Dissociative Disorders, Somatoform and Related Disorders

1. Dissociative Disorders,
Somatoform and Related
Disorders

2. Dissociative Disorder

3. Dissociative Disorder (DD)
• Are conditions that involve disruptions
or breakdowns of memory, awareness,
identity, or perception.

4. Dissociative Disorder
1. Dissociative Identity Disorder (DID)
2. Dissociative Amnesia
3. Depersonalization/Derealization Disorder

5. Dissociative Identity
Disorder

6. Dissociative Identity Disorder (DID)
A dissociative disorder, formerly called
multiple personality disorder, in which an
individual develops more than one self or
personality.
• Alters
• Host
• Birth Person
• Core Personality
• Switching

7. Common Dissociative Identity Disorder
Alter Types
• Child and adolescent alters – young alters are often
the first discovered in therapy and are the most
common type of alter. These alters emerge to handle
the abuse that the original personality couldn't
tolerate. A DID alter may be referred to as a "little"
if the alter acts seven years or younger.
• Protector or rescuer alters – these alters can be of
any age and were created to save the original person
from intolerable situations. These DID alters are
often tougher and braver than the original
personality.

8. Common Dissociative Identity Disorder
Alter Types
• Persecutor alters – these DID alters are modeled after
the abuser. Persecutor alters create negative messages
blaming the original identity for the abuse and telling
them they need to die or pay for it. Often the host will
act on these negative messages and self-harm or even
attempt suicide. This is often when the person is first
introduced to the mental health system.
• Perpetrator alters – also modeled after the abuser,
these dissociative identity disorder alters direct their
hostility outward rather than inward towards other
personalities.

9. Common Dissociative Identity Disorder
Alter Types
• Avenger alters – this dissociative identity
disorder alter holds the rage from the
childhood abuse and may seek retribution
from the abuser. They tend to express the
anger of the entire system and can be hostile.

10. Symptoms
• Memory loss (amnesia) of certain time periods,
events and people.
• Mental health problems, such as depression, anxiety,
and suicidal thoughts and attempts.
• A sense of being detached from yourself.
• A perception of the people and things around you as
distorted and unreal.
• A blurred sense of identity.
• Significant stress or problems in your relationships,
work or other important areas of your life.

11. Diagnostic Criteria
A. Disruption of identity characterized by two or more
distinct personality states, which may be described
in some cultures as an experience of possession. The
disruption in identity involves marked discontinuity
in sense of self and sense of agency, accompanied
by related alterations in affect, behavior,
consciousness, memory, perception, cognition,
and/or sensory-motor functioning. These signs and
symptoms may be observed by others or reported by
individual.

12. Diagnostic Criteria
B. Recurrent gaps in the recall of everyday events,
important personal information, and/or traumatic
events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
D. The disturbance is not a normal part of a broadly
accepted cultural or religious practice.

13. Diagnostic Criteria
E. The symptoms are not attributable to the
physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol
intoxication) or another medical condition
(e.g., complex partial seizures).

14. Treatment for Dissociative
Identity Disorder
While there's no "cure" for dissociative identity
disorder, long-term treatment is very successful,
if the patient stays committed.
Effective treatment includes:
• Talk Therapy
• Medications
• Hypnotherapy

15. Dissociative Amnesia

16. Dissociative Amnesia
Inability to remember details and
experiences associated with traumatic
or stressful events.

17. Symptoms
• Confusion
• Emotional distress related to the amnesia.
However, not all patients with dissociative
amnesia are distressed. The degree of
emotional upset is usually in direct proportion
to the importance of what has been forgotten,
or the consequences of forgetting.
• Mild depression.

18. Diagnostic Criteria
A. An inability to recall important
autobiographical information, usually of a
traumatic or stressful nature, that is
inconsistent with ordinary forgetting.
NOTE: Dissociative amnesia most often consists of
localized or selective amnesia for a specific event or
events; or generalized amnesia for identity and life
history.

19. Diagnostic Criteria
B. The symptoms cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
C. The disturbance is not attributable to the
physiological effects of a substance (e.g., alcohol or
other drug of abuse, a medication) or a neurological
or other medical condition (e.g., partial complex
seizures, transient global amnesia, other
neurological condition).

20. Diagnostic Criteria
D. The disturbance is not better explained by
dissociative identity disorder, posttraumatic
stress disorder, acute stress disorder, somatic
symptom disorder, or major or mild
neurocognitive disorder.

