Lesson 4: Somatic Symptom and Related Disorders and Dissociative Disorders

• Somatic Symptom Disorder

o Soma-body
o excessive or maladaptive response to physical symptoms or to associated
health concerns.
o medically unexplained physical symptoms
o they feel like they will not overcome and thins that it will lead to serious
illness
o hysterical neurosis
o Criteria for Somatic Symptom Disorder
§ A. One or more somatic symptoms that are distressing and/or result
in significant disruption of daily life.
§ B. Excessive thoughts, feelings, and behaviors related to the
somatic symptoms or associated health concerns as manifested by
at least one of the following:
§ Disproportionate and persistent thoughts about the
seriousness of one’s symptoms.
§ Example: umubo lang ng isang beses, iisipin na may lung
cancer na
§ High level of health-related anxiety.
§ Example: gugugulin ang oras to go to hospitals, seeking
medical help
§ Excessive time and energy devoted to these symptoms or
health concerns.
§ Example: combination of the first two
§ C. Although any one symptom may not be continuously present,
the state of being symptomatic is persistent (typically more than 6
months).
o Specify if: With predominant pain (previously pain disorder): This specifier
is for individuals whose somatic complaints predominantly involve pain.
o Specify current severity:
§ Mild: Only one of the symptoms in Criterion B is fulfilled.
§ Moderate: Two or more of the symptoms specified in Criterion B
are fulfilled.
§ Severe: Two or more of the symptoms specified in Criterion B are
fulfilled, plus there are multiple somatic complaints (or one very
severe somatic symptom).
• Illness Anxiety Disorder
o Formerly known as “hypochondriasis”.
o Physical symptoms are either not experienced at the present time or are
very mild, but severe anxiety is focused on the possibility of having or
developing a serious disease.
o Has mild pain, thinking it will lead to chronic illnesses
o Focused on having chronic illness
o Criteria for Illness Anxiety Disorder
 § Fear of having a serious illness
§ Somatic symptoms are not present or, if present, are only mild in
intensity.
§ There is a high level of anxiety about health, and the individual is
easily alarmed about personal health status.
§ The individual performs excessive health-related behaviors (e.g.,
repeatedly checks his or her body for signs of illness) or exhibits
maladaptive avoidance (e.g., avoids doctors’ appointments and
hospitals).
§ Illness preoccupation has been present for at least 6 months, but
the specific illness that is feared may change over that period of
time.
§ The illness-related preoccupation is not better explained by another
mental disorder, such as somatic symptom disorder, generalized
anxiety disorder, or obsessive-compulsive disorder.
o Specify whether:
§ Care-seeking type: Medical care, including physician visits or
undergoing tests and procedures, is frequently used.
§ Care-avoidant type: Medical care is rarely used
• Psychological Factors Affecting Medical Condition
o Presence of a diagnosed medical condition such as asthma, diabetes, or
severe pain clearly caused by a known medical condition such as cancer
that is adversely affected (increased in frequency or severity) by one or
more psychological or behavioral factors.
o The pattern would have to be consistent in the neglect of appropriate
monitoring and intervention, but the neglect is clearly a behavioral or
psychological factor that is adversely affecting the medical condition.
o Criteria for Psychological Factors Affecting Medical Condition
§ A medical symptom or condition (other than a mental disorder) is
present.
§ Psychological or behavioral factors adversely affect the medical
condition in 1 of the following ways:
§ 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.
§ The factors interfere with the treatment of the medical condition
(e.g. - poor adherence).
§ The factors constitute additional well-established health risks for the
individual.
§ The factors influence the underlying pathophysiology, precipitating
or exacerbating symptoms or necessitating medical attention
§ The psychological and behavioral factors in criterion B are not
better explained by another mental disorder (Panic Disorder, MDD,
or PTSD)
§ Specify if:
 § 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
• Conversion Disorder (Functional Neurological Symptom Disorder
o Physical malfunctioning, such as paralysis, blindness, or difficulty in
speaking, without any physical or organic pathology to account for
malfunction.
o Stress takes the form of a physical injury.
o (parang sa case ni Chin-TTW)
o Criteria for Conversion Disorder
§ One or more symptoms of altered voluntary motor or sensory
function.
§ Clinical findings provide evidence of incompatibility between the
symptom and recognized neurological or medical conditions.
§ The symptom or deficit is not better explained by another medical
or mental disorder.
§ The symptom or deficit causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning or warrants medical evaluation
• Factitious Disorder
o The symptoms are under voluntary control, as with malingering, but there
is no obvious reason for voluntarily producing the symptoms except,
possibly, to assume the sick role and receive increased attention.
o When an individual deliberately makes someone else sick, the condition is
called factitious disorder imposed on another (Munchausen syndrome by
proxy).
o Criteria for Factitious Disorder
§ Falsification of physical or psychological signs or symptoms, or
induction of injury or disease, associated with identified deception.
§ The individual presents himself or herself to others as ill, impaired
or injured.
§ The deceptive behavior is evident even in the absence of obvious
external rewards.
§ The behavior is not better accounted for by another mental disorder
such as delusional belief system or acute psychosis.
§ Specify if:
§ Single episode
§ Recurrent episodes: Two or more events of falsification of illness
and/ or induction of injury
Dissociative Disorders

