Dissociative and Somatic Related Disorder

Dissociative Disorders
Characterizes-
• Group of conditions involving disruption of and/or discontinuity in the person’s
normally integrated functions of consciousness, memory, identity, emotion,
perception , boy representation, motor control and behavior
• The term dissociation refer to the human mind’s capacity to engage in complex
mental activity in channels split off from or independent of conscious
awareness.
• Mild dissociative symptoms occur when we day dream or loose track of what is
going around us, when we drive miles beyond our destination, when we miss
part of conversation we are engaged in
• Are frequently found in the aftermath of trauma and many of the symptoms
including embarrassment and confusion about the symptoms ana desire to hide
them
Kind of Dissociative disorder
• Dissociative identity disorder

• Dissociative Amnesia
• Depersonalization/derealization disorder
1. Dissociative identity disorder
A)Disruption of identity characterized by two or more distinct personality states,
which may be described in some cultures as an experience of possession. The
disruption in identity involves marked discontinuity in sense of self and sense of
agency, accompanied by related alterations in the affect, behavior, consciousness,
memory, perception, cognition and/or sensory-motor functioning. These signs
and symptoms may be observed by others or reported by the individual.
B) Recurrent gaps in the recall of everyday events, important personal
information and/or traumatic events that are consistent with ordinary functioning
C) Symptoms cause clinically significant distress and impairment in overall
functioning
D) Disturbance is not a normal part of a broadly accepted cultural or religious
practice
E) Symptoms are not attributable to the physiological effects of a substance or
another medical condition
2. Dissociative Amnesia
A) An inability to recall important autobiographical information usually of a

traumatic or stressful nature that is inconsistent with ordinary forgetting
B) Symptoms cause clinically significant distress and impairment in overall
functioning
C) Symptoms are not attributable to the physiological effects of a substance or
another medical condition
D) Disturbance is not better explained by dissociative identity disorder,
posttraumatic disorder, acute stress disorder, somatic symptoms disorder etc.
Specify
With dissociative fugue- apparently purposeful travel or bewildered wandering that is

associated with amnesia for identity or for other autobiographical information
3. Depersonalization/derealization disorder
A) The presence of persistent or recurrent experiences of depersonalization, derealization or
both
1)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/physical numbing
2)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
B) During the depersonalization or derealization experiences, reality testing remains intact

C) Symptoms cause clinically significant distress and impairment in overall functioning
D) Symptoms are not attributable to the physiological effects of a substance or another medical
condition
E) Disturbance is not better explained by dissociative identity disorder, posttraumatic disorder,
acute stress disorder, somatic symptoms disorder etc.
Risk factors
• Genetic
• Temperamental- individuals with harm avoidant temperament,

immature defenses, cognitive disconnection schemata
• Environmental- childhood interpersonal traumas, emotional abuse

Treatment
• Medication
• Psychotherapy
• Group Therapy
Co morbidity
• Anxiety disorders
• Mood Disorders
• Obsessive compulsive disorders
• Psychotic disorders
• Substance induced disorders
Somatic symptom and
related disorder
Features
• Presence of somatic symptoms, involving a person having a significant

focus on physical symptoms such as pain , weakness or shortness of
breath resulting in significant distress, where the person may or may
not have underlying diagnosed medical condition
• Individual has excessive thoughts, feelings and behaviors relating to
the physical symptoms
Types
• Somatic symptom disorder
• Illness anxiety Disorder
• Conversion Disorder
• Physiological factors affecting other medical conditions
• Factitious disorder
• Other specified somatic symptom and related disorder
1. Somatic symptom disorder
A)One or more somatic symptoms that are distressing or result in significant

disruption of daily life
B) Excessive thoughts, feelings or behaviors related to somatic symptoms or
associated health concerns as manifested by at least one of the following
1) Disproportionate and persistent thoughts about the seriousness of one’s
symptoms
2) Persistently high level of anxiety about health or symptoms
3) Excessive time and energy devoted to these symptoms or health concerns
C) Although any one somatic symptom may not be continuously present, the
state of being symptomatic is persistent (typically more than 6 months)
Specify if
• With predominant pain (previously pain disorder)

