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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 ones
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 justsad
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 (theres 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 womans 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 persons
mind and cannot be recalled. However, the memories
might resurface on their own or after being triggered
by something in the persons 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.

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.
o

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, ones 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.

ATTENTION DYSFUNCTION

o
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

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 cigaretteswould 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

CAUSES

These are mental disorders in which the normally wellintegrated functions of memory, identity, perception, and
consciousness are separated (dissociated).

Psychological

People feel as though they have no identity, they are


confused about who they are, or they experience multiple
identities.
the breakdown of ones perception of his/her surroundings,
memory, identity, or consciousness.
People feel as though they have no identity, they are confused
about who they are, or they experience multiple identities.
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 contents coexist in parallel
consciousness.
TYPES OF DISSOCIATIVE DISORDERS:

Depersonalization is the third most common


psychological experience, after feelings of anxiety
and feelings of 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
Insight Oriented:
Psychodynamic psychotherapy
Cognitive-behavioral therapy
Medications:

Dissociative Identity

Dissociative Fugue

Dissociative Amnesia

DISSOCIATIVE AMNESIA

Dissociative Depersonalization

- Is the appropriate diagnosis when the dissociative


phenomena are limited to amnesia.

DEPERSONALIZATION DISORDER 300.6

Depersonalization is a state in which the individual


ceases to perceive the reality of the self or the
environment. The patient feels that his or her body is
unreal, is changing, or is dissolving; or that he or she
is outside of the body.

This can be experienced by normal individual. How?


- lack of sleep
- use of certain anesthetic
- emotionally stressful situations

Benzodiazepine tranquilizers
Tricyclic antidepressants
Selective serotonin reuptake inhibitors

KEY SYMPTOM the inability to recall information, usually


about stressful or traumatic events in persons life
A common form of dissociative amnesia involves amnesia for
personal identity but intact memory of general information.
Other type of amnesias (e.g., transient global amnesia and
postconcussion amnesia) does not occur in patients with
dissociative amnesia.
EPIDEMOLOGY
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.

SYMPTOMS
- emotional numbing
- changes in visual perception
- altered experience of one's body

It is thought to occur more often in women than in men and


more often in young adults than in older adults, but it can
occur at any age.

When symptoms of depersonalization are severe enough to


cause significant emotional distress, or interfere with normal
functioning, the criteria of the DSM-IV-TR for
"depersonalization disorder" are met.

Cases of dissociative amnesia related to domestic settings


for example, spousal abuse and child abuse are probably
constant in number.

CHARACTERISTICS

ETIOLOGY

A lasting or recurring feeling of being detached


from the patient's own body.

Reality experience is intact.

The phenomenon causes distress or impairs


work, social or personal functioning.

The experience doesn't occur solely in the


course of another mental disorder.

The disorder is not directly caused by a general


medical condition or by substance use, including
medications and drugs of abuse.

Most patients with dissociative amnesia cannot retrieve


painful memories of stressful and traumatic events, and thus
the emotional content of the memory is clearly related to the
pathophysiology and the cause of the disorder.
Psychoanalytic Approach - The disorder is considered
primarily a defense mechanism whereby a person alters
consciousness as a way of dealing with an emotional conflict
or an external stressor. Secondary defenses involved in
dissociative amnesia include repression and denial.
DIAGNOSIS

The diagnostic criteria for dissociative amnesia in DSM-IV-TR


(table20-1) emphasize that the forgotten information is
usually of traumatic or stressful nature.
It can only be diagnosed only when the symptoms are not
limited to amnesia that occurs in the course of dissociative
identity disorder and do not result from a general medical
condition (e.g., head trauma) or ingestion of a substance.

home, the travel itself, and the establishment of


an alternate life.
Treatment.
Most fugues last for hours or days, then disappear on
their own.
Psychotherapy (cognitive and creative art therapies)
Hypnosis

TREATMENT interviewing, drug-assisted interviews with


short-acting barbiturates, hypnosis (relax), psychotherapy

DISSOCIATIVE IDENTITY DISORDER


DISSOCIATIVE FUGUE DISORDER

The word fugue stems from the Latin word for flight
fugere .

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)

When in a fugue, people disappear from their usual


routine and may assume a new identity, forgetting all
or some of their usual life.

-MULTIPLE PERSONALITY DISORDER


- 2 or more distinct personalities distinct from each
other, each of which determines behavior and
attitudes
- host and alters
- most serious

ETIOLOGY

-unknown
-sever and prolonged Traumatic event in childhood
-4 causative factors

Usually, fugues last only hours or days, then resolve


on their own.

Causes

traumatic life event


vulnerability for the disorder
environmental factors
absence of external support

is usually triggered by severe trauma, such as wars,


accidents, natural disasters, or sexual abuse during
childhood.

Many fugues seem to represent disguised wish


fulfillment (for example, an escape from
overwhelming stresses, such as divorce or financial
ruin).

mean age of diagnosis- 30 years

Symptomsmay last from hours to weeks, months, or


occasionally even longer.

More common in first degree relatives

usually disappear from their usual haunts, leaving


their family and job.

Coexists with other diorders

Suicide attempts- common 2/3

EPIDEMIOLOGY

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.

If they are confused, they may come to the attention


of medical or legal authorities.

when the fugue ends, they may experience


depression, discomfort, grief, shame, intense conflict,
and suicidal or aggressive impulses.

5:1 -9:1 Female-to-male ratio


common in late adolescence and young adult life

SYMPTOMS

Depression

mood swings

suicidal tendencies 2/3

phobias

Diagnosis

doctor carefully reviews symptoms and does a


physical examination to exclude physical
disorders that may contribute to or cause
memory loss.
Sometimes dissociative fugue cannot be
diagnosed until people abruptly return to their
pre-fugue identity and are distressed to find
themselves in unfamiliar circumstances.
usually made retroactively when a doctor
reviews the history and collects information that
documents the circumstances before people left

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

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 persons behavior
C. Inability to recall important personal information that is too
extensive to be explained by ordinary forgetfulness
D. The disturbances is not due to the direct physiological
effects of a substance
TREATMENT
COUSELING & PSYCHOTHERAPY - family therapy, group
therapy
PHARMACOTHERAPY - tranquilizers or anti depressants
HYPNOSIS