Somatoform

&dissociative
Disorder

Prepered by :Prof.Dr. Elham Fayad

Alya AlGhamdi
 Basic definitions

 Somatoform disorders(somatic symptom disorder)

– pathological concern of individuals with the appearance or
functioning of their bodies when there is no identifiable
medical condition causing the physical complaints
 Dissociative disorders
– individuals feel detached from themselves or their
surroundings, and reality, experience, and identity may
disintegrate
 Historically, both somatoform and dissociative
disorders used to be categorized as hysterical
neurosis
– in psychoanalytic theory neurotic disorders result from
underlying unconscious conflicts, anxiety that resulted
from those conflicts and ego defense mechanisms
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 *Somatoform
disorders(somatic
symptom disorder)

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 Somatoform disorders(somatic symptom
disorder in DSM-V)

-The DSM-IV term somatoform disorders is replaced by somatic

symptom and related disorders in DSM-V.

-In DSM-IV there was a great deal of overlap across the somatoform
disorders and a lack of clarity about the boundaries of diagnoses.

- Non psychiatric physicians found the DSM-IV somatoform diagnoses

difficult to understand and use. The current DSM-5 classification
recognizes this overlap by reducing the total number of disorders as
well as their subcategories.

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 Diagnostic Criteria of(Somatic symptom
disorder)
A. One or more somatic symptoms that are distressing or result in
significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the
somatic symptoms or associated
health concerns as manifested by at least one of the following:
1. Persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy lost in these symptoms or health
concerns.
symptomatic is persistent (typically more than 6 months).

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 Somatoform Disorders

 Soma – Meaning Body

– Preoccupation with health and/or body appearance and
functioning
– No identifiable medical condition causing the physical
complaints
 Types of DSM-IV Somatoform Disorders
1. Hypochondriasis
2. Somatization disorder
3. Conversion disorder
4. Pain disorder
5. Body dysmorphic disorder

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 Somatoform Disorders

 Hypochondriasis
 severe anxiety focused on the possibility of having a serious
disease
 Client is preoccupied with fear that he/she has or will get a serious
disease
 History of seeing many doctors
 Misinterpretation of bodily sensations or functions despite medical
evaluations and reassurance
 Preoccupation with symptoms is not as intense or distorted as in
delusional disorder
 Significant distress/impairment in function
 Dependent behaviors/desires,demands attention
– Treatment: usually involves cognitive-behavioral therapy and
general stress management treatment)
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 Somatoform Disorders

 Somatization disorder
-C/b multiple recurrent physical
complaints over many years
-No organic etiology for these complaints
-Begins by age 30
-Pain, GI, sexual, pseudoneurologic
symptoms: impaired coordination or
balance,paralysis or localized
weakness,difficulty swallowing, aphonia,
urinary retention, hallucinations, loss of
touch or pain sensation,double
vision,amnesia,sensory losses,loss of
consciousness (APA 2000 DSM IV-TR)
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 Somatoform Disorders

 Somatization disorder
– may be connected to Antisocial personality disorder
– difficult to treat (reassurance, stress reduction, more
adoptive methods of interacting with family are
encouraged)
 Focus on anxiety reduction, not physical symptoms
 Minimize secondary gain(I.e. increased attention and decreased
responsibilities)

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 Somatoform Disorders

 Conversion Disorder
– Physical malfunctioning without any physical or
organic pathology
– Malfunctioning often involves sensory-motor areas
suggesting neurologic origin
Mainly example losing function in limbs
– Statistics
• Rare condition, with a chronic intermittent course
• Seen primarily in females, with onset usually in
adolescence
• Not uncommon in some cultural and/or religious
groups
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 Somatoform Disorders

 Conversion disorder (cont.)

