies (art therapy, music therapy) o These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way. o Clinical hypnosis o This is a treatment method that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness (awareness), allowing people to explore thoughts, feelings and memories they may have hidden from their conscious minds. The use of hypnosis for fixing dissociative disorders is controversial due to the risk of creating false memories. Dissociative Fugue Symptoms: o Sudden and unplanned trave or trips away from home o inability to recall past events o loss/confusion of memory about Identity o extreme distress and problems with daily function due to fugue episodes o a fugue may last from hours to weeks to month or even longer CAUSES of Dissociative fugue o Shocking death of a love one o feelings of rejection or separation leads to alternative suicide. o Often associated w/stressful events, unbearable pressure o Triggered by severe trauma such as wars Natural Disasters Sexual abuse TREATMENT Psychotherapy Cognitive therapy Hypnosis Hypnotized into remembering their painful memories and are told to face these memories. note: Dissociative fugue disorder is estimated to affect 0.2% of the population usually adults. DISSOCIATIVE IDENTITY DISORDER - A dramatic disorder in which 2 or more relatively independent personalities appear to exist in one person. CAUSES OF D.I.D combination of environmental and biological factors work together to cause it disorder is theoretically linked with the interaction of overwhelming stress, traumatic antecedents severe physical and sexual abuse, especially during their childhood SYMPTOMS OF D.I.D The patient has at least two distinct identities or personality states. Each of these has its own, relatively lasting pattern of sensing, thinking about and relating to self and environment. lapses in memory (dissociation), particularly of significant life events, like birthdays, wedding, etc. blackouts in time, resulting in finding oneself in places but not recalling how one traveled there; ASSOCIATED FEATURES: Depression Mood swings Suicidal tendencies Sleep disorders (insomnia, night terrors, and sleep walking) Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or "triggers") Alcohol and drug abuse Compulsions and rituals Psychotic-like symptoms (including auditory and visual hallucinations) Eating disorders Statistics show the rate of dissociative identity disorder is .01% to 1% of the general population Depersonalization Disorder What is Depersonalization? (Depersonalization is the third most common psychological experience) Depersonalization is a sense that things around you aren't real, or the feeling that you're observing yourself from outside your body. Many people have a passing experience of depersonalization at some point. But when feelings of depersonalization keep occurring, or never completely go away, it's considered depersonalization disorder. Persistent of recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling like one is in a dream). During the depersonalization experience, reality testing remains intact. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or other Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., drug abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy). Continuous or recurring feelings that you're an outside observer of your thoughts, your body or parts of your body Numbing of your senses or responses to the world around you Feeling like a robot or feeling like you're living in a dream or in a movie The sensation that you aren't in control of your actions, including speaking Awareness that your sense of detachment is only a feeling, and not reality Differential diagnosisTemporal Lobe Seizures ( epilepsy ) Atypical forms of Migraine and Headache Schizophrenia Panic disorder Acute stress Fugue DID Drug abuse Begin with no apparent trigger Start after a life-threatening event, such as an accident or assault Be triggered by fear of having another depersonalization experience Lack of sleep Severe stress Has a history of childhood emotional, physical or sexual abuse Counseling Medications While there are no medications specifically approved to treat depersonalization disorder, a number of medications generally used to treat depression and anxiety may help. Some examples that have been shown to relieve symptoms include fluoxetine (Prozac), clomipramine (Anafranil) and clonazepam (Klonopin). Two-thirds of the patients are women. The onset is often in adolescence or early adult life, with the condition starting before the age of 30 in about half the cases SCHIZOPHRENIC DISORDERS SCHIZOPHRENIA • A severe form of abnormal behavior = “madness” • Different kinds of psychotic symptoms indicating that the person has lost touch with reality. • Officially defined by various combinations of psychotic symptoms in the absence of other forms of disturbance, such as mood disorders, substance dependence, delirium, or dementia. • THREE PHASES OF SCHIZOPHRENIA • Prodormal phase others perceive a change in personality peculiar behaviors, unusual perceptual experiences, outbursts of anger, increased tension, restlessness social withdrawal, indecisiveness, lack of willpower • Active phase hallucinations, delusions, disorganized speech • Residual phase symptoms akin to those in the prodromal phase most dramatic symptoms of psychosis have improved, but negative symptoms remain pronounced SYMPTOMS Can be divided into three (3) dimensions: Positive symptoms - hallucinations, delusions Negative symptoms - blunted affect, anhedonia, apathy, avolition, alogia Disorganization - disorganized speech/thought disorder, catatonia, inappropriate affect DSM - IV - TR DIAGNOSTIC CRITERIA FOR