Dissociative Somatoform Disorders DISORDER V FAKING Malingering faking

Dissociative & Somatoform Disorders DISORDER V. FAKING Malingering = faking bad - symptoms deliberate - for gain - not a disorder

Factitious Disorder = psychological need to lie - only for psychological gain - symptoms deliberate - a mental disorder

Ex. Munchausen’s Syndrome - lies for medical attention Munchausen by proxy - creating physical problems in another for medical attention

Somatoform Disorders = physical symptoms without physical basis - psychological disorder - may be gain - symptoms not deliberate**

Undiagnosed physical illness

Somatoform Disorders Physical complaints with no physical cause

1. Conversion Disorder Freud: conflicts converted into sxs - women

Description • Affects voluntary movement/sensation • Identifiable stressors • Not explained medically • Not intentional • Distress/impairment • Decreasing incidence

Signs of conversion • Sudden onset after stress • La belle indifference • Selective symptoms

Possible Causes Psychodynamic: 4 processes: 1) traumatic event --> impulse emerges 2) conflict is repressed

3) anxiety increases, is “converted” into physical symptom - avoid anxiety (primary gain) 4) attention/sympathy & avoid tasks (secondary gain)

Learning Theory 1) traumatic event => escape/avoid 2) symptom develops 3) environment reinforces symptoms

Other: Personality type - histrionic

Treatment 1) Deal with stressor 2) Remove secondary gain 3) Teach reuse of body part

2. Hypochondriasis Description - belief of serious illness (anxiety) - illness is long-term - misinterpret body symptoms - symptoms are wide-ranging - agree that reaction is excessive

• “doctor shopping” • distress/impairment • men & women

Possible Causes Theoretical agreement • faulty interpretation of sensations • biological hypersensitivity • learned focus on illness

Treatment • Uncover unconscious conflicts • Attack illness beliefs via cognitive-behavioral • Support groups

3. Somatization Disorder Description • Multiple somatic complaints • Most major body systems • No physical basis

• • • Concern = symptoms themselves, not illness Life revolves around symptoms Relating to others = symptoms Lengthy medical history Severe impairment Very rare - women

Possible Causes • Childhood learning • Identifiable stressor

• Personality traits - insensitive to punishment - impulsive (short-term gains) - irresponsible - aggressive • Women - socialization

Treatment • Very difficult • Reduce help-seeking behavior • Increase independence • No reinforcement for symptoms • Teach more appropriate behavior

4. Body Dysmorphic Disorder Description • Perceived defect in appearance • Imagined/exaggerated • Face/head flaws

• • • Difficulty controlling obsession Frequently check appearance Requests reassurance Plastic surgery Distress & life impairment

• Prevalence unknown but probably common • Men & women

Causes & Treatment • Little known • Related to OCD? - anxiety • Surgery increases complaints

Dissociative Disorders Splitting off of a psychological function from rest of conscious mind

1. Dissociative Identity Disorder (DID) Description • 2+ distinct personalities • Alternate control of body —> NOT INTEGRATED • “Core” has amnesia

• DID vs. Schizophrenia • Does DID exist? (iatrogenic effects)

Indications of DID • Amnestic periods • Childhood abuse or trauma • Unsuitable nickname • Hypnotizability

2. Dissociative Amnesia • Loss of memory • Traumatic event • Lack of distress

3. Dissociative Fugue • • Amnesia for identity Flight New life & identity Brief duration

4. Depersonalization Disorder • • Recurrent detachment from self/body Observing self Good reality perception Distress

Possible Causes • Childhood sexual abuse/trauma • Self-hypnosis • Biological vulnerability

Treatment • Amnesia & fugue get better on own • Resolve trauma • Improve coping

Tx for DID • Uncover & deal with trauma • Hypnosis to remember • Goal: integrate personalities