Somatoform Disorders

Somatoform Disorders

• Somatoform disorders manifest as physical symptoms that are caused by psychological distress without medical explanations.
• Dissociative disorders involve disruptions in memory, identity, or consciousness.

History of Somatoform Disorders

• Historically, unexplained physical symptoms in women were attributed to a "wandering uterus".
• Freud's "Talking Cure", exemplified by the case of Anna O., demonstrated how addressing psychological issues could alleviate physical symptoms.

Key Concepts in Somatoform Disorders

• Malingering is faking symptoms for external benefits and factitious disorder is deliberately producing symptoms for the "sick role."
• Conversion disorder involves psychological conflicts converting into neurological symptoms like blindness or paralysis.
• Somatization disorder presents as multiple chronic physical complaints across different systems.
• Pain disorder is persistent, severe pain without an identifiable physical cause.
• Hypochondriasis (illness anxiety disorder) is excessive worry about having a serious illness despite medical reassurance.
• Body dysmorphic disorder (BDD) is extreme distress over minor/nonexistent flaws.

Dissociative Disorders

• Mild dissociation includes daydreaming or "zoning out". Severe dissociation involves memory loss or identity fragmentation.
• Dissociative Identity Disorder (DID) involves two or more distinct personalities (alters), e.g., Sybil's claim of 16 personalities.
• Dissociative fugue is sudden travel and identity change with amnesia.
• Dissociative amnesia is memory loss of personal information, either localized to a traumatic event or generalized to an entire life history.
• Depersonalization/derealization disorder is feeling detached from oneself or surroundings.

Schizophrenia: Historical Context

• Ancient civilizations recognized "madness" with hallucinations and erratic behavior.
• In the Middle Ages, it was often linked to demonic possession.
• Emil Kraepelin described Dementia Praecox in the 1800s, distinguishing it from mood disorders.
• Eugen Bleuler coined "Schizophrenia" in 1908, meaning "split mind," to describe fragmentation of thought.

Schizophrenia: Symptoms

• Positive symptoms are excesses or distortions of normal functions.
  • Hallucinations are sensory experiences without external stimuli. Auditory hallucinations are most common.
  • Delusions are strongly held false beliefs.
  • Persecutory delusions are beliefs of being spied on.
  • Grandiose delusions are beliefs of being the chosen savior of humanity.
  • Control delusions are beliefs of having thoughts controlled by aliens.
  • Disorganized speech is incoherent or fragmented speech.
  • Word salad is jumbling words together without meaning.
  • Tangential speech is going off-topic without returning.
• Negative symptoms are deficits in normal functioning.
  • Alogia is reduced speech output or empty speech.
  • Anhedonia is an inability to feel pleasure.
  • Avolition is a lack of motivation or inability to initiate activities.
  • Flat affect is limited or absent emotional expression.
  • Social withdrawal is avoiding relationships or interactions.
• Cognitive symptoms are difficulties in thought processing.
  • Attention deficits include struggling to focus on a task.
  • Impaired memory includes difficulty recalling information.
  • Poor executive functioning involves trouble with planning and decision-making.

Related Disorders

• Schizoaffective disorder is a combination of schizophrenia and mood disorders.
• Schizophreniform disorder lasts less than six months.
• Brief psychotic disorder is a sudden onset of psychotic symptoms.
• Delusional disorder involves persistent non-bizarre delusions without other schizophrenia symptoms.
• Shared psychotic disorder (Folie à deux) is when two individuals share the same delusional beliefs.

Causes of Schizophrenia

• Neurotransmitter imbalances, particularly excessive dopamine, play a role.
• Genetic influences are significant.
• Brain structure abnormalities are enlarged ventricles indicating loss of brain tissue, reduced gray matter affecting thought processing, and prefrontal cortex dysfunction impairing judgment and emotional regulation.
• Environmental & social triggers, like prenatal exposure to viruses or malnutrition, urban environments, childhood trauma, and expressed emotion (hostile, critical family environments), can trigger relapse.

Treatments for Schizophrenia

• Typical antipsychotics (first-generation) block dopamine receptors, but can cause Tardive Dyskinesia.
• Atypical antipsychotics (second-generation) target dopamine and serotonin with fewer motor side effects.
• Cognitive Behavioral Therapy (CBT) challenges delusions.
• Family therapy reduces relapse by educating families.
• Assertive Community Treatment (ACT) offers 24/7 support for independent living.
• Social skills training enhances communication and self-care abilities.

