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Psychosomatic disorders
Psychosomatic means mind (psyche) and body (soma). A psychosomatic disorder is a disease
which involves both mind and body.
The term psychosomatic disorder is mainly used to mean:” a psychical disease that is thought to
be caused, or made worse, by mental health factors.”
Psychosomatic disorder, also called psycho-physiologic disorder, condition in which
psychological stresses adversely affect psychological (somatic) functioning to the point of distress.
It is a condition of dysfunction or structural damage in bodily organs through inappropriate
activation of the involuntary nervous system and the gland of internal secretion. Thus, the
psychosomatic symptom emerges as a physiological concomitant of an emotional state.
Same people also use the term psychosomatic disorder when mental factors cause psychical
symptoms, but where there is no psychical disease. For example, a chest pain may be caused due
to stress, and no psychical disease can be found. psychical symptoms that caused by mental factors
are called ‘somatization and somatoform disorders.’
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Classnotes by Samikshya Sharma Poudel
Somatoform disorders are the major forms of psychosomatic illness:
The psychical symptms of somatoform disorders are real. However, they have
psychological roots rather than psychical causes
The symptoms aften resembles symptoms of medical illnesses. As, such people suffering
from somatoform disorders may undergo extensive testing and medical evaluations to
determine the cause of their symptoms.
People who suffer from somatoform disorders will generally not recognize the role these
emotions play in their psysical symptoms.
However, they are not intentionally producing these psysical symptoms or making up their
psychical problems. Their psychical symptoms are real, but are caused by psychological
factors.
Women are more likely than men to have a somatoform disorders.
Symptoms usually begin before age 30 and persist for several years.
The severity of the symptoms may vary from year to year, but there are rarely times when
symptoms are not present. Examples of somatoform symptoms include digestive problems,
headaches, pain, fatigue, menstural problems, and sexual difficulties.
Treatment:
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The health care provider must show empathy and sensitivity to the client’s psychical
symptoms.
A strong trusting relationship is key to getting help with SSD.
Counseling for family and friends may also be useful.
Involve the client in visual imaging and relaxation therapies to reduce psychological
pain.
Conversion disorder:
Conversion disorder, also known as functional neurological symptom disorder, occurs when
a person experiences neurological symptoms (symptoms of the nervous system) not
attributable to any medical condition. The symptoms are real and not imaginary, and they
can affect motor functions and senses.
Difficulty walking
Loss of balance
Body tremors
Weakness or paralysis
Hearing difficulty
Vision problems or blindness
Loss of sensation
Trouble swallowing
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Seizures or shaking episodes
Unresponsiveness
Speech problems, such as inability to speak or slurred speech
Causes:
Treatments
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Dissociative disorder
Dissociation is a subconscious defense mechanism that helps a person protect his or her
emotional self.
Dissociative disorders involve problems with memory, identity, emotion, perception,
behavior and sense of self.
Dissociative disorder is the stress related disorder characterized by disturbance in the
normally integrated functions of consciousness, identity and/ or memory. Dissociative
disorders have essential features of a disruption in the usually integrated functions of
consciousness, memory, identity or perception of the environment. Dissociative symptoms
are often seen in clients with PTSD. Dissociative disorders are relatively rare in the general
population but are much more prevalent among persons with histories of childhood
physical and sexual abuse.
The total population of people with dissociative disorders is estimated at 2%, with women
being more likely than men to be diagnosed
Symptoms
Symptoms and signs of dissociative disorders include:
Significant memory loss of specific times, people and events
Out-of-body experiences
Depression, anxiety and/or thoughts of suicide
A sense of detachment from your emotions or emotional numbness
A lack of a sense of self-identity
There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of
Mental Disorders (DSM):
Dissociative amnesia.
Depersonalization disorder.