SCHIZOPHRENIA A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a one-month period (or less if successfully treated): Delusions Hallucinations Disorganized speech (such as frequent derailment or incoherence) Grossly disorganized or catatonic behavior Negative symptoms (such as affective flattening, alogia, or avolition) B. Social/Occupational Dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care is markedly below he level achieved prior to the onset. C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms that meet criterion A (active phase symptoms), and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in attenuated form (such as odd beliefs, unusual perceptual experiences). SUBTYPES Arranged hierarchically: • Catatonic • Disorganized • Paranoid • Undifferentiated • Residual Catatonic • Characterized by symptoms of motor immobility (rigidity, posturing) or excessive and purposeless motor activity. • May also include a decreased awareness of the environment and a lack of movement and activity. Disorganized • Characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect. – – Social impairment – Incoherence of speech – Delusions/hallucinations are not wellorganized Paranoid • Characterized by systematic delusions with persecutory or grandiose content. • Preoccupation with frequent auditory hallucinations. * Patients who exhibit disorganized speech, disorganized behavior, flat or inappropriate affect, or catatonic behavior are excluded from a diagnosis of paranoid schizophrenia and would fall into one of the other subtypes. Undifferentiated • Covers patients who do not fit one of the traditional types • Patients with schizophrenia who display prominent psychotic symptoms and either meet the criteria for several subtypes or otherwise do not meet the criteria for catatonic, disorganized, or paranoid types. • Often exhibit some disorganized symptoms together with hallucinations and/or delusions. Residual • Patients who no longer meet the criteria for active phase symptoms but nevertheless demonstrate continued signs of negative symptoms or attenuated forms of delusions, hallucinations, or disorganized speech RELATED PSYCHOTIC DISORDERS • Schizoaffective Disorder • Delusional Disorder • Brief Psychotic Disorder Schizoaffective Disorder • Defined by an episode in which the symptoms of schizophrenia partially overlap with a major depressive episode or a manic episode. • There is a presence of delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. Delusional Disorder • Does not meet the full symptomatic criteria for schizophrenia, but patients are preoccupied for at least 1 month with delusions that are not bizarre. • The presence of hallucinations, disorganized speech, catatonic behavior, or negative symptoms rules out a diagnosis of delusional disorder. Brief Psychotic Disorder • Includes those people who exhibit psychotic symptoms for at least 1 day but no more than 1 month. • Typically accompanied by confusion and emotional turmoil, often but not necessarily following a markedly stressful event. The Dimensions of Schizophrenia • Another way of organizing schizophrenia, less exclusive (dimensions serve as continuous variation): Process-Reactive or Good-Poor Premorbid Positive-Negative Symptoms Paranoid-Nonparanoid Psychogenic Psychoses • Reactive Schizophrenia – onset is sudden: reaction to traumatic event, more responsive to psychoactive drugs • Good Premorbid – prior normal functioning (social, sexual and occupational adjustment) , late onset, better prognosis • Positive Symptoms – presence of something normally absent (i.e. hallucinations, delusions, bizarre / disorganized behavior or thought ) . Performs poorly on test s that involve auditory stimuli. Symptoms may develop to negative symptoms or vice-versa. • Paranoid - TYPE 1 SCHIZOPHRENIA Presence of delusions of persecution or grandeur. Biogenic Psychoses • Process Schizophrenia – onset is gradual: result of an abnormal psychological process (neurophysiologic abnormalities), less responsive to psychoactive drugs • Bad Premorbid – prior poor functioning (social, sexual and occupational adjustment) , early onset, worse prognosis (unremitting course) • Negative Symptoms – absence of something normally present (i.e. poverty of speech, flat affect, withdrawal, apathy or attention impairment –> deficit symptoms endure across all stages of schizophrenia unlike non-deficit symptoms : negative symptoms due to medication ). Performs poorly on test s that involve visual stimuli. Symptoms may develop to positive symptoms or vice-versa. • Non-Paranoid - TYPE 2 SCHIZOPHRENIA Risks & Influencing Factors • Culture influences symptoms and prognosis – Police vs. Sorcerer Delusions or Paranoia – Less industrialized nations (stable family structures) have better prognosis than more industrialized nations (emphasis on competition and self-reliance) – Individual differences affect schizophrenia • likely to be experienced by people who have low IQs, are unemployed, unmarried, live in the city and are of African American descent (vs. European Americans) • Schizophrenia normally strikes in adolescence or early adulthood – Men have it in their Mid20s – Women have it in Late20s • Gender plays an important role too – Men are 1.5 times more vulnerable than women (could be due to the presence of estrogen) – Men tend to exhibit negative symptoms due to brain abnormalities and acquire Type 2 Schizophrenia. This is contrary to women. – SCHIZOPHRENIA:Theory & Therapy Cognitive Perspective Prominent symptom of Schizophrenia is ATTENTION DYSFUNCTION o o Leads to the inability to cope with environmental stress thus contributing to the development of psychoses Over Attention • Cannot focus on one