Somatoform and dissociative disorders are linked to stress and anxiety. They are interesting in that these disorders have to do with knowing oneself; knowing one’s history or body. Somatoform disorders are problems that seem to be medical but are actually psychological. Dissociative disorders cause losses or changes in memory and identity. Both groups of disorders share similarities that allow them to be discussed together.
Hysterical Somatoform Disorders
A person with a hysterical somatoform disorder will experience physical changes as a result of their psychological condition. Such disorders are sometimes hard to distinguish from real organic medical problems. Sometimes an actual physiological medical condition will be incorrectly diagnosed as a hysterical somatoform disorder . To help distinguish between a true medical problem and a hysterical somatoform disorder doctors have to try and find out whether or not the symptoms match up with medical knowledge about the physical body. There are three hysterical somatoform disorders.
Conversion disorder is when a psychosocial conflict or need is converted into physical ailments that affect motor or sensory functioning. Symptoms will usually appear neurological, such as paralysis, blindness, or loss of feeling. The DSM-IV-TR explains the requirements of the disorder :
- One or more physical symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.
- Psychological factors judged to be associated with the symptom or deficit.
- Symptom or deficit not intentionally produced or feigned.
- Symptom or deficit not fully explained by a general medical condition or a substance.
- Significant stress or impairment.
The disorder will typically begin in late childhood and early adulthood. Women are diagnosed with conversion disorder twice as often as men. Conversion disorders appear suddenly, usually when a person is under a lot of stress, and last for weeks. The disorder is fairly rare and some research indicates that it occurs in people who are more suggestible than others .
Somatization disorder, or Briquet’s syndrome, is a disorder that consists of recurring physical ailments that have little or no organic basis. Sufferers of the disorder will experience a number of ailments in these categories: pain symptoms (headaches, chest pains, etc.), gastrointestinal symptoms (nausea, diarrhea, etc.), a sexual symptom (erectile difficulties, etc.), and a neurological symptom (double vision, paralysis, etc.) . People with this disorder usually see many doctors in search of relief, and will exagerate and dramatize their symptoms. They tend to feel anxious and depressed . The DSM-IV lists the following for somatization disorder :
- History of physical complaints, beginning before the age of 30, that occur over a period of several years and result in treatment being sought or in significant impairment.
- Physical compaints over the period include: four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one neurological-type symptom.
- Physical complaints not fully explained by a known general medical condition or a drug, or extending beyond the usual impact of such a condition.
- Symptoms not intentionally produced or feigned.
The disorder runs in families and begins between early adolescence and young adulthood. Somatization disorder typically lasts for many years, and will not go away without therapy . It occurs in 0.2 to 2.0 percent of women and 0.2 percent of men in any given year .
Pain Disorder Associated with Psychological Factors
The key symptom of pain disorder associated with psychological factors is pain. Psychosocial factors have an influence on the onset, severity, or continuation of pain. The DSM-IV explains the disorder as the following :
- Significant pain as the primary problem.
- Psychosocial factors judged to have the major role in the onset, severity, exacerbation, or maintenance of the pain.
- Symptom or deficit not intentionally produced or feigned.
- Significant distress or impairment.
Pain disorder associated with psychological factors is fairly common and begins at any age . Women are more likely to get the disorder than men.
It is important to distinguish the difference between hysterical and factitious symptoms. Hysterical symptoms indicate that the patient is experiencing distress without intentionally producing or feigning their symptoms. Factitious symptoms, on the other hand, occur when a person is intentionally faking or producing physical symptoms. When symptoms are faked or produced on purpose the patient is said to have factitious disorder. Those with factitious disorder will do dangerous things to make themselves appear sick, such as taking medications, injecting drugs, or infecting themselves . They research their supposed illness well and will not admit to faking symptoms. Factitious disorder usually begins in early adulthood and is more common in women than in men. It is also common in people who have experienced or who have the following :
- Extensive medical treatment as a child for a physical disorder.
- Physical or emotional abuse as a child, or family disruptions.
- A grudge against the medical industry.
- Have been a nurse, laboratory technician, or medical aide.
- Have a personality problem.
They will also have little family life and limited social relationships and support.
Munchausen syndrome is factitious disorder in the extreme and long-term form. Munchausen syndrome by proxy is when a parent makes up or produces physical illness in their child.
Preoccupation Somatoform Disorders
Those with preoccupation somatoform disorders will misinterpret and overreact to bodily symptoms or features no matter what others say . These disorders will cause distress to a person and have a lasting impact on their lives. Two preoccupation somatoform disorders are hypochondriasis and body dysmorphic disorder.