Dissociative identity disorder
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Classnotes by Samikshya Sharma Poudel
Dissociative identity disorder:
Dissociative identity disorder (DID) also known previously as multiple personality disorder, has
often been confused and misunderstood. DID also known as multiple personality disorder or split
personality disorder is a chronic psychopathological condition which commonly manifests after
trauma or childhood abuse. It includes disruption in memory and identity of a person.
Dissociative identity disorder is a severe form of dissociation, a mental process which produces a lack
of connection in a person's thoughts, memories, feelings, actions, or sense of identity. One may feel
the presence of two or more people talking or living inside their head, and one may feel as though
they are possessed by other identities. Each identity may have a unique name, personal history and
characteristics, including obvious differences in voice, gender, mannerisms and even such physical
qualities as the need for eyeglasses.
Symptoms:
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B) Recurrent gaps in the recall of everyday events, important personal information, and/or
traumatic events that are inconsistent with ordinary forgetting.
D) The disturbance is not a normal part of a broadly accepted cultural or religious practice.
Note: In children, the symptoms are not better explained by imaginary playmates or
other fantasy play.
E) The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or another medical condition
(e.g., complex partial seizures).
Causes:
The causes of dissociative identity disorder appear to be complex. About 90% of the cases
of DID involve some history of abuse. Some causes are:
Treatment:
Dissociative identity disorder is primarily treated with psychopathology of various types.
According to the Cleveland Clinic, the following are DID therapy types:
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Family therapy: helps to educate the family about the disorder, recognize its presence as
well as work through issues that have developed in the family because of dissociative
identity disorder.
Creative therapy such as art or music therapy: allows the patient to explore thoughts,
feelings and memories in a safe and creative way.
Medications: The use of medication, except for the treatment of acute, specific concurrent
Axis I disorders, is not recommended. Maintenance and effective use of prescriptions given
the multiple personality states is difficult to attain. If medication is prescribed, it should be
carefully monitored.
Depersonalization/derealization disorder
Depersonalization/derealization disorder is a type of dissociative disorder that consists of
persistent or recurrent feelings of being detached (dissociated) from one’s body or mental
processes, usually with a feeling of being an outside observer of one’s life (depersonalization),
or of being detached from one's surroundings (derealization). The disorder is often triggered by
severe stress.
People with depersonalization/derealization disorder often have experienced severe stress, such
as the following:
Symptoms
Persistent and recurrent episodes of depersonalization or derealization or both cause distress and
problems functioning at work or school or in other important areas of your life. Symptoms usually
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begin in the mid- to late teens or early adulthood. Depersonalization-derealization disorder is rare
in children and older adults.
Episodes of depersonalization-derealization disorder may last hours, days, weeks or even months
at a time. In some people, these episodes turn into ongoing feelings of depersonalization or
derealization that may periodically get better or worse.
Depersonalization symptoms
Feelings that you're an outside observer of your thoughts, feelings, your body or parts of
your body — for example, as if you were floating in air above yourself
Feeling like a robot or that you're not in control of your speech or movements
The sense that your body, legs or arms appear distorted, enlarged or shrunken, or that your
head is wrapped in cotton
Emotional or physical numbness of your senses or responses to the world around you
A sense that your memories lack emotion, and that they may or may not be your own
memories
Derealization symptoms
Feelings of being alienated from or unfamiliar with your surroundings — for example, like
you're living in a movie or a dream
Feeling emotionally disconnected from people you care about, as if you were separated by
a glass wall
Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial, or a
heightened awareness and clarity of your surroundings
Distortions in perception of time, such as recent events feeling like distant past
Distortions of distance and the size and shape of objects
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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. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, medication) or other medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder, such as schizophrenia,
panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress
disorder, or another dissociative disorder. Read more:
http://traumadissociation.com/depersonalization
Risk factors
Certain personality traits that make you want to avoid or deny difficult situations or make
it hard to adapt to difficult situations
Severe trauma, during childhood or as an adult, such as experiencing or witnessing a
traumatic event or abuse
Severe stress, such as major relationship, financial or work-related issues
Depression or anxiety, especially severe or prolonged depression, or anxiety with panic
attacks
Using recreational drugs, which can trigger episodes of depersonalization or derealization
Treatment:
Psychotherapy: Various psychotherapies (e.g., psychodynamic psychotherapy,
cognitive-behavioral therapy) are successful for some patients:
Cognitive techniques can help block obsessive thinking about the unreal state of being.