thing and screen out others • Type 1: positive-symptom Schizophrenia (auditory hallucinations leading to bizarre delusions) UNDERATTENTION • Deficit in the working memory making it hard for them to retain information long enough for them to process it (backward-masking paradigm) Cognitive Therapy Process Approach: Cognitive Rehabilitation • Give patient tasks that call upon their defective cognitive skills – memory, attention, social perception – and build them by means of instruction, training, prompting and even monetary rewards Content Approach: Cognitive Therapy • Therapists leads patient to question their thoughts, hallucinations and delusions and teaches them to use efficient coping devices for dealing with unwelcomed thoughts Interpersonal Perspective • High levels of Expressed Emotion (EE) – based on two factors : level of criticism and emotional overinvolvement - is the best predictor for relapse (3 to 4 times more) • Negative and emotionally charged family atmosphere may be related to both the onset and the course of schizophrenia • Communication Deviance (CD) --Double-bind Communication (no-win interchange with mutually contradictory messages wherein one is always the loser) – also contributes to Schizophrenia Family Treatment • Step-by-step method for working out problems, from planning a dinner menu to coping with major crises (brief about schizophrenia and symptoms). More effective in underdeveloped countries than in western industrialized countries, contributes to lower risk of relapse. Behavioral Perspective • Bizarre behaviors elicit a reinforcing response (attention, sympathy, release from responsibilities ) responses become habitual. Wherein “Crazy” behaviors sometimes reap rewards. • Goal of behavioral treatment is to relearn behavior. Social attention should no longer be given following inappropriate behavior. Social attention and cigarettes…would be the consequence of socially acceptable behavior. • The Token Economy: patients are given tokens, points, or some other kind of generalized conditioned reinforcer in exchange for performing certain target behaviors. Improves behavior release from hospital. • Social-skills training. Schizophrenics are socially inept . Thus we help to alleviate problems by teaching them conversation skills, eye contact, appropriate physical gestures, smiling, improved speech intonation. Done in groups, highly structured, give homework. Do retain skills, better adjustment. Sociocultural Perspective • Short term cure for schizophrenia. It is a longterm multifaceted support programs within the community. • Staff maintain daily contact with the patients calling them, dropping by, offering suggestions and generally helping them. • Assertive Community Treatment (ACT) improves social functioning and facilitate independent living. • Personal Therapy – one-on -one case, designed to fit emotional needs of patient , focus on management of emotions avoid the kind that causes relapse. Stress and Emotion Management – 3 years. Unitary Theories: Diathesis and Stress • Cannot be entirely controlled by genes, 81% have no schizophrenic parent or sibling, both genetic and environmental causes. What stresses are likely to convert to schizophrenia? • Feelings of clumsiness and a sense of being different as a result of attention deficits • Increase dependence on parents as a result of being impaired • Poor academic performance and poor coping skills, because of impairment • Stressful family interaction, high EE levels • Communication deviance in family leading to difficulty in communicating with others hence isolation • Frequent hospitalization of a parent or other family member DISSOCIATIVE DISORDERS • A lasting or recurring feeling of being detached from the patient's own body. These are mental disorders in which the normally well-integrated functions of memory, identity, perception, and consciousness are • Reality experience is intact. • The phenomenon causes distress or impairs work, separated (dissociated). People feel as though they have no identity, they are confused about social or personal functioning. who they are, or they experience multiple identities. • …the breakdown of one’s perception of his/her surroundings, memory, The experience doesn't occur solely in the course of another mental disorder. identity, or consciousness. • The disorder is not directly caused by a general medical People feel as though they have no identity, they are confused about condition or by substance use, including medications who they are, or they experience multiple identities. and drugs of abuse. Dissociation arises as a self-defense against trauma. Unlike the phenomenon of repression, in which material is transferred to the dynamic unconscious, dissociation creates a situation in which mental CAUSES Psychological contents coexist in parallel consciousness. Depersonalization is the third most common psychological experience, after feelings of anxiety and feelings of TYPES OF DISSOCIATIVE DISORDERS: • Dissociative Identity • Dissociative Fugue • Dissociative Amnesia • Dissociative Depersonalization depression, and often occurs after a person experiences life threatening danger, such as an accident, assault, or serious illness or injury. Neurobiological Sensory Cortex Hypothalamic-pituitary-adrenal Axis TREATMENTS DEPERSONALIZATION DISORDER 300.6 Insight Oriented: Depersonalization is a state in which the individual ceases to Psychodynamic psychotherapy perceive the reality of the self or the environment. The Cognitive-behavioral therapy patient feels that his or her body is unreal, is changing, or is dissolving; or that he or she is outside of the body. Medications: This can be experienced by normal