Examples

• John Nash (A Beautiful Mind) managed paranoid schizophrenia while continuing academic work.
• The Genain quadruplets, all diagnosed with schizophrenia, demonstrate a strong genetic link.

Personality Disorders (PDs)

• Long-term, pervasive patterns of maladaptive thoughts and behaviors that emerge in adolescence and affect core identity.

Cluster A - Odd, Eccentric, or Socially withdrawn.

• Paranoid Personality Disorder (PPD) features a persistent distrust of others, interpreting remarks as attacks, suspiciousness, and unforgiving nature, often rooted in neglect and abuse, treatable with CBT.
• Schizoid Personality Disorder (SPD) features detachment from social relationships, preference for solitude, and disinterest in praise or criticism, linked to schizophrenia or emotional coldness, treatable with social skills training and CBT.
• Schizotypal Personality Disorder (STPD) features odd beliefs or magical thinking, eccentric behavior, and social paranoia, linked to schizophrenia, trauma or isolation, treatable with antipsychotic medication and CBT.

Cluster B - Dramatic, Emotional, Impulsive

• Antisocial Personality Disorder features disregard for others' rights, deceitfulness, lack of remorse, and illegal acts, linked to low serotonin and impaired impulse control, often from abuse/neglect, treatable with CBT.
• Borderline Personality Disorder (BPD) features fear of abandonment, unstable relationships, self-harm, and mood swings; caused by trauma, neglect or brain dysregulation, treated with Dialectical Behavior Therapy and medications.

Cluster C - Anxious, Fearful, Avoidant

• Avoidant Personality Disorder (AvPD) features sensitivity to rejection, desire for relationships but fear of interaction, and low self-esteem, caused by rejection and bullying, linked to social anxiety, treatable with CBT.
• Dependent Personality Disorder (DPD) features reliance, fear of being alone, and submissive behavior, stemming from overprotective parenting, treatable with CBT.
• Obsessive-Compulsive Personality Disorder (OCPD) features preoccupation with rules, order, and perfectionism, potentially from high parental expectations, treatable with CBT.

Clinical Assessment and Diagnosis

• Measurement of psychological, biological, and social factors in an individual to identify symptoms, understand problems, and formulate a diagnosis using systems like DSM-5.
• Reliability refers to the consistency of measurement through test-retest, inter-rater, and internal consistency.
• Validity refers to the accuracy of measurement, including face, content, construct, and criterion validity (concurrent and predictive).
• Standardization involves uniform procedures and use of norms to compare results meaningfully.
• Clinical interviews can be unstructured (informal), semi-structured (fixed yet flexible), or structured (highly standardized).
• A Mental Status Examination (MSE) systematically observes a client's behavior and mental functioning.
• Psychological testing uses formal, standardized tools:

Psychological Tests

• Projective tests uncover unconscious dynamics, Rorschach Inkblot Test, Thematic Apperception Test (TAT), Draw A Person, House Tree Person
• Minnesota Multiphasic Personality Inventory (MMPI-2) for clinical diagnosis
• Millon Clinical Multiaxial Inventory (MCMI) is used to diagnose
• Cognitive and intelligence testing includes Wechsler Scales (WAIS-IV, WISC-V), Standford-Binet Intelligence Scales assesses disability or giftedness, and Kaufman Assessment Battery for Children
• Neuropsychological testing examines brain-behavior relationships and cognitive deficits.
  • Trail Making Test measures speed and executive functioning.
  • Bender Visual-Motor Gestalt Test assesses visual-motor integration.
  • Wisconsin Card Sorting Test assesses cognitive flexibility.
  • Rey Complex Figure Test assesses visual memory.

Diagnosis and Classification

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the APA and the International Classification of Diseases (ICD-11) from the WHO are key tools.
• Cultural Formulation Interview (CFI) considers cultural influences.
• Comorbidity is the presence of more than one disorder.
• Labeling and stigma are potential issues.
• The distinction between dimensional (fluidity) vs. categorical (fixed categories) approaches is important.