Chapter 6 Somatoform and Dissociative Disorders. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 6 2 Somatoform and Dissociative.

Chapter 6

Somatoform and Dissociative Disorders

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 62

Somatoform and Dissociative Disorders Considered by some to be the result of

psychological process known as dissociation, in which different parts of an individual’s identity, memories, or consciousness become split off from one another.


Dissociative Experiences in the General Population

83

29

56

18

47

12

45

11

26

7

23

414

10

10

20

30

40

50

60

70

80

90

Missing part ofconversation

Talking outloud tooneself

Feeling asthought one were

two differentpeople

Fantasy seemsreal

Hearing voices Feeling as thoughone's body is not

one's own

Not recognizingone's reflection in

a mirror

Percentacknowledging

Percent in pathologicalrange


Somatoform Disorders

A group of disorders in which people experience significant physical symptoms for which there is no apparent organic cause

Symptoms are often inconsistent with possible physiological processes

Strong reason to believe that psychological factors are involved

People do not consciously produce or control the symptoms but truly experience the symptoms

Symptoms pass only when the psychological factors that led to the symptoms are resolved



Somatoform and Pain Disorders

Subjective experience of many physical symptoms, with no organic causes

Psychosomatic Disorders

Actual physical illness present and psychological factors seem to be contributing to the illness

Malingering Deliberate faking of physical symptoms to avoid an unpleasant situation, such as military duty

Factitious Disorder

Deliberate faking of physical illness to gain medical attention


Distinguishing Somatoform from Related Disorders Psychosomatic Disorders Malingering Factitious Disorders Factitious Disorders by Proxy



Conversion disorder Loss of functioning in some part of the body for psychological rather than physical reasons

Somatization disorder History of complaints about physical symptoms, affecting many different areas of the body, for which medical attention has been sought but no physical cause found

Pain disorder History of complaints about pain, for which medical attention has been sought but that appears to have no physical cause

Hypchondriasis Chronic worry that one has a physical disease in the absence of evidence that one does; frequently seek medical attention

Body dysmorphic disorder

Excessive preoccupation with some part of the body the person believes is defective


SymptomsLoss of functioning in some part of the body due to

psychological rather than physiological causes—there may be indifference to the loss of functioning (la belle

indifference)Etiology

Often can occur after trauma or stress, perhaps because the individual cannot face memories or emotions

associated with the trauma

TreatmentPsychoanalytic therapy focuses on helping the individual expression of emotions or memories. Behavioral therapy

uses systematic desensitization and other techniques

Conversion Disorder


SymptomsSomatization disorder involves a long history of multiple physical complaints for which people have sought treatment but for which there is no apparent organic cause. Pain disorder involves only

the experience of chronic, unexplainable pain

EtiologyThese disorders run in families, but it is not clear whether

this is due to genetics or modeling. Different theories claim different origins for this disorder

TreatmentPsychoanalytic treatment involves helping people identify

feelings and thoughts behind the symptoms and find more adaptive ways of coping

Somatization & Pain Disorders


SymptomsChronic worry that one has a serious medical disease

despite evidence that one does not; frequent consultations with physicians over this worry

EtiologyA family history of depression or anxiety is common.

These people may suffer from chronic distress and cope with this distress by exaggerating physical symptoms

TreatmentSame as somatization disorder, involving helping people identify feelings and thoughts behind the symptoms and

find more adaptive ways of coping

Hypochondriasis


Body Dysmorphic Disorder


Dissociative Disorders

Process in which different parts of an individual’s identity, memories, or consciousness become split off from one another.

Most people experience some form of dissociation— daydreaming is one example of dissociation.

When dissociation becomes chronic and a defining features of people’s lives, people may be diagnosed with a dissociative disorder.


Dissociative Disorders

Dissociative Identity Disorder

There are separate, multiple personalities in the same individual

Dissociative Fugue

The person moves away and assumes a new identity, with amnesia for the previous identity

Dissociative Amnesia

The person loses memory of important personal facts, including personal identity, for no apparent organic cause

Depersonalization Disorder

Frequent episodes in which individual feels detached from his or her mental state or body


SymptomsPresence of two or more separate personalities or identities in

the same individual. These personalities may have different ways of speaking and relating to others and may even have

different ages, genders, and physiological responses

EtiologyAlters may be created by people under conditions of extreme

stress, often child abuse. Self-hypnosis may be involved. Some evidence it runs in families

TreatmentLong-term psychotherapy and use of hypnosis to discover functions of the personalities and to assist in “integration.”

Antidepressants and antianxiety drugs may be used

Dissociative Identity Disorder


SymptomsPerson suddenly moves away from home and assumes an entirely new identity, with no memory of previous identity

EtiologyFugue states usually occur in response to some stressor, but because they are extremely rare, little is known about etiology

TreatmentPsychotherapy to help the person identify the stressors leading

to the fugue state and learn better coping skills

Dissociative Fugue


SymptomsLoss of memory due to psychological rather than physiological causes. The memory loss is usually

confined to personal information only

EtiologyTypically occurs following traumatic events. May involve

motivated forgetting of events, poor storage of information during events due to overarousal, or

avoidance of emotions experience during an event

TreatmentHelp the individual remember traumatic events and

accept them

Dissociative Amnesia


People with this disorder have frequent episodes in which they feel detached from their own mental processes or bodies, as if they are outside observers of themselves.

Occasional experiences of depersonalization are common, especially when people are sleep deprived.

Depersonalization disorder is only diagnosed when they are so frequent and distressing that they interfere with an individual’s ability to function.

Depersonalization Disorder

Chapter 6 Somatoform and Dissociative Disorders. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 6 2 Somatoform and Dissociative.

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