Chapter 6: Dissociative & Somatoform Disorders
Dissociative Disorders
 characterized by severe disturbances of identity, memory and consciousness
 causal factors …
1. Dissociative Identity Disorder (formerly MPD) - 1st appeared in DSM-III (1980):
since then …
 At least two distinct personalities exist within the person
 Two or more of these personalities repeatedly take complete control of the
individual’s behaviour.
 There is a failure to recall important personal info too substantial to be accounted
for by ordinary forgetfulness.
 The disorder cannot be accounted for by the effects of a psychoactive substance
or a general medical condition.
 host vs alters …
 Etiology of DID
– vast majority are a result of __________________________________
– dissociative vulnerability – may have a genetic component …
– often have multiple diagnoses ...
 controversial …
2. Dissociative Amnesia
 real & complete memory loss ...
 often only personal info is lost …
 sudden onset …
 Types:
1. Localized Amnesia
2. Selective Amnesia
3. Continuous Amnesia
4. Systematized Amnesia
5. Generalized Amnesia
Repressed Memory Debate – Controversial!
–
Is it possible to “forget” that a trauma/abuse ever happened?
–
Is it possible for someone to go into therapy for other psychological
symptoms (e.g., anxiety, depression), and through psychotherapy
“discover” early abuse?
3. Dissociative Fugue
 sudden, unexpected flight from home; inability to remember past and who one is
 duration …
 typically sudden onset …
 during fugue state:
 memory
 behaviour
4. Depersonalization Disorder
 feeling of being detached from oneself …
 sudden onset …
 impairment in memory loss or identity confusion? …
 common?
for a diagnosis:
–
–
 most likely to occur when mild anx or depression …
Etiology
Abuse, trauma, war
Psychodynamic theory
Massive use of repression
Learning theory
Dissociation = learned response that involves not thinking
about disturbing acts or thoughts; negative reinforcement
Diathesis-stress Model
Proneness to fantasize, highly hypnotizable … = diathesis
Abuse, trauma, warfare = stress
Treatment
DID
Depersonalization Disorder
Somatoform Disorders
 characterized by phys symptoms for which there is no phys cause
 often difficult to differentiate among the various somatoform disorders …
 comorbidity …
 somatoform disorders are distinguished from:

Malingering …

Factitious disorders …
 most common form = Münchausen syndrome …
1. Conversion Disorder
 loss or impairment of physical function but no phys cause
 motor or sensory functioning …
 examples …
 la belle indifference
 some people may be misdiagnosed …
2. Hypochondriasis
 excessive concern about serious illness …
 other cues may trigger fears ...
 comorbidity
 "doctor-shop”
 cognitive perspective …
3. Somatization Disorder
 multiple symptoms … do not have any organic basis
 key feature …
 colourful accounts by patients, yet lacking in precise factual info
 H vs SD …; comorbidity possible
 SD:
 H:
4. Body Dysmorphic Disorder
•
severe preoccupation with defect in appearance in any part of the body
Etiology
Psychodynamic
theory
–
–
Emotions converted into physical symptoms
Symptom may be functional
Learning theories
–
Reinforcing properties of the sick role
Cog mechanisms
–
–
Interpretation of the meaning & significance of these events (e.g., catastrophize
minor bodily sensations)
Uncontrollable preoccupation w somatic experiences
Behavioural
approach
–
–
Reward attempts to assume responsibility & remove sources of reinforcement
Stress mgmt …
Cognitive
restructuring
–
Avoid catastrophizing …
–
_______________ for hypochondriasis
Formative
experiences
Treatment
Medications