Somatoform Disorders PDF

DISSOCIATIVE DISORDERS Disturbances or changes in memory, consciousness or identity due to psychological factors. No sign of organic brain damage. 3 main disorders AMNESIA DEPERSONALISATION DISORDER DISSOCIATIVE IDENTITY DISORDER(DID)  AMNESIA Four major types Local...

DISSOCIATIVE DISORDERS Disturbances or changes in memory, consciousness or identity due to psychological factors. No sign of organic brain damage. 3 main disorders AMNESIA DEPERSONALISATION DISORDER DISSOCIATIVE IDENTITY DISORDER(DID)  AMNESIA Four major types Localised amnesia Selective Amnesia Generalised Amnesia Continous Amnesia  Dissociative Fugue Sudden departure to new areas Assumption of new identity Deficits in explicit memory and not implicit memory. Rule out-memory loss due to brain injury substance abuse and dementia..  DEPERSONALISATION DISORDER Most common disorder. Feelings of unreality-of self and world. Loss of sense of self feelings of detachment-from one’s mind, self or body. Derealisation-Feelings of unreality of detachment from one’s surroundings.  Usually begins in adolescence. Also seen in Schizophrenia, PTSD, Borderline personality disorder, Panic attacks.  DISSOCIATIVE IDENTITY DISORDER-MULTIPLE PERSONALITY DISORDER Existence of two or more distinct personalities/alters Different modes of being, thinking, feeling, and acting that exist independently of one another and that emerge at different times. Original personality-Host personality Others-Alter personalities Opposite personalities.  Begins in childhood, but is diagnosed in early adulthood. Does it Exist?? More cases documented after books are written on DID.  ETIOLOGY Psychoanalytic Theory-Repression Behavioural/learning theory- role play and selective attention. Two major theories Post traumatic model-Childhood abuse. Sociocognitive model- abuse. Learning to enact social roles. Suggestions made by therapists.  ETIOLOGY Biological Theory- Tsai et al(1999)-changes in Hippocampal and medial temporal lobe. Putnam(1984)-EEG activity is different in different personalities(Simulates) Ross(1997)-suggests 4 ‘pathways’ Childhood abuse pathway Childhood neglect pathway Factitious pathway Iatrogenic pathway Sociocultural factors Spirit possession-cultural context.  TREATMENT Psychodynamic Perspective-Hypnosis. Emerging of alters(may increase) Age regression Integration of alters. Psychotherapy-explain to patients that additional personalities used to serve a purpose, but now alternative coping strategies are available. Biological treatment- Antianxiety and anti depressants  SOMATIC SYMPTOM AND RELATED DISORDERS Somatic-bodily symptom. DSM-IV- bodily symptom without any organic cause. DSM-V– bodily symptom with/without organic cause. Somatic symptoms-no physical or organic basis.  Somatic symptom disorder Hypochondriasis-Illness Anxiety Disorder Conversion disorder  CRITERIA FOR SOMATIC SYMPTOM DISORDER- One or more somatic symptom that are distressing and disruptive. Excessive concern and anxiety Showing the symptoms for last 6 months. Multiple doctor visits/doctor shopping. Complaints of pain, discomfort(abdominal gas,nausea, dizziness, feeling sickly.  ILLNESS ANXIETY DISORDER (HYPOCHONDRIASIS) CRITERIA  Hypochodriasis Onset-after the age of 30. Does not focus on any particular set of symptoms. Hypersensitive to bodily functioning Kellner(1985) Found several predisposing factors History of physical illness,parental attention on somatic symptoms,low pain threshold and greater sensitivity to somatic symptoms.  CONVERSION DISORDER (Functional Neurological Symptom Disorder) Earlier called Hysteria Hippocrates viewpoint Freud’s view point Contemporary psychopathology -primary gain -secondary gain Common disorder during world wars.  Three categories of symptoms 1. Sensory Anaesthesia Hypesthesia Hyperesthesia Analgesia Paresthesia Hysterical blindness, deafness, anosmia, tunnel vision.  2. Motor symptoms Conversion paralysis -selective loss of function ‘writer’s block’ Tremors and tics Walking disturbances-astasia abasia Aphonia and mutism  Visceral symptoms Lump in the throat, choking sensations, coughing spells, belching, hiccoughing, sneezing.  ETIOLOGY Psychoanalytic perspective- Behavioural perspective -assume sick role as it is reinforcing. sociocultural perspective social mores societal restrictions low socio-economic status, low education, strong religious background.  Neurobiological perspective Higher than normal arousal level. Conversion symptoms more on the left side of the body. Right hemisphere generates unpleasant emotions. Anterior cingulate cortex, Anterior insula,Somatosensory cortex.  Cognitive Behavioural factors -worry more and give more attention to physiological disturbance -→emotional arousal→ Catastrophising thougts- >Communiation of distress->disability and avoidance.  TREATMENT Psychodynamic Hypnosis Biological-antidepressants Behavioural Extinction and non reinforcement of complaints CBT