LEARNING UNIT 3: SOMATIC SYMPTOM AND

RELATED DISORDERS AND DISSOCIATIVE

DISORDERS [CHAPTER 6]

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Ls o k h ay a@ g m ail. c om
TIPS
• The best way to go about a case study to enable you to get to a diagnosis is to
underline/highlight symptoms and descriptions as you read through it. The next step would
be to look at the keywords of symptoms and descriptions and to ask yourself “Which
disorder(s) has this kind of symptoms?” or “To what disorder do these symptoms point?”
• Also, remember: For example, the criteria for a panic attack say 4 (or more) symptoms –
you might NOT in all case studies find the full number of symptoms in the case study [that
will make it too easy!]. So, do not, NOT MAKE A DIAGNOSIS, find the
symptoms/descriptions and if they clearly point to a specific disorder, although the number
might be insufficient, still make the diagnosis for this year’s academic exercise purpose
[However, in the real world with real clients, we will NOT do this. We can ask more
questions to get the full picture, and with real clients, ALL DSM-5 CRITERIA as stipulated,
MUST BE MET before we will make a diagnosis].
• It will therefore, be important to study and to know the disorders. If you do not have some
knowledge of the symptoms and/or an understanding of the disorders, you will find it
difficult to make the correct diagnosis.
IAD VERSUS SSD
• Illness anxiety disorder; A disorder which a person does not typically have physical
symptoms, rather they are preoccupied with a fear of developing severe medical
condition. The two categories of patients in this group are care-seeking and care-
avoidant. While somatic symptom disorder is a mental disorder that manifests as
physical symptoms that suggest illness or injury but cannot be explained fully by a
general medical condition.
IAD VERSUS SSD
Which of the following scenarios involves a patient who is most likely to be diagnosed
with somatic symptom disorder
A. Riley is a cancer survivor who has been in remission for three years. Recently, she
began to feel more tired than usual and noticed a spot on her arm that hadn't been
there before. She immediately sought treatment and though her initial results
showed a negative cancer screen, she still continues with checkups every few
months over the next year to monitor the spot on her arm and ensure it stays
malignant.
B. Ben was severely neglected as a child and learned from a very early age that the
more he complained of illness, the more attention he received. Since the pediatrician
was the only person who seemed to genuinely care about him, he wanted to visit the
clinic as often as possible. Years later, he continues to feign symptoms, especially
when he feels he's being mistreated or abandoned by someone he loves.
IAD VERSUS SSD
C. Sven grew up with a mother and brother who had hereditary illnesses that left
them chronically sick and eventually led to early deaths. Now, as an adult, he is
convinced that he may have had the same hereditary issues and has racked up over
a hundred thousand dollars in hospital bills for various tests, visits, and exams,
despite his doctor's insistence that this isn't necessary.
D. Felix has had chronic pain since adolescence. He feels various cramps and or
unexplained muscle twitching, among other things, but his family had told him it was
just "in his head." Now that he's an adult, he started working with doctors to find the
cause of these problems. He takes the maximum sick leave each year and despite
consistent negative lab results and the reassurance of his physicians that nothing is
physically wrong, he has begun to distrust the medical system and spends hundreds
of dollars on every alternative medicine he can find, but to no avail. This had
furthered his spiral into depression; all this has a significant impact on his work and
social life.
IAD VERSUS SSD
ANSWER IS D: Felix's symptoms don't seem to have a medical cause despite
treatment and diagnostics, additionally, this has been going on for years and it's
affecting him significantly.
TUTOR ACTIVITY: Case study 1
• Activity: Read through the following clinical case study and answer the
questions that follow.
• A 29-year-old female laboratory technician was admitted to the medical service via the
emergency room because of bloody urine. The patient said that she was being treated
for lupus erythematosus by a physician in a different city. She also mentioned that she
had had Von Willebrand’s disease (a rare hereditary blood disorder) as a child. On the
third day of her hospitalization, a medical student mentioned to the resident that she
had seen this patient several weeks before at a different hospital in the area, where
the patient had been admitted for the same problem. A search of the patient’s
belongings revealed a cache of anticoagulant medication. When confronted with this
information she refused to discuss the matter and hurriedly signed out of the hospital
against medical advice.
• (Spitzer et al., 1981, p. 33)
• 1. Name the principal DSM-5 diagnosis based on the information in the
description of the 29-year-old female laboratory technician.
• 2. Describe the DSM-5 diagnostic criteria of your diagnosis as listed in the
DSM-5 manual.
Illness Anxiety
Disorder
BE CAREFUL!!!
• It can be difficult to differentiate between
Somatic Symptom Disorder and Illness Anxiety
Disorder.

• Read case studies carefully!!!

