PSPA3714

Learning unit 3: Somatic Symptom and Related Disorders and Dissociative

Disorders [CHAPTER 6]

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.

Answers: Case study 1

1. Illness Anxiety Disorder
2. DSM-5 diagnostic criteria for Illness Anxiety Disorder [see next page]

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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.

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 Read the following scenarios and see with how many you can identify:

 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 Behaviour 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.

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 your
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.

For this activity only you can answer whether you have experienced any of these ‘dissociative
experiences’.

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 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 tumour? . . .
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.

Answers: Case study 2

1. Depersonalization-Derealisation Disorder Illness Anxiety Disorder
2. DSM-5 diagnostic criteria for Depersonalization-Derealisation Disorder [see next page]

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