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Somatoform and Dissociative Disorders

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Compare and contrast SOMATOFORM AND DISSOCIATIVE DISORDERS.

Focus on:
*how repression and anxiety (psychodynamic model) is possibly involved,
*DSM-IV diagnosis criteria,
*and the most effective treatments.

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Let's look at the descriptions and DSM-IV diagnosis criteria to differentiate these disorders, which each have a number of disorders. Treatments and medications are also discussed.

RESPONSE:

Compare and contrast SOMATOFORM AND DISSOCIATIVE DISORDERS. Focus on how repression and anxiety (psychodynamic model) is possibly involved, DSM-IV diagnosis criteria, and the most effective treatments.

1. Dissociative Disorders

Patients with these mental disorders suffer disruption of memory, consciousness, identity, and general perception of themselves and their surroundings. Disorders included in this category are: (a) Dissociative Amnesia, (b) Depersonalization Disorder, (c) Dissociative Fugue, (d) Dissociative Identity Disorder, and (e) Dissociative Disorder NOS (300.15)
Disorders and DSM-IV-TR Diagnostic Criteria.

?Dissociative Amnesia

Patients with this Dissociative Disorder experience marked but reversible impairment of recall of important personal information or experience, usually involving emotional trauma.

According to DMS-IV-TR, the diagnostic criteria for 300.12 Dissociative Amnesia are as follows:

A. The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.
B. The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, Posttraumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma).
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (http://www.behavenet.com/capsules/disorders/disamnesia.htm)

?Depersonalization Disorder

Patients with this Dissociative Disorder experience episodes during which they feel detached from themselves. They may experience themselves or their surroundings as unreal. They may feel outside or lacking control of themselves. They retain awareness that this is only a feeling.

According to DMS IV-TR, the diagnostic criteria for 300.6 Depersonalization Disorder are as follows:

A. Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).
B. During the depersonalization experience, reality testing remains intact.
C. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy). (http://www.behavenet.com/capsules/disorders/depersdis.htm)

?Dissociative Fugue

Patients with this Dissociative Disorder suddenly and unexpectedly travel away from their home geographic location, experience impaired recall of their past. They may be confused about their former identity and may assume a new identity.

According to DMS IV-TR, the diagnostic criteria for 300.13 Dissociative Fugue are:

A. The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past.
B. Confusion about personal identity or assumption of a new identity (partial or complete).
C. The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).
D. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (http://www.behavenet.com/capsules/disorders/disfugue.htm)

?Dissociative Identity Disorder

Patients with this Dissociative Disorder suffer from alternation of two or more distinct personality states with impaired recall among personality states of important information.

The DSM-IV-TR criteria for dissociative identity disorder are: a) the presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self), b) at least two of these identities or personality states recurrently take control of the person's behavior, c) inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness, and d) the disturbance is not due to direct physiological effects of substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play. (http://www.behavenet.com/capsules/disorders/did.htm)

DID is a trauma related disorder. Individuals who suffer from it usually have experienced severe and repeated abuse as a child (Allers, & Snow, 1999). The alternate personalities develop as a way of coping and hiding from the abuse (Allers et al., 1999). It assumes the ability to "repress" memory to cope with earlier trauma.

Treatments and drugs

Psychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues with a mental health professional. The therapist works to help the patient understand the cause of her or his condition and to form new ways of coping with stressful circumstances. Psychotherapy for dissociative disorders often involves techniques, such as hypnosis, that help the person remember and work through the trauma that triggered the dissociative symptoms. The course of psychotherapy may be long and painful, but this treatment approach often is very effective in treating dissociative disorders (http://www.mayoclinic.com/health/dissociative-disorders/DS00574/DSECTION=treatments-and-drugs.

Dissociative disorders that are linked to repressed memories, psychodynamic psychotherapy is a method of psychotherapy evolved from Freudian psychoanalysis and is based on the same theories that the treatment works by bringing the unconscious into conscious awareness, achieving insight, resolving neurotic conflict, and working through resistance and the transference among others. However, this method, which is often considered standard or at least traditional among many psychiatrists and psychologists, may involve a shorter course of less frequent sessions and no psychoanalytic couch. The psychotherapist usually faces the sitting patient (http://www.behavenet.com/capsules/).

Other dissociative disorder treatment may include:

? Creative art therapy. This type of therapy uses the creative process to help people who might have difficulty expressing their thoughts and feelings. Creative arts can help you increase ...

Solution Summary

This compares and contrasts the different somatoform and dissociative disorders on several dimensions, such as how repression and anxiety (psychodynamic model) is involved, DSM-IV diagnosis criteria and the most effective treatments.

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Somatoform, Factitious, and Dissociative Disorders

When a client presents physical ailments for which no medical evidence confirms a condition, the client's pain may not simply go away. Rather, the pain may persist, further disrupting the client's life. In these cases, psychological evaluations may be used to determine if any psychological disorders exist. Specifically, somatoform disorders, factitious disorders, and dissociative disorders may be considered for the client's diagnosis. Additionally, psychologists may also evaluate whether other confounding factors, such as environmental and/or individual variables, influence a diagnosis.

Axes I through V diagnoses for the client in the case study and explain your rationale for assigning these diagnoses on the basis of the DSM-IV-TR. Then describe three confounding factors that may influence client diagnosis and why.

Casestudy:
Male Client: All things considered, I'm doing pretty well. I own my own consulting firm. I help online businesses identify and build their customer base. The company keeps growing every year, so I'm kept pretty busy. I've got it made, really. I mean, I have more free time to play with than most people, a lot more. But to be honest, I'm not happy with my life right now. I wouldn't be here otherwise, right?

Psychologist: So tell me what's going on for you?

Male Client: Well I can't seem to keep a relationship going. I have so much good in my life right now, but just not that. I'll start going out with someone a couple of times, and they stop returning my calls. I used to think that it was just a run of bad luck, but now I know that it's me. I'm just not very attractive. I think that's what happened with my last real boyfriend. We were together for eight months, and never came right out and said it, but I know the reason he ended things - it was because I was just too fat. No matter what I do, I can't seem to get rid of this right here, my love-less handles.

Psychologist: Well, if sounds as if you exercise some, because you look in shape.

Male Client: I do. I should. I run five miles a day. I go to the gym a couple times a week and lift weights. I even take a hot yoga class. But it might look like I'm in shape, but trust me; I need to burn more weight.

Psychologist: You're what, 6 foot, 5'11"? How much do you weigh?

Male Client: 155, but 155 pounds of flab. Don't get me wrong. I know you might - I don't purge or anything. What goes in my belly stays there.

Psychologist: Tell me about your diet. What are your eating habits?

Male Client: I eat two meals a day, breakfast, lunch. That's it, no dinner. I drink a lot of protein mixes. I'll have a smoothie every now and then, but as long as its low fat. No alcohol, that's fattening. And definitely no pot. If you smoke that, you'll eat the whole grocery store.

Psychologist: When was the last time you had a physical?

Male Client: Three months ago. Everything was great. Blood pressure, cholesterol. I've never had a sick day in my life. Never seen a shrink, either. You know what my GP said last time I was there, putting my clothes back on? You're too skinny. You know what I said to him? Brother, you can never be too rich or too thin.

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