Behavioral techniques can help patients engage in tasks that distract them from the
depersonalization and derealization.
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Grounding techniques use the 5 senses (e.g., by playing loud music or placing a piece
of ice in the hand) to help patients feel more connected to themselves and the world and
feel more real in the moment.
Psychodynamic therapy helps patients deal with negative feelings, underlying conflicts,
or experiences that make certain affects intolerable to the self and thus dissociated.
Moment-to-moment tracking and labeling of affect and dissociation in therapy
sessions works well for some patients.
Dissociative amnesia
Dissociative amnesia is a type of dissociative disorder that involves inability to recall important
personal information that would not typically be lost with ordinary forgetting. It is usually caused
by trauma or stress.
Dissociative amnesia, formerly called psychogenic amnesia, is one of a group of conditions
called dissociative disorders. Dissociative amnesia is a condition in which a person cannot
remember important information about his or her life. This forgetting may be limited to certain
specific areas (thematic), or may include much of the person’s life history and / or identity
(general).
It is rare: it affects about 1% male and 2.6 % female in the general population.
Dissociative Amnesia is not caused by head injuries or physical damage to the brain, it is amnesia
which has a psychological cause. It can occur due to mental health conditions, including
posttraumatic stress disorder and acute stress disorder, dissociative identity disorder, somatoform
disorder, and anxiety disorders. Dissociation Amnesia can last for between a few days to a few
years, but is typically less than a week. The period of time which cannot be remembered can range
from minutes to decades.
Symptoms
The main symptom of dissociative amnesia is memory loss that is inconsistent with normal
forgetfulness. The amnesia may be
Localized
Selective
Generalized
Localized amnesia involves being unable to recall a specific event or events or a specific period
of time; these gaps in memory are usually related to trauma or stress.
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For example, patients may forget the months or years of being abused as a child or the days
spent in intense combat. The amnesia may not manifest for hours, days, or longer after the
traumatic period. Usually, the forgotten time period, which can range from minutes to decades,
is clearly demarcated. Typically, patients experience one or more episodes of memory loss.
Selective amnesia involves forgetting only some of the events during a certain period of time or
only part of a traumatic event. Patients may have both localized and selective amnesia.
In generalized amnesia, patients forget their identify and life history. E.g., who they are, where
they went, to whom they spoke, and what they did, said, thought, experienced, and felt. Some
patients can no longer access well-learned skills and lose formerly known information about the
world.
Generalized dissociative amnesia is rare; it is more common among combat veterans, people
who have been sexually assaulted, and people experiencing extreme stress or conflict. Onset is
usually sudden.
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Fugue:
Dissociative fugue is a type of amnesia that is caused by an extreme psychological trauma instead
of physical trauma, illness, or another medical condition. It’s a form of dissociative amnesia that’s
severe, and it’s considered rare.
The dissociative fugue is, essentially, the active state of amnesia wherein a person is doing things
he or she will later forget. A person in a dissociative fugue will suddenly, and uncharacteristically,
travel from the home or work with a purpose in mind but without memory of some or of all of
one's past. The definition of a dissociative fugue indicates the person is not confused or dazed, but
rather he or she seems to be running away from something from which they are not aware.
Someone with dissociative fugue won’t have any memory of their past or about themselves
personally. The type of memories that they lose are sometimes referred to as autobiographical
memories. The condition is a means of escaping a situation of extreme stress that the person can’t
cope with.