21. Dissociative Amnesia
Five Patterns:
1. Localized Amnesia
2. Selective Amnesia
3. Generalized Amnesia
4. Systematized Amnesia
5. Continuous Amnesia

22. Five Patterns:
1. Localized Amnesia – a failure to recall events
during a circumscribed period of time.
2. Selective Amnesia – the individual can recall some,
but not all, of the events during circumscribed
period of time.
3. Generalized Amnesia – a complete loss of memory
for one’s life history. May also forget personal
identity.

23. Five Patterns:
4. Systematized Amnesia – the individual loses
memory for a specific category of
information.
5. Continuous Amnesia – the individual forgets
each new event as it occurs.

24. Treatment
• Psychotherapy
• Cognitive-Behavioral Therapy
• Eye Movement Desensitization and
Reprocessing
• Dialectic-Behavior Therapy
• Clinical Hypnosis
• Medication

25. Depersonalization/Derealization
Disorder

26. Depersonalization/Derealization
Disorder
Depersonalization – one’s sense of one’s
own self and one’s own reality is
temporarily lost.
Derealization – one’s sense of the reality of
the outside world is temporarily lost.

27. Symptoms (Depersonalization)
• Feelings that you're an outside observer of your thoughts,
feelings, your body or parts of your body, perhaps as if you
were floating in air above yourself.
• Feeling like a robot or that you're not in control of your
speech or movements.
• The sense that your body, legs or arms appear distorted,
enlarged or shrunken, or that your head is wrapped in cotton.
• Emotional or physical numbness of your senses or responses
to the world around you.
• A sense that your memories lack emotion, and that they may
or may not be your own memories.

28. Symptoms (Derealization)
• Feelings of being alienated from or unfamiliar with your
surroundings, perhaps like you're living in a movie.
• Feeling emotionally disconnected from people you care
about, as if you were separated by a glass wall.
• Surroundings that appear distorted, blurry, colorless, two-
dimensional or artificial, or a heightened awareness and
clarity of your surroundings.
• Distortions in perception of time, such as recent events
feeling like distant past.
• Distortions of distance and the size and shape of objects.

29. Diagnostic Criteria
A. The presence of persistent or recurrent experiences of
depersonalization, derealization, or both:
1. Depersonalization: Experiences of unreality, detachment,
or being an outside observer with respect to one’s thoughts,
feelings, sensations, body, or actions (e.g., perceptual alterations,
distorted sense of time, unreal or absent self, emotional and/or
physical numbing).
2. Derealization: Experiences of unreality or detachment
with respect to surroundings (e.g., individuals or objects are
experienced as unreal, dreamlike, foggy, lifeless, or visually
distorted).

30. Diagnostic Criteria
B. During the depersonalization or derealization
experiences, reality testing remains intact.
C. The symptoms cause clinically significant
distress or impairment in social, occupational
or other important areas of functioning.
D. The disturbance is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, medication) or another medical
condition (e.g., seizures).

31. Diagnostic Criteria
E. The disturbance is not better explained by
another mental disorder, such as
schizophrenia, panic disorder, major
depressive disorder, acute stress disorder,
posttraumatic stress disorder, or another
dissociative disorder.

32. Treatment
• Psychotherapy
• Psychodynamic therapy
• Cognitive techniques
• Behavioral techniques
• Grounding techniques
• Moment-to-moment tracking and labeling of
affect and dissociation

33. Somatic Symptom and
Related Disorder

34. Somatic Symptom Disorders
soma = “body” in Greek
• A wide variety of conditions in which psychological
conflicts are translated into physical problems or
complaints.
• Impair functioning, cause distress.
• No physiological basis.
• Won’t be indicated on physical or neurological tests.

35. Symptoms
• Having a high level of worry about potential illness.
• Considering normal physical sensations as a sign of
severe physical illness.
• Fearing the medical seriousness of symptoms, even
when there is no evidence to support that concern.
• Appraising physical sensations as threatening,
harmful or causing problems.
• Feeling that medical evaluation and treatment have
not been adequate.

36. Symptoms
• Fearing that physical activity may cause damage to
your body.
• Repeatedly checking your body for abnormalities.
• Frequent health care visits that don't relieve your
concerns or that make them worse.
• Being unresponsive to medical treatment or
unusually sensitive to medication side effects.
• Having a more severe impairment than would
usually be expected related to a medical condition.

37. Diagnostic Criteria
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. Disproportionate and persistent thoughts about the
seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or
symptoms.
3. Excessive time and energy devoted to these symptoms or
health concerns.

