DISSOSIATIONDISSOSIATION DISORDERDISORDER

Dissociative disorders◦a change/disturbance in function of

self-identity, memory, unconscious that make personality whole.

◦There is a disruption/dissociation (splitting off)

Dissociative and somatoform Dissociative and somatoform disordersdisorders

Alternate personalities may require different eyeglass prescription, display different allergies, different response to same medicine, differences in color blindness. It is as if conflicting internal impulses cannot coexist or achieve dominance.

Dissociative identity Dissociative identity disorderdisorder

◦Mechanism of dissociation is controlled by unconscious process.

◦Individual may report auditory hallucinations like 2 voices arguing about them, some complain of being “possessed.”

Cont. dissociative identity Cont. dissociative identity disorderdisorder

they may display wide range abnormal behavior before being accurately diagnosed:◦ physical complaints without an organic basis◦ amnesia, ◦ depression/suicide,◦ anxiety/ panic attacks◦ depersonalization◦ derealization (loss of sense of reality:

people/objects change size/shape or in the sense of time)

Inability to recall important personal information usually involving traumatic experiences that cannot be explained by simple forgetfulness. May last hours/years

There are 5 types:◦ localized a: cannot recall events for a number of hours

after stressful/traumatic incident.◦ Selective a: forget only disturbing particulars during

certain time.◦ Generalized a: forget entire life but retain habits,

tastes, skills. (rare)

Dissociative amnesiaDissociative amnesia

Continuous a: forget all events that take place after the problem begins.

Systematized a: memories relating to specific categories of information are lost, ie., college experiences.

Malingering: attempt to fabricate symptoms/make false claims of amnesia for personal gain.

Fugue means flight.Individual travels suddenly from

home/work, shows loss of memory for past personal information, becomes confused about identity or assumes a new one.

Dissociative fugueDissociative fugue

Amnesia is wandering aimlesslyFugue Is acting more purposefully

◦Not psychotic◦when memory returns can’t

remember fugue state.◦Rare◦Most likely to occur in

wartime/disasters,◦Difficult to distinguish from

malingering.

To differentiate amnesia from To differentiate amnesia from fugue:fugue:

Experience of depersonalization are persistent/recurrent and cause distress.

Controversy of including depersonalization disorder with dissociative because depersonalization disorder does not affect memory.

In other dissociative disorders, it protects individual from anxiety; depersonalization generates anxiety.

Depersonalization disorderDepersonalization disorder

Psychodynamic◦trauma (abuse, warfare, severe

problems, averting punishment) plays a role.

◦Dissociating helps to block out troubling memory.

◦Use repression.

Theoretical PerspectivesTheoretical Perspectives

Learning:◦Individual learns not to think about

disturbing thoughts to avoid guilt/shame.

◦Negative reinforcement when relieved from anxiety.

◦Learned through observational learning.

Psychodynamic:◦uncover early childhood traumas◦learn to cope.

Behavioral: ◦Consider personalities◦Reinforcement contingencies.

TreatmentTreatment

A condition where people have physical symptoms but no organic abnormalities can be found to account for them. There is some reason to believe that the symptoms reflect psychological factors or conflict.

Somatoform DisordersSomatoform Disorders

con vers ion d iso rd erTyp e t it le h ere

h yp och on d rias isTyp e t it le h ere

som atiza tion d isord erTyp e t it le h ere

S om ato fo rm d iso rd erTyp e t it le h ere

A major change in or loss of physical functioning, although there are no medical findings to support the physical symptoms or deficits.

The physical symptoms usually come on suddenly during a stressful time.

It is named because it is believed that repressed sexual/aggressive energy is converted into physical symptoms.

Conversion disorderConversion disorder

Symptom patterns involve ◦paralysis◦epilepsy◦problems in coordination◦blindness/tunnel vision◦loss of hearing, smell, feeling in a

limb

A fear of having a serious illness.A fear that their bodily signs or

sensations are due to a serious illness.Unlike conversion disorder,

hypochondriasis does not involve the loss or distortion of physical functioning.

Unlike conversion disorder, hypochondriacs are very concerned about their symptoms.

HypochondriasisHypochondriasis

The disorder is about equally common in men and women, and most often begins between 20 and 30.

They are more likely to report being sick as children.

They frequently doctor shop.

HypochondriasisHypochondriasis

Formerly known as Briquet’s syndrome.Multiple, recurrent somatic complaints that

began prior to the age of 30, usually begins in late adolescence. Complaints usually involve different organ systems.

The groups of symptoms are categorized as pain involving multiple sites.

10 times more likely to be found in women; 4 times more likely among Afr-Americans.

Somatization DisorderSomatization Disorder

Hippocrates believed the strange bodily symptoms were caused by a wandering uterus which created internal chaos.

Freud believed that hysteria was rooted in psychological rather than physical causes.

Theoretical PerspectivesTheoretical Perspectives

Hysterical symptoms are functional. They allow the patients to achieve primary(keeping internal conflicts repressed) and secondary gains (avoiding burdensome responsibilities)◦Example of primary - hand paralysis

to prevent masturbation or murder◦secondary - hand paralysis to keep

from firing a gun in battle thus being removed from the front line.

Cont. theoreticalCont. theoretical

Psychodynamic and learning concur that the symptoms reduce anxiety.

Learning theory - the symptoms carry the benefits or reinforcing properties of the “sick role” though it is not conscious.◦Distinguish from malingering which

is conscious.

Cont. TheoreticalCont. Theoretical

Cognitive - ◦Hypochondriasis may represent a

type of self-handicapping.◦May also be a cognitive bias to

misinterpret changes in bodily cues or sensations.

Psychodynamic◦Uncover unconscious conflicts.

Behavioral◦Remove the secondary gains.

Biological◦Use anti-depressants

TreatmentTreatment

Patients who tell tall tales to their doctors.

A type of factitious disorder. Münchausen syndrome is a term for psychiatric disorders known as factitious disorders wherein those affected feign disease, , illness, or psychological trauma in order to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome.

Münchausen SyndromeMünchausen Syndrome

Medical professionals suspecting Münchausen's in a patient should first rule out the possibility that the patient does indeed have a disease state, but it is in an early stage and not yet clinically detectable.

take a careful patient history, and seek medical records,

to look for early deprivation, childhood abuse, mental illness.

If a patient is at risk to himself or herself, inpatient psychiatric hospitalization. should be initiated.

Medical providers should consider working with mental health specialists to help treat the underlying mood or disorder as well as to avoid countertransference.

Therapeutic and medical treatment should center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder, or borderline personality disorder.

The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication and/or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time,thus offers the worst prognosis.

Ganser’s SyndromeGanser’s SyndromeGanser syndrome is a rare

dissociative disorder previously classified as a factitious disorder.. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness.

Ganser is an extremely rare variation of dissociative disorder. It is a reaction to extreme stress and the patient thereby suffers from approximation or giving absurd answers to simple questions.

Symptoms clouding of consciousness, somatic conversion

symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia.

Individuals also give approximate answers to simple questions. For example, "How many legs are on a cat?", to which the subject may respond '3?'.

The syndrome may occur in persons with other mental disorders such as schizophrenia, depressive disorders, toxic states, paresis, alcohol use disorders and factitious disorders. EEG data does not suggest any specific organic cause.

It is also sometimes called nonsense syndrome, syndrome of approximate answers, pseudodementia, hysterical pseudodementia or prison psychosis. This last name, prison psychosis, is sometimes used because the syndrome occurs most frequently in prison inmates, where it may represent an attempt to gain leniency from prison or court officials.