• When individuals feel detached from themselves or their surroundings, almost as

if they are dreaming or living in slow motion, they are having dissociative
experiences.
• May happen after an extreme stressful event like accident.
• It also is more likely to happen when you’re tired or sleep deprived from staying
up all night cramming for an exam.
o Depersonalization- your perception alters so that you temporarily lose
the sense of your own reality, as if you were in a dream and you were
watching yourself.
o Derealization- your sense of the reality of the external world is lost.
Things may seem to change shape or size; people may seem dead or
mechanical.
• Depersonalization-Derealization Disorder
o When feelings of unreality are so severe and frightening that they
dominate an individual’s life and prevent normal functioning.
o Anxiety, mood, and personality disorders are also commonly found in
these individuals
o Tunnel visions (perceptual distortions) and Mind emptiness (difficulty
absorbing new information)
o Criteria for Depersonalization-Derealization Disorder
§ The presence of persistent or recurrent experiences of
depersonalization, derealization, or both: 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). 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).
§ During the depersonalization or derealization experience, reality
testing remains intact.
§ The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
§ 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).
§ The disturbance is not better explained by another mental disorder,
such as schizophrenia or panic disorder
• Dissociative Amnesia
o Generalized Amnesia- people who are unable to remember anything,
including who they are. May be lifelong or may extend from a period in the
more recent past, such as 6 months or a year previously.
 o Localized or selective Amnesia- a failure to recall specific events,
usually traumatic, that occur during a specific period
o Dissociative Fugue- individuals just take off and later find themselves in
a new place, unable to remember why or how they got there.
o Amok- Individuals in this trancelike state often brutally assault and
sometimes kill people or animals.
o Criteria for Dissociative Amnesia
§ 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.
§ The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
§ 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, sequelae of a closed head
injury/traumatic brain injury, or other neurological condition).
§ 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.
§ Specify if:
§ With dissociative fugue: Apparently purposeful travel or bewildered
wandering that is associated with amnesia for identity or for other
important autobiographical information
• Dissociative Identity Disorder
o May adopt as many as 100 new identities, all simultaneously coexisting,
although the average number is closer to 15.
o In some cases, the identities are complete, each with its own behavior,
tone of voice, and physical gestures. But in many cases, only a few
characteristics are distinct, because the identities are only partially
independent, so it is not true that there are “multiple” complete
personalities.
o Different personalities are called alters.
o Host, the person who becomes the patient and asks for treatment.
o The transition from one personality to another is called a switch.