Clinical Definitions of Dissociative, Sexual, and Somatic Disorders

Dissociative Disorders and Identity

Dissociative Fugue

Sudden, unexpected travel away from home or one’s customary place of work with an inability to recall one’s past.

Associated Features of Dissociative Fugue

• Confusion about personal identity or assumption of a new identity.
• Semantic and procedural memory remain intact.
• Very rare.
• Often serves as a defense against overwhelming stress.

Dissociative Amnesia

Inability to recall important personal information that cannot be explained by ordinary forgetfulness.

Associated Features of Dissociative Amnesia

• Episodic/autobiographical memory is impaired.
• Loss is (usually) reversible.
• Procedural and semantic memory remain intact.
• Lasts from days to weeks (rarely, years).

Dissociative Identity Disorder (DID)

Formerly known as Multiple Personality Disorder.

Presence of two or more distinct identities or personality states (“alters”). At least two of the identities recurrently take control of the person's behavior.

History of DID Cases

• 1880–1920: Many cases reported.
• 1920–1970: Almost no cases reported.
• Since 1973: Sharp increase in cases following the publication of Sybil.
• Early Cases: Reported an average of 2 alters.
• Modern Studies: Report an average of 13–16 alters, with some patients reporting more than 100 alters.

The Oddball Effect and DID

When the brain detects novelty, there is a spike in brain activity (P300). Word sample tests across multiple personalities suggest that the different personalities are not truly dissociative from one another:

• A P300 response is observed to previously learned words, though not as robust as seen in control samples.
• Words learned with one personality are endorsed across all other personalities.

Treatment for DID

Treatment for DID is often considered ineffective or challenging.

Theoretical Models of DID

Traumagenic View

• Childhood trauma “fractures” the personality.
• The child defends against trauma by dissociating.
• Involves a “locus of control shift,” where the individual copes by allowing different parts of their personality to control behavior at different times.

Sociocognitive View

This view posits that DID is iatrogenic (caused by treatment or suggestion).

• Many or most DID patients are highly suggestible.
• Therapists and others can create false memories.
• Alters may be created in response to therapists’ leading questions (e.g., “Is there another person, part of the mind, or force that exists in this body?”).

Sexual Response and Paraphilic Disorders

The Sexual Response Cycle

1. Desire Phase
2. Excitement Phase
3. Orgasm Phase
4. Resolution Phase

Physiological Measurement Tools

• Vaginal Plethysmograph: A device used to measure a woman’s physiological arousal, blood flow, and potential for orgasm.
• Penile Plethysmograph: Measures changes in the size of the penis (erection).

Sexual Desire Disorders

Male Hypoactive Sexual Desire Disorder

Refers to deficient or absent sexual fantasies and urges, as judged by the clinician.

Paraphilic Disorders

Recurrent, intense sexual attraction to unusual objects or sexual activities.

• Frotteuristic Disorder: Sexual desire and urges involving touching or rubbing against an unsuspecting person.
• Sexual Sadism Disorder: The desire for inflicting pain or psychological suffering on another person.
• Sexual Masochism Disorder: The desire for being subjected to pain or humiliation.

Hypothetical Model of Paraphilia Development

1. Often begins with early inappropriate sexual experiences or associations.
2. This may then lead to the development of inadequate arousal patterns and difficulties in relationships with other adults.
3. The individual may have inappropriate sexual fantasies and masturbate to them, thus affirming the fantasies.
4. Over time, the individual may try to inhibit arousal or behavior (this may accidentally increase arousal and affirm it even more).
5. Resulting in a paraphilia.

Somatic Symptom and Related Disorders

Conversion Disorder

Symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other medical condition, but without a corresponding neurological cause.

Often occurs in response to life stress or trauma. Examples include:

• Partial paralysis
• Pseudoseizures
• “Hysterical” blindness

Somatization Disorder

Characterized by numerous physical complaints, beginning before the age of 30, including at least:

• Four pain symptoms
• Two gastrointestinal symptoms
• One sexual symptom
• One pseudoneurological symptom

Hypochondriasis

Fears or beliefs of having a serious disease based on a misinterpretation of bodily symptoms.

Illness Anxiety Disorder

Often associated with high anxiety and sensitivity to physical symptoms regarding health status.