Chapter 5
Somatoform and Dissociative Disorders
Somatoform Disorders
• Soma – Meaning Body
– Preoccupation with health and/or body
appearance and functioning
– No identifiable medical condition causing
the physical complaints
Somatoform Disorders (continued)
• Types of DSM-IV Somatoform Disorders
– Hypochondriasis
– Somatization disorder
– Conversion disorder
– Pain disorder
– Body dysmorphic disorder
Hypochondriasis
• Clinical Description
– Physical complaints without a clear cause
– Severe anxiety about the possibility of
having a serious disease
– Strong disease conviction
– Medical reassurance does not seem to
help
Hypochondriasis (continued)
• Statistics
– Good prevalence data are lacking
– Onset at any age
– Runs a chronic course
Hypochondriasis: Causes and Treatment
• Causes
– Cognitive perceptual distortions
– Familial history of illness
• Treatment
– Challenge illness-related misinterpretations
– Provide more substantial and sensitive
reassurance
– Stress management and coping strategies
Fig. 5.1, p. 176
Somatization Disorder
• Clinical Description
– Extended history of physical complaints
before age 30
– Substantial impairment in social or
occupational functioning
– Concern about the symptoms, not what
they might mean
– Symptoms become the person’s identity
Somatization Disorder (continued)
• Statistics
– Rare condition
– Onset usually in adolescence
– Mostly affects unmarried, low SES women
– Runs a chronic course
Somatization Disorder: Causes and
Treatment
• Causes
– Familial history of illness
– Relation with antisocial personality disorder
– Weak behavioral inhibition system
• Treatment
– No treatment exists with demonstrated
effectiveness
– Reduce the tendency to visit numerous
medical specialists
Somatization Disorder: Causes and
Treatment (continued)
– Assign “gatekeeper” physician
– Reduce supportive consequences of talk
about physical symptoms
Conversion Disorder
• Clinical Description
– Physical malfunctioning
– Lack physical or organic pathology
– Malfunctioning often involves sensorymotor areas
– Persons show “la belle indifference”
– Retain most normal functions, but lack
awareness
Conversion Disorder (continued)
• Statistics
– Rare condition, with a chronic intermittent
course
– Seen primarily in females
– Onset usually in adolescence
– Common in some cultural and/or religious
groups
Conversion Disorder: Causes
• Causes
– Freudian psychodynamic view is still
popular
– Emphasis on the role of past trauma and
conversion
• Detachment from the trauma and
negative reinforcement
– Address primary/secondary gain
Conversion Disorder: Treatment
• Treatment
– Similar to somatization disorder
– Core strategy is attending to the trauma
– Remove sources of secondary gain
– Reduce supportive consequences of talk
about physical symptoms
Body Dysmorphic Disorder
• Clinical Description
– Previously known as dysmorphophobia
– Preoccupation with imagined defect in
appearance
– Often display ideas of reference for imagined
defect
– Suicidal ideation and behavior are common
Body Dysmorphic Disorder (continued)
• Statistics
– More common than previously thought
– Seen equally in males and females
– Onset usually in early 20s
– Most remain single, and many seek out
plastic surgeons
– Usually runs a lifelong chronic course
Body Dysmorphic Disorder: Causes
• Causes
– Little is known – Disorder tends to run in
families
– Shares similarities with obsessivecompulsive disorder
Body Dysmorphic Disorder: Treatment
• Treatment
– Treatment parallels that for obsessive
compulsive disorder
– Medications (i.e., SSRIs) that work for
OCD provide some relief
– Exposure and response prevention is also
helpful
– Plastic surgery is often unhelpful
An Overview of Dissociative Disorders
• Overview
– Involve severe alterations or detachments
– Affects identity, memory, or consciousness
– Depersonalization – Distortion is
perception of reality
– Derealization – Losing a sense of the
external world
An Overview of Dissociative Disorders
(continued)
• Types of DSM-IV Dissociative Disorders
– Depersonalization Disorder
– Dissociative Amnesia
– Dissociative Fugue
– Dissociative Trance Disorder
– Dissociative Identity Disorder
Depersonalization Disorder: An Overview
• Overview and Defining Features
– Severe and frightening feelings of unreality
and detachment
– Feelings dominate and interfere with life
functioning
– Primary problem involves
depersonalization and derealization
Depersonalization Disorder: An Overview
(continued)
• Facts and Statistics
– High comorbidity with anxiety and mood
disorders
– Onset is typically around age 16
– Usually runs a lifelong chronic course
Depersonalization Disorder: Causes and
Treatment
• Causes
– Cognitive deficits in
– Attention, short-term memory, spatial
reasoning
– Deficits related to tunnel vision and mind
emptiness
– Such persons are easily distracted
• Treatment
– Little is known
Dissociative Amnesia: An Overview
• Dissociative Amnesia
– Includes several forms of psychogenic
memory loss
– Generalized vs. localized or selective type
Dissociative Fugue: An Overview
• Dissociative Fugue
– Related to dissociative amnesia
– Take off and find themselves in a new
place
– Unable to remember the past
– Unable to remember how they arrived at
new location
– Often assume a new identity
Dissociative Amnesia and Fugue: Causes
• Statistics
– Usually begin in adulthood
– Show rapid onset and dissipation
– Occur most often in females
• Causes
– Little is known
– Trauma and stress can serve as triggers
Dissociative Amnesia and Fugue: Causes
and Treatment
• Treatment
– Most get better without treatment
– Most remember what they have forgotten
Dissociative Trance Disorder: An Overview
• Clinical Description
– Symptoms resemble other dissociative
disorders
– Dissociative symptoms and sudden
changes in personality
– Changes often attributed to possession by
a spirit
– Presentation varies across cultures
Dissociative Trance Disorder: Causes, and
Treatment
• Facts and Statistics
– More common in females than males
• Causes
– Often attributable to a life stressor or
trauma
• Treatment
– Little is known
Dissociative Identity Disorder (DID): An
Overview
• Clinical Description
– Formerly known as multiple personality
disorder
– Defining feature is dissociation of
personality
– Adoption of several new identities (as
many as 100)
– Identities display unique behaviors, voice,
and posture
Dissociative Identity Disorder (DID): An
Overview (continued)
• Unique Aspects of DID
– Alters – Different identities or personalities
– Host – The identity that keeps other
identities together
– Switch – Quick transition from one
personality to another
Dissociative Identity Disorder (DID): An
Overview (continued)
• Statistics
– Average number of identities is close to 15
– Ratio of females to males is high (9:1)
– Onset is almost always in childhood
– High comorbidity rates & lifelong, chronic
course
Dissociative Identity Disorder (DID): Causes
• Causes
– Histories of horrible, unspeakable, child
abuse
– Closely related to PTSD
– Mechanism to escape from the impact of
trauma
Dissociative Identity Disorder (DID):
Treatment
• Treatment
– Focus is on reintegration of identities
– Identify and neutralize cues/triggers that
provoke memories of trauma/dissociation
Diagnostic Considerations in Somatoform
and Dissociative Disorders
• Separating Real Problems from Faking
– Malingering – Deliberately faking
symptoms
• False Memories and Recovered Memory
Syndrome
• Related Conditions – Factitious Disorder
– Factitious Disorder by Proxy
Summary of Somatoform and Dissociative
Disorders
• Features of Somatoform Disorders
– Physical problems without on organic
cause
• Features of Dissociative Disorders
– Extreme distortions in perception and
memory
• Well Established Treatments Are Generally
Lacking