38. Diagnostic Criteria
C. Although any one somatic symptom may not be
continuously present, the state of being symptomatic is
persistent (typically more than 6 months).
Specify if:
With predominant pain (previously pain disorder): This
specifier is for individuals whose somatic symptoms predominantly
involve pain.
Specify if:
Persistent: A persistent course is characterized by severe
symptoms, marked impairment, and long duration (more than 6
months).

39. Diagnostic Criteria
Specify current severity:
Mild: Only one symptoms specified in
Criterion B is fulfilled.
Moderate: Two or more of the symptoms
specified in Criterion B is fulfilled.
Severe: Two or more of the symptoms
specified in Criterion B is fulfilled, plus there are
multiple somatic complaints (or one very severe
somatic symptom).

40. 1. Illness Anxiety Disorder
2. Conversion Disorder
3. Psychological Factor Affecting
Other Medical Conditions
4. Factitious Disorder
Types of Somatic Symptom
Disorders

41. Illness Anxiety
Disorder

42. Illness Anxiety Disorder
more commonly referred to as Hypochondria, or
Hypochondriasis
A type of "somatoform" disorder in which
a person misinterprets their normal physical
experiences as symptoms of some type of
disease.

43. Symptoms
• Thinking that a headache is indicative of a
brain tumor.
• Believing that a cough must be sign of lung
cancer.
• Assuming that a minor chest pain is a heart
attack.
• Thinking that a minor sore is a sign of AIDS.

44. Symptoms
• Multiple doctor visits, sometimes “doctor-hopping”
on the same day.
• Multiple medical tests, often for the same alleged
condition.
• Repetitive checking of the body for symptoms of an
alleged medical condition.
• Repeatedly avoiding contact with objects or
situations for fear of exposure to diseases.
• Habitual internet searching for information about
illnesses and their symptoms (“Cyberchondria“).

45. Diagnostic Criteria
A. Preoccupation with fears of having, or the idea that
one has, a serious disease based on the person’s
misinterpretation of bodily symptoms.
B. The preoccupation persists despite appropriate
medical evaluation and reassurance.
C. The belief in Criterion A is not of delusional
intensity (as in Delusional Disorder, Somatic Type)
and is not restricted to a circumscribed concern
about appearance (as in Body Dysmorphic
Disorder).

46. Diagnostic Criteria
D. The preoccupation causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
E. The duration of the disturbance is at least 6 months.
F. The preoccupation is not better accounted for by
Generalized Anxiety Disorder, Obsessive-
Compulsive Disorder, Panic Disorder, a Major
Depressive Episode, Separation Anxiety, or another
Somatoform Disorder.

47. Treatment
• Exposure and Response Prevention (ERP)
• Cognitive Restructuring
• Imaginal Exposure

48. Conversion Disorder

49. Conversion Disorder (CD)
(Functional Neurological Symptom Disorder)
A somatic symptom disorder involving the
actual loss of bodily function such as
blindness, paralysis, and numbness due to
excessive anxiety.

50. Four categories of symptoms:
1. Motor symptoms or deficits
2. Sensory symptoms or deficits
3. Seizures or convulsions
4. Mixed presentations
Conversion Disorder (CD)

51. Diagnostic Criteria
A. One or more symptoms of altered voluntary motor or
sensory function.
B. Physical findings provide evidence of incompatibility
between the symptom and recognized neurological or
medical conditions.
C. The symptom or deficit is not better explained by
another medical or mental disorder.
D. The symptom or deficit causes clinically significant
distress or impairment in social, occupational, or other
important areas of functioning or warrants medical
evaluation.

52. Treatment
• Counseling (psychotherapy)
• Physical therapy
• Treating related stress and other conditions

53. Psychological Factor
Affecting Other Medical
Conditions

54. Psychological Factor Affecting Other
Medical Conditions
Psychological factors affecting other medical
conditions (PFAOMC) is a disorder that is
diagnosed when a general medical condition is
adversely affected by psychological or
behavioral factors; the factors may precipitate or
exacerbate the medical condition, interfere with
treatment, or contribute to morbidity and
mortality. In addition, the factors are not part of
another mental disorder (e.g., unipolar major
depression).

55. Diagnostic Criteria
A. A medical symptom or condition (other than a
mental disorder) is present.
B. Psychological or behavioral factors adversely
affect the medical condition in one of the
following ways:
1. The factors have influenced the course of the
medical condition as shown by a close temporal
association between the psychological factors and
the development or exacerbation of, or delayed
recovery from, the medical condition.

