Somatoform and Dissociative
Disorders
Somatoform Disorders
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Somatoform Disorders- Conditions involving
physical complaints of disabilities that occur
without any evidence of physical pathology
to account for them.
Somatization Disorder
Hypochondriasis
Pain Disorder
Conversion Disorder
Somatization Disorder
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Characteristics include
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Multiple complaints and ailments that extend over
a long period beginning before age 30
These complaints are not explained by physical
illness or injury.
Must include four levels of symptoms
Four pain symptoms (different areas of body)
 Two gastrointestinal symptoms (nausea, bloating)
 One sexual symptom (sexual dysfunction / irregularity)
 One pseudoneurological symptom (sensory loss)
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Somatization Disorder II
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Up to 10x more common in females
Evidence is linked with some genetic
factors.
Possibly the underlying etiology is
expressed differently in females and
males. These being somatization and
antisocial behavior respectively.
Evidence is linked to family disoganization
such as abuse
Hypochandriasis
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Differentiation from Somatization Disorder
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Onset may be after age 30
Focus on having a disease rather than symptoms
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Unrealistic fears of disease
Difficulty in describing exact symptoms (general)
Mental orientation of alertness for new symptoms
Focus on remedies and studying different diseases.
Lack of intense fear normally associated with having their
feared disease
Has a 4-9% prevalence in medical practices
Malingering- consciously faking symptoms to
achieve a nonmedical goal.
Hypochandriasis
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Theories
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Interpersonal
I deserve more attention
 Don’t expect as much from me as a person
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Maintanence by physicians rejection
Abuse and Trauma as children
Pain Disorder
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A somatoform Disorder characterized by
reported pain of sufficient duration and
severity to cause significant life disruption
and the absence of medical pathology that
would explain the experienced pain.
Subjectivity of Pain
Conversion Disorder
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A somatoform disorder in which symptoms
of some physical malfunction or loss of
control appear without any underlying
organic pathology; originally called hysteria.
Secondary gain or excuse enabling escape
or avoidance of an intolerably stressful
situation.
Treatment of Somatoform Disorders
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Caution against medication
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Support, reassurance, explanations etc..
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Prognosis generally poor
Dissociative Disorders
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Dissociative Amnesia
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Dissociative Fugue
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Memory loss accompanied by leaving home
and establishing a new identity
Depersonalization Disorder
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Memory loss following a stressful
experience
Experience of the self is altered
Dissociative Identity Disorder
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At least two distinct ego states
Dissociative Amnesia
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Unable to recall important information usually of
a traumatic or stressful nature
Amnestic episode- forgotten period
Dissociative amnesia may be:
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localized –losses all memory within a period of time
(most common)
selective- remember some but not all
generalized- may forget identity
Continuous- unlike others there is not an end
Dissociative Amnesia (Cont)
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Interference is primarily with episodic
memory (ones autobiographical memory)
while semantic memory (facts) remains
intact
Dissociative Fugue
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Forget personal details, identity, and flee
to an entirely new location
Tend to end abruptly
Majority regain most of memories without
a recurrence
Must face consequences of their fugue
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Illegal or violent activity etc…
Dissociative Identity Disorder
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Develop two or more distinct personalities
(subpersonalities or alternate
personalities)
Switching- transition from one
subpersonality to another
Primary or Host Personality- that
personality which appears most often
97% of cases are thought to have
experienced abuse
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Women are diagnosed 3 times as often
as men
Subpersonality Interaction
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Mutual Amnesia- no awareness of alters
Cognizant- each alter is aware of the other
(hear each others voices and talk among
themselves)
One-way Amnesic- some are aware of
others without them being aware of them
(most common)
Co-conscious- quiet observers with no
interaction
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How do subpersonalities differ
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Vital statistics (age, sex, family history,
race)
Abilities and Preferences
Evidence suggests different physiological
responses
Iatrogenic- unintentionally produced by
practitioners
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100 cases in 1973 and now thousands
Increase due to 1) belief that it exists and
2) diagnostic procedures tend to be more
accurate
Etiology / Explanations
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Psychodynamic
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Behavioral
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Operant conditioning in which forgetting is
reinforced by drop in anxiety
State-Dependent Learning
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Caused by excessive memory repression
Extremely rigid state-to-memory links
Self-Hypnosis
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Self induced hypnotic amnesia
Treatments for Dissociative
Amnesia and Fugues
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Psychodynamic therapy
Hypnotic therapy
Drug therapy
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Sodium pentobarbital (“truth serums”).
Medication decreases inhibitions making recall
more likely but may forget again upon awake.
All focus on uncovering memories
Treatment Dissociative
Dissociative Disorder
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Three Major Goals
1) Help recognize fully the nature of their
disorder
2) Recover gaps in their memory
3) Integrate their personalities into one
functioning personality
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Fusion- final merging of 2 or more alters
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Goal is integration
Help each alter to understand they are
part of one person
Use alters names for convenience not to
confirm existence of separate autonomy
All alters should be treated with fairness
Encourage empathy amongst the alters
Gentleness and supportiveness are
needed in consideration of childhood
traumas