Schizophrenia Diagnosis

Two or more symptoms for most of the time during 1 month period (less if treated successfully) Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms

Social/occupation dysfunction Continuous signs of disturbance for at least 6

months:1 month of symptoms plus 5 months of prodromal or residual periods (usually negative sx) Prodromal – gradual decline prior to active phase

Somatoform & Dissociative Disorders

Chapter 6

An Overview of Somatoform Disorders

Extreme Body Concerns Appearance or functioning of body No known medical condition

Types of DSM-IV Somatoform Disorders Hypochondriasis Somatization disorder Conversion disorder Pain Disorder Body Dysmorphic Disorder

Hypochondriasis

Preoccupation with fear that have serious disease or physical condition

Preoccupied persists despite medical reassurance

Misinterpretation of bodily cues and function Little data, but occurs 1-3% with

#men=#women Onset in adolescence, age 40-50, and after 60

Somatization Disorder

Multiple physical complaints and symptoms Before age 30 multiple physical complaints, impaired

functioning, medical treatment sought, but no medical basis

Multiple symptoms: 4 pain sx + 2 gastrointestinal sx + 1 sexual sx + 1 pseudoneurological sx (double vision)

Preoccupied with physical condition Little data – very rare, typically starts in

adolescence, more common in women

Conversion Disorder

Voluntary motor or sensory function suggests neurological or medical condition, but no medical condition exists Stress and other conflicts precede onset Distress or impairment

Paralysis, blindness, seizures Rare, but often occurs with somatization

disorder Onset in adolescence or early adulthood, more

common in women

Conversion Disorder

Related Disorders Malingering – faking to gain something (disability

payments) Factitious disorders – voluntary control of symptoms,

only purpose appears to be gaining attention, fill illness role

Factitious or Munchausen by proxy – fake/cause illness in another while take on the caretaker role

Pain Disorder

Serious pain in 1 or more areas Psychological factors play role in onset,

severity, exacerbation, maintenance of pain Not faking pain Often follows actual medical condition that

causes pain; when healed, pain persists

Body Dysmorphic Disorder

Preoccupied with imagined defect in appearance or serious exaggeration of minor physical anomaly

Significant distress, impaired functioning Distinct from distorted body image in eating

disorders Little data on prevalence, but appears to be a

lifelong problem with severe impairment, distress, and possible negative consequences (multiple surgeries, attempts to correct themselves)

Causes

Biological – runs in families, but not clear whether inherit personality or other traits, limited data

Psychological Stress or traumatic event usually precedes Overly sensitive to bodily cues – may be modeled Misinterpretation of physical sensations – bias in

perceiving threat/danger Unconscious processes and anxiety/trauma (Freud)

Cultural differences – distinguish cultural practices from disorders

Treatment

Little data on treatment effectiveness, most with hypochondriasis, somatization & conversion disorder

Cognitive Behavior Therapy Identify and challenge misinterpretation of cues Learn to produce own physical symptoms (control) Coach to seek less reassurance May add general stress management techniques

Scheduled visits to medical facilities Address traumatic event Reduce/remove secondary gain (attention,

disability

Treatment cont’d

Body dysmorphic disorder – SSRIs and exposure & response prevention

Dissociative Disorders

Depersonalization Disorder Feeling detached from own body or mind (in a dream)

Dissociative Amnesia Generalized amnesia – lose all memory, including own

identity Localized, selective amnesia – lose memory of specific

events (usually traumatic) during particular period of time

Dissociative Fugue Unexpected travel associated with loss of memory Lose memory of own past, may assume new identity

Dissociative Trance Disorder Trance or possession with undesirable state; in

nonWestern cultures

Dissociative Identity Disorder

Multiple personalities, identities or “alters” At least 2 distinct identities with own pattern

take control of person’s behavior Unable to recall important information Onset usually in childhood, average 15

personalities Prevalence .5 to 1% Characteristic that are highly suggestible

Causes

Biological vulnerability? Twin studies do not support genetic vulnerability to

DID

Psychological factors Trauma is precipitating event; repeated trauma or

extreme trauma for DID Suggestibility or ability to autohypnotize False memories

Treatment

Amnesia & Fugue Usually get better on their own May help recall events or present information and

help integrate into conscious experience Hypnosis and benzodiazepines to aid in recall of

events

DID No controlled studies of treatment, limited success Exposure treatment using PTSD model, extinguish

cues triggering anxiety and dissociation May use hypnosis to bring memories into conscious

awareness