56. Diagnostic Criteria
2. The factors interfere with the treatment
of the medical condition (e.g., poor
adherence).
3. the factors constitute additional well-
established health risks for the individual.
4. The factors influence the underlying
pathophysiology, precipitating or
exacerbating symptoms or necessitating
medical attention.

57. Diagnostic Criteria
C. The psychological and behavioral factors in Criterion B are not
better explained by another mental disorder (e.g., panic disorder,
major depressive disorder, posttraumatic stress disorder).
Specify current severity:
Mild: Increases medical risk (e.g., inconsistent adherence
with antihypertension treatment).
Moderate: Aggravates underlying medical condition (e.g.,
anxiety aggravating asthma).
Severe: Results in medical hospitalization or emergency
room visit.
Extreme: Results in severe, life-threatening risk (e.g.,
ignoring heart attack symptoms).

58. Factitious Disorder

59. Factitious Disorder
Is a condition in which a person acts as if they
have an illness by deliberately producing,
feigning, or exaggerating symptoms. Factitious
disorder imposed on another is a condition in
which a person deliberately produces, feigns, or
exaggerates the symptoms of someone in his or
her care.

60. Symptoms
• Clever and convincing medical problems
• Frequent hospitalizations
• Vague or inconsistent symptoms
• Conditions that get worse for no apparent
reason
• Conditions that don't respond as expected to
standard therapies
• Eagerness to have frequent testing or risky
operations

61. Symptoms
• Extensive knowledge of medical terms and diseases
• Seeking treatment from many different doctors or
hospitals, which may include using a fake name
• Having few visitors when hospitalized
• Reluctance to allow health professionals to talk to
family or friends or to other health care providers
• Arguing with hospital staff
• Frequent requests for pain relievers or other
medications

62. Diagnostic Criteria
Factitious Disorder Imposed on Self
A. Falsification of physical or psychological signs or
symptoms, or induction of injury or disease, associated
with identified deception.
B. The individual presents himself or herself to others as ill,
impaired, or injured.
C. The deceptive behavior is evident even in the absence of
obvious external rewards.
D. The behavior is not better explained by another mental
disorder, such as delusional disorder or another psychotic
disorder.

63. Diagnostic Criteria
Specify:
• Single Episode
• Recurrent Episode (two or more events of falsification of
illness and/or induction of injury)
Factitious Disorder Imposed on Another (Previously Factitious
Disorder by Proxy)
A. Falsification of physical or psychological signs or symptoms,
or induction of injury or disease, associated with identified
deception.
B. The individual presents another individual (victim) to others
as ill, impaired, or injured.

64. Diagnostic Criteria
C. The deceptive behavior is evident even in the
absence of obvious external rewards.
D. The behavior is not better explained by another
mental disorder, such as delusional disorder or
another psychotic disorder.
NOTE: The perpetrator, not the victim, receives this diagnosis.
Specify:
• Single Episode
• Recurrent Episode (two or more events of falsification of
illness and/or induction of injury)

65. Treatment
• Talk Therapy (psychotherapy)
• Behavior Counseling
• Family Therapy

66. Other Specified Somatic
Symptom and Related Disorder
This category applies to presentations in which
symptoms characteristic of a somatic symptom
and related disorder that cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning predominate but do not meet the full
criteria for any of the disorders in the somatic
symptom and related disorders diagnostic class.

67. Other Specified Somatic
Symptom and Related Disorder
Examples of presentations that can be specified using the
“other specified” designation include the following:
1. Brief somatic symptom disorder: Duration of symptoms is
less than 6 months.
2. Brief illness anxiety disorder: Duration of symptoms is less
than 6 months.
3. Illness anxiety disorder without excessive health-related
behaviors: Criterion D for illness anxiety disorder is not
met.
4. Pseudocyesis: A false belief of being pregnant that is
associated with objective signs and reported symptoms of
pregnancy.

68. Unspecified Somatic Symptom
and Related Disorder
This category applies to presentations in which
symptoms characteristic of a somatic symptom and
related disorder that cause clinically significant distress
or impairment in social, occupational, or other
important areas of functioning predominate but do not
meet the full criteria for any of the disorders in the
somatic symptom and related disorders diagnostic class.
The unspecified somatic symptom and related disorder
category should not be used unless there are decidedly
unusual situations where there is insufficient
information to make a more specific diagnosis.

69. Thank You =)