Hypochondriasis is a disorder in which a person mistakenly fears that changes in their physical functioning indicates a serious disease. Usually the changes in physical functioning are minor and are such common changes as coughing, sores, or sweating. Hypochondriasis is similar to somatization disorder in that they both result in physical symptoms and numerous trips to the doctors . The difference is that those with hypochondriasis will have a lot of anxiety but minor physical symptoms, whereas a person with somatization disorder will have serious symptoms but little stress . Hypochondriasis is marked in the DSM-IV as :
- Preoccupation with fears or beliefs that one has a serious disease, based on misinterpretation of bodily symptoms, lasting at least six months.
- Persistence of preoccupation despite appropriate medical evaluation and reassurance.
- Absence of delusions.
- Significant distress or impairment.
The disorder occurs at any age, but starts usually in early adulthood. Between 1 and 5 percent of all people experience hypochondriasis, and it is experienced equally among men and women .
Body Dysmorphic Disorder
Body dysmorphic disorder, or dysmorphophobia, is a deep concern about an imagined or minor defect in appearance. Sufferers of the disorder will constantly worry about things like wrinkles, swelling of the face, a mishapen nose or mouth, or body odors from sweat or breath . The DSM-IV explains it as :
- Preoccupation with an imagined or exaggerated defect in appearance.
- Significant distress or impairment.
Sufferers of the disorder will go to extreme lengths to avoid social situations or to conceal parts of their body. Around half the people with body dysmorphic disorder will get plastic surgery or dermatology treatment . People with this disorder will often stay home and can suffer from depression and, at worst, suicidal thoughts. The disorder begins in adolescence and affects around 2 percent of people in the United States .
Treatment for Somatoform Disorders
At first , those with somatoform disorders seek every kind of help possible besides psychotherapy, since they believe their problems are biological and not psychological. Once they realize their condition they will seek psychotherapy or psychiatric medication.
Treatment for hysterical somatoform disorders often resemble the treatment used for those with posttraumatic stress disorder. These include insight, exposure, and drug therapies. Psychodynamic therapists attempt to get the patient to become conscious of and resolve underlying fears and anxiety causing conflicts . Behavioral therapists use exposure treatments and biological therapists use antianxiety or antidepressant drugs to reduce anxiety. Techniques involving suggestion, reinforcement, or confrontation are also used to treat hysterical somatoform disorders.
Preoccupation somatoform disorders are usually treated with the same methods used for those with generalized anxiety disorder or obsessive compulsive disorder . This includes the prescribing of antidepressant pills or the use of exposure and response prevention.
Memory is important for humans to be able to recognize themselves, where they are, and who they are around. When memory is damaged and we cannot recall information correctly, consciousness is incomplete and identity is lost. A person who is unable to remember new or old information without any clear physical explanation as to why is suffering dissociative disorder. In such disorders, one part of a person’s memory is dissociated or separated from the rest. These disorders are dissociative amnesia, dissociative fugue, depersonalization disorder, and dissociative identity disorder. Dissociative disorders are particularly popular in the media, since many books, movies, and television shows portray amnesia or identity disorders.
A person with dissociative amnesia is unable to recall important personal events and information. This goes way beyond normal forgetting since entire days kind be lost and closest family members forgotten. Usually the information or event that is forgotten is upsetting to the person, and an upsetting event is what triggers the amnesia . Things like sexual abuse, war, and natural disasters can trigger dissociative amnesia. Dissociative amnesia comes in four types: localized, selective, generalized, or continuous.
Localized amnesia (also called circumscribed amnesia) is the most common form of dissociative amnesia. In this form of amnesia, a person loses all memory of events that took place within a certain period of time . Usually there will be a disturbing occurence and then a person will not be able to recall anything that happened within a window of time (a few days, weeks, etc.) but will remember everything before and after that window of time. The window of time that has been forgotten is called the amnestic episode. During the amnestic episode a person will experience memory difficulties but might not be aware of them.
Those with selective amnesia will remember some but not all of the events that occured during a certain period of time . A person who was in a car crash may remember conversations they had but not the actual car crash itself. Selective amnesia is the second most common form of dissociative amnesia.
Sometimes a person with dissociative amnesia forgets things from earlier in their life, as well as a certain period of time. In rare cases a person can forget who they are or who their family and friends are. When many different parts of a person’s memory is forgotten, they are said to have generalized amnesia.
In continuous amnesia a person will continue to forget things into the present . They will not be able to retain new memories and will not be able to remember incidents from the past either. This is a rather rare form of dissociative amnesia.
