Chapter 8 -- Dissociative Disorders and Somatic Symptom Disorders

I. Dissociative Disorders (very rare)
A. Dissociative Amnesia (inability to remember personal information, typically of a stressful experience)
1. Posttraumatic model: cope with severe sexual abuse
2. Sociocognitive model: a response to suggestions by therapist to enact social roles
B. Depersonalization/derealization Disorder (persistent detachment from one's mental processes or body)
C. Dissociative Identity Disorder (Multiple Personality Disorder) (Existence within person of two or more personality states that take full control of behavior)
D. Psychodynamic treatment to gain access to repressed material

II. Somatic Symptom Disorders
A. Complex Somatic Symptom Disorder (4% prevalence)
1. At least one somatic symptom that is distressing or disrupts daily life
2. At least two of health-related anxiety, concerns about medical seriousness, or excessive energy devoted to health concerns
3. Duration of at least 6 months
B. Illness Anxiety Disorder (3% lifetime prevalence)
1. Preoccupation with and high level of anxiety about having or gaining a serious disease
2. Excessive illness behavior or avoidance
3. No more than mild somatic symptoms
4. Not explained by other disorders
5. Duration of at least six months
C. Conversion Disorder (Functional Neurological Symptom Disorder) (less than 1%)
1. Loss of motor function, sensory function, cognitions, or seizure-like episodes
2. Physical signs are inconsistent with a neurological disorder
3. Not explained by medical conditions
4. Significant distress or impairment
D. Factitious Disorder
1. Imposed on self
a. Falsify physical or psychological symptoms
b. Present to others as impaired
c. Deceptive behavior in the absence of rewards
2. Imposed on another
a. Falsify physical or psychological symptoms in another
b. Present another individual as impaired
c. Deceptive behavior in the absence of rewards
E. Conditions Related to Somatoform Disorders
1. Malingering: faking a physical illness for gain
2. Munchausen's Syndrome:  constant pursuit of medical care after faking symptoms
3. Munchausen's Syndrome by proxy: a person induces physical symptoms of another person under their care

III. Treatment of Somatic Symptom Disorders
A. Cognitive Behavioral Treatment
1. Identify and change triggering emotions
2. Change cognitions about symptoms
3. Replace sick role behaviors with more appropriate social interactions
B. Antidepressants
1. Tofranil
2. Effective even at low dosages that do not alleviate depressive symptoms