• Persistent – marked impairment for long duration (6 months)
• Current severity
-Mild
-Moderate
-Severe
2. Illness anxiety Disorder
A)Preoccupation with having or acquiring serious illness

B)Somatic symptoms are not present or if present are only mild in intensity. If
another medical condition is present or there is a high risk for developing
medical condition, the preoccupation is clearly excessive and disproportionate
C) There is a high level of anxiety about health, and the individual is easily
alarmed about personal health status
D)Individual performs excessive health related behaviors or exhibit maladaptive
avoidance
E)Illness preoccupation has been present for at least 6 months but the specific
illness that is feared may change over that period of time
F) Disturbance is not better explained by any other mental disorder
3. Conversion Disorder
A) One or more symptoms of altered voluntary motor or sensory

function
B) Clinical findings provide evidence of incompatibility between the
symptom and recognized neurological or medical condition
C) Symptom is not better explained by another medical or mental
disorder
D) Symptoms present clinically significant distress and impaired areas
of functioning
Specify
• Symptom type
- With weakness or paralysis
- With abnormal movement (tremor, dystonic movement, gait disorder)
- With swallowing symptoms
- With speech symptoms
- With attacks or seizures
- With sensory loss or anesthesia
- With special sensory symptom ( visual, olfactory, auditory)
- With mixed symptom
- With acute episode (less than 6 months) or persistent (6 months or more)
- With or without psychological stressor
4. Physiological factors affecting other medical conditions
A)A medical symptoms or condition (other than a mental disorder) is present

B) Psychological or behavioral factors adversely affect the medical condition in one
of the following ways-
1) 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 or delayed recovery from, the medical condition
2) Factors interfere with the treatment of the medical condition
3) Factors constitute additional well established health risks for individual
4) Factors influence the underlying pathophysiology, precipitating or exacerbating
symptoms or necessaiting medical condition
C) Symptoms in criterion B are not better explained by another medical condition
5. Factitious disorder
A) Falsification of physical or psychological signs or symptoms or

induction of injury or disease associated with identified deception
B) Individual presents himself /herself to others as ill, impaired or
injured
C) Deceptive behavior is evident even in the absence of obvious
external rewards
D) Behavior is not better explained by another mental disorder
6. Other specified somatic symptom and related disorder
This category applies to presentations in which symptoms characteristic

of a somatic symptom and related disorder that cause clinically significant
distress of impairment in social, occupation or other important areas of
functioning predominate but do not meet the full criteria for any of the
disorders in the somatic symptom and related disorders diagnostic class
- Brief somatic symptom disorder- duration is less than 6 months
- Brief illness anxiety disorder
- Illness anxiety disorder without excessive health related behaviors
- Pseudocyesis- false belief of being pregnant that is associated with
objective signs and reported symptoms of pregnancy
Risk factors
• Temperamental – maladaptive personality traits

• Genetic
• Environmental- history of childhood abuse and neglect, stressed life
events
Treatment
• Medication
• Psychotherapy
• Group Therapy
Comorbidity
• Other medical conditions
• Panic disorder
• GAD
• Depressive disorders
• Conversion disorder
• OCD
• Body dysmorphic disorder
• Adjustment disorder
• Psychotic disorder

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Dissociative and Somatic Related Disorder

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Dissociative Disorders

• Dissociative identity disorder

A) An inability to recall important autobiographical information usually of a

With dissociative fugue- apparently purposeful travel or bewildered wandering that is

B) During the depersonalization or derealization experiences, reality testing remains intact

• Temperamental- individuals with harm avoidant temperament,

• Environmental- childhood interpersonal traumas, emotional abuse

• Presence of somatic symptoms, involving a person having a significant

A)One or more somatic symptoms that are distressing or result in significant

• With predominant pain (previously pain disorder)

A)Preoccupation with having or acquiring serious illness

A) One or more symptoms of altered voluntary motor or sensory

A)A medical symptoms or condition (other than a mental disorder) is present

A) Falsification of physical or psychological signs or symptoms or

This category applies to presentations in which symptoms characteristic

• Temperamental – maladaptive personality traits

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