individual. How? Benzodiazepine tranquilizers Tricyclic antidepressants - lack of sleep Selective serotonin reuptake inhibitors - use of certain anesthetic - emotionally stressful situations SYMPTOMS - emotional numbing DISSOCIATIVE AMNESIA - Is the appropriate diagnosis when the dissociative phenomena are limited to amnesia. - changes in visual perception KEY SYMPTOM – the inability to recall information, usually about - altered experience of one's body stressful or traumatic events in person’s life When symptoms of depersonalization are severe enough to cause A common form of dissociative amnesia involves amnesia for personal significant emotional distress, or interfere with normal functioning, the identity but intact memory of general information. criteria of the DSM-IV-TR for "depersonalization disorder" are met. CHARACTERISTICS Other type of amnesias (e.g., transient global amnesia and postconcussion amnesia) does not occur in patients with dissociative amnesia. EPIDEMOLOGY • own. Amnesia is the most common dissociative symptom and occurs in almost all the dissociative disorders. Dissociative amnesia is thought to be the most common disorder. Causes • childhood. in young adults than in older adults, but it can occur at any age. • stresses, such as divorce or financial ruin). number. Most patients with dissociative amnesia cannot retrieve painful memories of stressful and traumatic events, and thus the emotional • • • they may appear normal and attract no attention however, at some point, they may become aware of the memory loss or confused about their identity. defense mechanism whereby a person alters consciousness as a way • defenses involved in dissociative amnesia include repression and If they are confused, they may come to the attention of medical or legal authorities. denial. • DIAGNOSIS when the fugue ends, they may experience depression, discomfort, grief, shame, intense conflict, and suicidal or aggressive impulses. The diagnostic criteria for dissociative amnesia in DSM-IV-TR (table201) emphasize that the forgotten information is usually of traumatic or usually disappear from their usual haunts, leaving their family and job. Psychoanalytic Approach - The disorder is considered primarily a of dealing with an emotional conflict or an external stressor. Secondary Symptomsmay last from hours to weeks, months, or occasionally even longer. content of the memory is clearly related to the pathophysiology and the cause of the disorder. Many fugues seem to represent disguised wish fulfillment (for example, an escape from overwhelming example, spousal abuse and child abuse – are probably constant in ETIOLOGY is usually triggered by severe trauma, such as wars, accidents, natural disasters, or sexual abuse during It is thought to occur more often in women than in men and more often Cases of dissociative amnesia related to domestic settings – for Usually, fugues last only hours or days, then resolve on their Diagnosis stressful nature. doctor carefully reviews symptoms and does a physical It can only be diagnosed only when the symptoms are not limited to examination to exclude physical disorders that may amnesia that occurs in the course of dissociative identity disorder and contribute to or cause memory loss. do not result from a general medical condition (e.g., head trauma) or ingestion of a substance. Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity TREATMENT – interviewing, drug-assisted interviews with short-acting and are distressed to find themselves in unfamiliar barbiturates, hypnosis (relax), psychotherapy circumstances. history and collects information that documents the DISSOCIATIVE FUGUE DISORDER • • involves one or more episodes of sudden, unexpected, but purposeful travel from home during which people cannot remember some or all of their past life, including who they are (their identity) • circumstances before people left home, the travel itself, and the establishment of an alternate life. The word fugue stems from the Latin word for flight— fugere . usually made retroactively when a doctor reviews the Treatment. Most fugues last for hours or days, then disappear on their own. Psychotherapy (cognitive and creative art therapies) Hypnosis When in a fugue, people disappear from their usual routine and may assume a new identity, forgetting all or some of their usual life. DISSOCIATIVE IDENTITY DISORDER -MULTIPLE PERSONALITY DISORDER - 2 or more distinct personalities distinct from each other, each of which determines behavior and attitudes - host and alters - most serious Diagnostic criteria for 300.14 Dissociative Identity Disorder A. Presence of two or more distinct identities or personality states B. At least 2 of these identities or personality states recurrently take control of the person’s behavior C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness ETIOLOGY D. The disturbances is not due to the direct physiological effects of a -unknown -sever and prolonged Traumatic event in childhood -4 causative factors • traumatic life event • vulnerability for the disorder • environmental factors • absence of external support EPIDEMIOLOGY 5:1 -9:1 Female-to-male ratio common in late adolescence and young adult life mean age of diagnosis- 30 years More common in first degree relatives Coexists with other diorders Suicide attempts- common 2/3 SYMPTOMS Depression mood swings suicidal tendencies – 2/3 phobias Flashbacks or intrusive memories headaches panic attacks alcohol and drug abuse eating disorders compulsions and rituals amnesia, back outs or time loss psychotic- like symptoms substance TREATMENT COUSELING & PSYCHOTHERAPY - family therapy, group therapy PHARMACOTHERAPY - tranquilizers or anti depressants HYPNOSIS