– Freudian psychodynamic view is still popular (anxiety converted into
physical symptoms)
– Emphasis on the role of trauma (stress), conversion, and
primary/secondary gain
– Detachment from the trauma and negative reinforcement seem critical
– Different from factitious disorder (intentional)
– Treatment
• Similar to somatization disorder
• Core strategy is attending to the trauma
• Remove sources of secondary gain
• Reduce supportive consequences of talk about physical symptoms
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 Somatoform Disorders

Pain Disorder
 C/b physical symptom of pain-one or
more anatomic sites
 May occur with a General medical
condition
 Pain –not relieved by analgesics
 Onset,severity, exacerbation and
maintenance affected by psychological
stressors

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 Somatoform Disorders

Pain d/o interventions

 Pain management
 Encourage participation in activities
 Provide distractions

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 Somatoform Disorders

Body Dysmorphic Disorder

– Preoccupation with imagined defect in
appearance
– Either fixation or avoidance of mirrors
– Previously known as dysmorphophobia
– Suicidal ideation and behavior are common
– Statistics
• More common than previously thought
• Usually runs a lifelong chronic course
• Seen equally in males and females, with onset usually in early 20s
• Most remain single, and many seek out plastic surgeons
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 Somatoform Disorders

 Body Dysmorphic Disorder (cont.)

– Causes
• Little is known – Disorder tends to run in families
• Shares similarities with obsessive-compulsive disorder
– Treatment
• Treatment parallels that for obsessive compulsive disorder
• Medications (i.e., SSRIs) that work for OCD provide some relief
• Exposure and response prevention are also helpful
• Plastic surgery is often unhelpful
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 Dissociative
Disorders

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 Dissociative Disorders

 5 types
– Depersonalization &
Derealization disorder.
– Dissociative amnesia*.
– Dissociative fugue*.
– Dissociative trance disorder.
– Dissociative identity disorder*.

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 Dissociative Disorders

 Depersonalization&Derealization disorder:

 Derealization
– Loss of sense of the reality of the
External surrounding world
 Depersonalization
– Loss of sense of your own reality or identity.

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 Dissociative Disorders

 Depersonalization & Derealization disorder

– Severe feelings of depersonalization& Derealization
dominate the individual’s life and prevent normal
functioning
– It is chronic
– 50% suffer from additional mood and anxiety disorders

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 Dissociative Disorders

 Dissociative Amnesia
– Inability to recall personal information,
usually of a stressful or traumatic nature
– Not due to effects of substance abuse.
 Dissociative Fugue
– Sudden, unexpected travel away from home,
along with an inability to recall one’s past
(new identity)
– Occur in adulthood and usually end abruptly

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 Dissociative Disorders

 Dissociative trance disorder

– Altered state of consciousness in which
the person believes firmly that he or she
is possessed by spirits; considered a
disorder only where there is distress and
dysfunction
– Trance and possession are a common
part of some traditional religious and
cultural practices and are not considered
abnormal in that context

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 Dissociative Disorders

 Dissociative Identity Disorder

– Formerly multiple personality disorder
– At least two of these personality states
take control of the individuals behavior
– Many personalities (alters) or fragments
of personalities within one body
– The personalities or fragments are dissociated
– Switch (transition form one personality to another, includes
physical changes)
– Can be simulated by malingers are usually eager to
demonstrate their symptoms whereas individuals with DID
attempt to hide symptoms
– Prevalence about 3%
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 Dissociative Disorders

 Dissociative Identity Disorder

– Auditory hallucinations (coming from inside their heads)
– 97% severe child abuse
– Extreme subtype of PTSD
– Suggestible people may use dissociation as defense against severe
trauma
– Real and false memories

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 Dissociative Disorders

 Treatment
– Dissociative amnesia and fugue
• Get better on their own
• Coping mechanisms to prevent future episodes
– DID
• Reintegration of identities
• Confrontation of early trauma
• hypnosis

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 Intervention of somataform and dissosicative
disorder.

 Be aware of own responses

 Minimize secondary gain(I.e. increased attention and
decreased responsibilities
 Focus on anxiety reduction, not physical symptoms
 Use matter-of-fact approach
 Encourage client to discuss conflict
 Provide diversionary activities
 Encourage expression of feelings

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