• group of disorders in which people experience significant physical symptoms for which there is no apparant organic cause.
• often mixed up with real physical disorders

• *different from somatoform disorders*
• medical disorders in which people have actual physical illness that can be documented and is worsened by psychological factors 

• *different from somatoform*
• because they don't actually experience symptoms, instead they only fake them to get out of a situation or to gain something

• *different from somatoform*
• person deliberately fakes an illness in order to get medical attention
• aka Munchhausen's Syndrome
• also different from malingering because motive is different

1. Conversion Disorder
2. Somatotization Disorder
3. Pain Disorder
4. Hypochondriasis Disorder
5. Body Dysmorphic Disorder

• Relatively rare and most dramatic type of somatoform disorder
• lose functioning in parts of their bodies, apparantly due to neurological or other medical causes
• Symptoms: paralysis, blindness, mutism, seizures,hearing loss, loss of coordination, anesthesia in a limb (usually involves one specific symptom that happens suddenly and follows a stressor)
• "La belle indifference": people seem completely indifferent to what's happening to them

• Psychoanalysis: learning to relate emotions to physical pain
• Cognitive Therapy: learn not to catastrophize physical symptoms
• Antidepressants

• very similar to somatization (may be variations of the same disorder)
• difference: ppl. with somatization experience symptoms and seek treatment, whereas hypochondriacs often just worry that they have serious diseases but do not always experience physical symptoms

• 3% of patients in general medical practice
• More in women

• excessively preoccupied with a part of body that they believe is defective (sometimes perceptions are so bizarre they seem out of touch with reality)
• Women:concerened with breasts, thighs, hips, weight
• Men:concerned with having a small body build, genitals, body hair, hair thinning
• 98% avoid social contact due to "deformity"
  • 30% housebound
  • 20% attempted suicide
• Average age of onset:16. usually takes 6 years to get treatment, and on average obsessed with 4 different parts of body

• best is cognitive-behavioral (hierarchy and systematic desentization)
• SSRI's

• Very controversial disorder because most of what we know is from case studies, not group research. So there is a lot of disagreement and it’s difficult to generalize

• Two or more distinct identities or personality states which take turns controlling the person’s behavior.

o   Often one or more of the personality states is amnestic for events (can’t remember)…“losing time” in a big way.

o   More than one personality state can be present at one time.

• Inability to recall personal information, not able to be explained by forgetfulness. Ex-people talk about seeing clothes in their closet they don’t remember buying, or having people you don’t know refer to you by a different name.

• Very difficult to define because it’s hard to define a personality state, or to know when a different identity is controlling the behavior.

o   man who worked with Eve White and Eve Black was named Harve Cleckley. He basically defined the word psychopath.

·         Arrested for the murders of two women in Washington State, then linked to the murders of 10 women in Los Angeles in the late ‘70’s. Known as “The Hillside Strangler”

·         Pled not guilty by reason of insanity

o   Claimed an alter ego named “Steve Walker” committed the murders.

·         A psychologist with expertise in hypnosis proved he was faking

o   Hinted to Bianchi that most cases had more than one personality

o   Bianchi later developed another personality named “Billy”

o   When confronted, he admitted he was faking.

o   Sentenced to life in prison in Washington State.

o   Turned out he and his cousin were both involved in the murders, and cousin got in trouble too.

• The later-developing personalities
• Average number: 13
• May be of different age, sex.
• May engage in self-destructive behavior (hard to discern between borderline PD), and sometimes have different skills than host
• Sometimes they're well developed (Think: Sibyll who's could speak French), other's not well developed (Think: Ninja guy)
• More difficult to understand...
  • may vary in handwriting, blood pressure, allergies, intelligence, diabetes, eye color, EEG patterns

• Similar to borderline PD, and even depression and anxiety
• Big jump in diagnosis in 80's. Why?

• Alters frequently change
• Alters only emerge in hypnosis
• No clear signs of switch between personalities (voice, body language)
• Information Contamination: if you tell host something and then one of the alters knows
• No accompanying depression, anxiety, panic

• 85% report sexual abuse (68% incestual)
• 75% report physical abuse
• over 50% report witnessing violent death

o   Partial or total forgetting of past experience

o   Different types:

§  Anterograde – inability to make new memories, can’t remember stuff since the trauma

§  Retrograde – lose memories from before the trauma

o   Can be due to organic causes (head trauma, disease, drugs, surgery)

§  Generally anterograde

§  Generally both personal and general information

• Forgetting caused by psychological factors
• Often for identity but not personal information
• Person is indifferent to loss of memories (protective?)
• Onset and remission are gradual
• Usually more than 1 episode (makes sense if it's a coping strategy. Worked, so do it again)

• Rare
• Person forgets all/most of past
• Sudden, unexpected travel away from home
• May remit suddenly after confrontation (amnestic during fugue)

1. Develop trust
2. Recall traumatic memory (through hypnosis or sodium amytal relaxant)
3. Integrate traumatic memory

• hypnosis can exacerbate dissociation
• eliciting memories is traumatizing
• may take a long time
• often, integration is dissolved during stress

• Frequent episodes in which they feel detached from their bodies or mental processes, as if they are outside observers
• So often that it interferes with daily life