Dissociative disorders
• Dissociative disorders are characterized by an individual becoming split off, or
dissociated, from their core sense of self. Memory and identity become disturbed;
these disturbances have a psychological rather than physical cause. Dissociative
disorders listed in the DSM-5 include dissociative amnesia,
depersonalization/derealization disorder, and dissociative identity disorder.
Dissociative amnesia
Amnesia refers to the partial or total forgetting of some experience or event. An
individual with dissociative amnesia is unable to recall important personal information,
usually following an extremely stressful or traumatic experience such as combat,
natural disasters, or being the victim of violence. The memory impairments are not
caused by ordinary forgetting. Some individuals with dissociative amnesia will also
experience dissociative fugue whereby they suddenly wander away from their home,
experience confusion about their identity, and sometimes even adopt a new identity.
Most fugue episodes last only a few hours or days, but some can last longer.
Activity: “Normal” Dissociations.”
• Before we move on to some case studies exploring the dissociative disorders, we want to
illustrate that there are periods of dissociation that are “normal” and can happen to all of us.
• Read the following scenarios and see with how many you can identify: For this
activity only you can answer whether you have experienced any of these ‘dissociative
experiences.’
• Many people have had the experience of wanting to drive to a friend's house, but ending up
at their school or office because they are so used to driving that route.
• Others have had experiences of driving on the highway only to find that they have no
recollection of the last 10 or so kilometres they have driven, including obvious landmarks
they had passed along the way.
• Alternatively, you may have driven home from school or work for example and when you
arrived home at some stage you asked yourself “Did I stop at the robots?”, “Did I turn there
at…” etc. because you had no recollections that you did these things while driving.
• Many also have had the experience of dialling a phone number intending to talk to one
particular friend, only to have dialled the number of someone else without being consciously
aware of doing so.
• These examples illustrate that one can fail to be conscious of what one is doing,
and yet safely guide oneself through a task.
• Another example occurs when studying. Again, almost every student has had the
experience of reading pages of material (perhaps in their Abnormal text!), only to
snap out of their “trance” and realize that, although their eyes were moving over
the words, they were thinking about very different things besides their textbook
material. That is, they get to the bottom of a page and have no idea how they got
there.
• Finally, many students may have experienced some form of trauma in which they
felt cut off from feelings or numb from shock.
• Highlighting these experiences helps illustrate that dissociative disorders are not as
bizarre as they first appear. Emphasizing the continuum of behaviour is important
here to enhance student empathy for people with this class of disorders. We are all
capable of forms of dissociation, and people with severe dissociative disorders may
be simply using a natural process to protect themselves from the ongoing onslaught
of trauma.
POP QUIZ
Tori came home from college and found their father alone in the house. Tori's father
wasn't breathing and it was later determined he had died of a heart attack. For three
days, Tori could not be found after this traumatic event. Tori was later discovered
wandering in a nearby city and did not immediately recall who she was. Eventually
Tori regained memory of her identity as she grieved her father's passing. What
disorder seems to match most closely to Tori's behaviors?
ANSWER: DISSOCIATIVE FUGUE
POP QUIZ
A middle-aged woman was experiencing significant distress in her life and reported
recurrent gaps in memory for everyday events. When she was evaluated at her local
mental health center, she described her distinct personalities as Shakira, Milly, and
the "other one." What disorder does she appear to have?
ANSWER: DISSOCIATIVE IDENTITY DISORDER
TUTOR ACTIVITY: Case study 2
• Activity: Read through the following clinical case-study and answer the questions
that follow.
• A 24-year-old graduate student sought treatment because he felt he was losing his mind. He
had begun to doubt his own reality. He felt he was living in a dream in which he saw himself
from without, and did not feel connected to his body or his thoughts. When he saw himself
through his own eyes, he perceived his body parts as distorted—his hands and feet seemed
quite large. As he walked across campus, he often felt the people he saw might be robots; he
began to ruminate about his dizzy spells—did this mean that he had a brain tumor? . . . He
often noted that he spent so much time thinking about his situation that he lost contact with
all feelings except a pervasive discomfort about his own predicament. In his second session,
he was preoccupied with his perception that his feet had grown too large for his shoes, and
fretted over whether to break up with his girlfriend because he doubted the reality of his
feelings for her, and had begun to perceive her in a distorted manner. He said he had hesitated
before returning for his second appointment, because he wondered whether his therapist was
really alive. He was very pessimistic that he could be helped, and had vague suicidal ideation.
A thorough medical and neurological evaluation found no organic aetiology.(Kluft, 1988, p.
580)
• 1. Name the principal DSM-5 diagnosis based on the information in the description
of the student.
• 2. Describe the DSM-5 diagnostic criteria of your diagnosis as listed in the DSM-5
manual.
Depersonalization-
Derealization
Disorder
Depersonalization-Derealization
Disorder
Disconnected from your thoughts,
Disconnected from your surroundings
feelings and body (depersonalization).
or environment (derealization).
QUESTIONS???