Symptoms
A dissociative fugue may last only a few hours. The person undergoing it may seem to be confused
and forgetful to others during that time, but they’ll return to normal afterward. A person with
dissociative fugue lasting longer than just a few hours may have the following symptoms:
confusion
sudden lack of attendance at work or avoidance of other places they frequent
loss of autobiographical memory (about themselves, other people, events in their lives,
etc.)
detachment from their own emotions
severe stress at work or from relationships
confused identity
depression, anxiety, thoughts of suicide, and other mental health issues
inability to recognize loved ones
wandering or going places they usually don’t go
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Classnotes by Samikshya Sharma Poudel
Causes
Dissociative fugue is caused by a situation that gives the person extreme emotional stress. A
common cause of dissociative fugue is severe sexual trauma of some sort. Other causes may
include:
Treatment
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Classnotes by Samikshya Sharma Poudel
These goals are accomplished through several types of therapies, which may include:
family therapy
psychotherapy
cognitive behavioral therapy
meditation and relaxation techniques
music or art therapy
clinical hypnosis
dialectical behavior therapy
Hypochondriasis
Hypochondriasis is defined as a persistent preoccupation with a fear (or belief)) of having one (or
more) serious disease, based on person’s own interpretation of normal body function or a minor
physical abnormality. Usually it begins between 20 and 30 years of age: can occur across the life
time. Generally, people with this disorder do not develop "somatic delusions" (ideas about health
that are completely divorced from reality). The belief and fear of serious illness which lasts for six
months, beyond and despite medical reassurance.
For example, a person may fear that the normal sounds of digestion, sweating or a mark on the
skin may be a sign of a serious disease.
Hypochondriasis is in some ways similar to obsessive-compulsive disorder. The person is
obsessively preoccupied with thoughts of illness and feels compelled to do things (feel lumps,
browse for medical information, visit the doctor) to quell the anxiety they feel.
Hypochondriasis may also be called hypochondria, hypochondriasm, or hypochondriacal neurosis,
health anxiety or illness anxiety disorder. It is the excessive and unrealistic worries about health.
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Classnotes by Samikshya Sharma Poudel
Symptoms
Some symptoms include:
Frequent doctor visits: If one doctor declares that Sal is healthy, he goes to two more to
make sure because he truly thinks he is sick and that the initial doctor is missing something.
Requests for tests and surgery: Even though certain tests and operations come with risks,
hypochondriacs ask for them over and over again.
Severe anxiety about health
Excessive self-diagnosis and research: When hypochondriacs see a news story or an article
online about a new disease, they think they have it.
Thoughts that anything unusual with the body means a serious illness
Lack of attendance at work or school due to anxiety over possible illnesses
Constant attention to blood pressure, heartbeat; constant examinations of body to detect
something unusual
Constant talk about health issues - these concerns quickly become the center of
conversations
The diagnosis of illness anxiety disorder is based on criteria from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5), including the following:
The patient is highly anxious about health and easily alarmed about personal health
issues.
The patient repeatedly checks health status or maladaptive avoids doctor appointments
and hospitals.
The patient has been preoccupied with illness for ≥ 6 months, although the specific illness
feared may change during that time period.
Symptoms are not better accounted for by depression or another mental disorder.
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Causes
Genetic
Beliefs: some people don’t understand the meaning of body sensations aor poor
understanding of diseases can also be one of the causes of this disorder.
History of childhood illness: if someone had serious illness in childhood then minor
physical sensations are also frightening to him/her.
Major life stress.
A severe symptom believed to threaten one’s health ( e.g. chest pain, memory issues)
History of childhood abuse or neglect
Risk factor
Treatment
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Classnotes by Samikshya Sharma Poudel
Education about hypochondria: known as psycho education, this type of counseling can help
patient and family better understand what hypochondria is, why a patient has it and how to cope
with patient health fears
Relaxation techniques, healthy diet, exercise and yoga can also be beneficial.
Supportive psychotherapy
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