A person with dissociative fugue will forget their identity and incidents from the past as well as run away to a new location. The DSM-IV describes it as :
- Sudden, unexpected travel away from one’s home or work, with inability to recall one’s past.
- Confusion about personal identity, or the assumption of a new identity.
- Significant distress or impairment.
He or she will travel short or far and start living life in their new setting with confusion about who they are. The fugue can be brief, and once the person remembers their past they will resume life as it was. Other times the fugue will last long, and the person assumes a new identity altogether, starting a new line of work and making new friends. Fugue will usually follow a very stressful event, and once the fugue ends ther person will tend to forget everything that happened during the fugue and remember everything before it. Only 0.2 percent of the population will experience dissociative fugue . Most of the time people recover from dissociative fugue and never experience it again.
Dissociative Identity Disorder
Dissociative identity disorder, also called multiple personality disorder, is marked by the development of two or more distinct personalities, often called subpersonalities or alternate personalities. Each of these subpersonalities will have its own memories, thoughts, behaviors, and emotions. The DSM-IV describes the disorder as :
- The presence of two or more distinct identities or personality states.
- Control of the person’s behavior recurrently taken by at least two of these identities or personality states.
- An inability to recall important personal information that is too extensive to be explained by ordinary forgetfullness.
One subpersonality will take over a person’s functioning at a time. As the subpersonalities switch, it is usually discovered that there is one that appears more often than the others, and is called the primary or host personality. Switching between subpersonalities happens quickly and can be dramatic. These switches usually occur after a stressful event.
Subpersonalities interact with one another in three different kinds of relationships: mutually amnesic, mutually cognizant, and one-way amnesic. In a mutually amnesic relationship the subpersonalities have absolutely no awareness of one another . In a mutually cognizant pattern each subpersonality is aware of the other subpersonality and can even communicate with one another. In one-way amnesic relationships, some subpersonalities will be aware of each other, but that awareness is not always mutual . Co-conscious subpersonalities are aware of other subpersonalities but never interact with them. The average number of subpersonalities is 8 for men and 15 for women .
Dissociative Identity disorder is usually diagnosed in during late adolescence or early adulthood, but can and usually begins in early childhood after incidents of abuse . Women are diagnosed with dissociative identity disorder three times as often as men .
Those with depersonalization disorder will experience a persistent and recurrent feeling of being detached from their mental processes or body . Depersonalization is a change in the experience of the self where one’s mental processes or body feels unreal or foreign . Those with the disorder will feel like they are separate from their body and observing it from the outside. The mind can feel like it is floating above the body (known as doubling) and body parts can seem foreign or smaller or bigger than usual. Loss of control over things like speech or judgment can occur.
Depersonalization also involves derealization, which is the feeling that the external world is unreal and strange . People may appear dead and objects seem to change shape or size. Both depersonalization and derealization put the person in a dreamlike state where everything seems artificial or spacy. Symptoms of depersonalization disorder cause distress and interfere with a person’s life, causing damage to social relationships or work performance .
Depersonalization disorder occurs in adolescents and young adults, and rarely in those over 40 years old. It is triggered by things like fatigue, physical pain, stress, anxiety, or depression and can be long lasting.
Treatment for Dissociative Disorders
People with dissociative amnesia and fugue usually recover on their own, over time. Once in awhile they can require psychodynamic therapy, hypnotic therapy, or drug therapy to recover . Barbiturates can be injected into patients with amnesia or fugue to help regain lost memories. By sedating people, the drugs free them up to recall anxiety causing events .
Dissociative identity disorder is treated by therapists who guide clients to recognize the nature of their disorder, recover gaps in memory, and integrate subpersonalities into one functional personality . The merging of subpersonalities into one personality is called fusion. Even after fusion, therapy is required to help prevent dissociation.
Treatment for depersonalization disorder has not been well studied, but psychodynamic, cognitive, hypnotic, and drug therapies have been tried .
Somatoform disorders and dissociative disorders are alike because they both involve confusion over the self. On one hand a person can feel sick because of psychological reasons and may or may not be faking their symptoms. On the other hand a person can lose their memory, identity, or sense of reality. Somatoform and dissociative disorders are all very interesting and continue to be researched. They may help shed light on the important role of the still highly illusive subconscious. Once we understand why subpersonalities form, why a person may feel physical pain due to psychosocial reasons, or why a person forgets a part of their life, we will have a much firmer grasp on how the human brain works. As of right now, we can marvel at the mysterious intricacies of the human mind that cause such disorders, and hope the people who suffer from them are able to find the help they require.
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