CHAPTER SEVEN
DISSOCIATIVE AND SOMATOFORM DISORDERS
Learning Objectives
1. Describe the major features of dissociative disorders, including dissociative identity,
dissociative amnesia, dissociative fugue, and depersonalization disorder.
2. Recount various theoretical perspectives on the dissociative disorders.
3. Describe various methods for treating dissociative disorders.
4. Differentiate between malingering and factitious disorder, and describe the symptoms of
Munchausen syndrome.
5. Describe the features of somatoform disorders, including conversion disorder,
hypochondriasis, body dysmorphic disorder, pain disorder, and somatization disorder.
6. Discuss theoretical perspectives of somatoform disorders.
7. Distinguish somatoform disorders from malingering.
Chapter Outline
I. Dissociative Disorders
A.
B.
C.
D.
E.
F.
G.
Dissociative Identity Disorder
Dissociative Amnesia
Dissociative Fugue
Depersonalization Disorder
Culture-Bound Dissociative Syndromes
Theoretical Perspectives
Treatment of Dissociative Disorders
II. Somatoform Disorders
A.
B.
C.
D.
E.
F.
G.
H.
Conversion Disorder
Hypochondriasis
Body Dysmorphic Disorder
Pain Disorder
Somatization Disorder
Koro and Dhat Syndromes: Far Eastern Somatoform Disorders?
Theoretical Perspectives
Treatment of Somatoform Disorders
III. Summing Up
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Chapter Overview
Dissociative Disorders
Dissociative disorders involve changes or disturbances in identity, memory, or consciousness
that affect the ability to maintain an integrated sense of self. Dissociative disorders include
dissociative identity disorder, dissociative amnesia, dissociative fugue, and depersonalization
disorder.
In dissociative identity disorder, two or more distinct personalities, each possessing well-defined
traits and memories, exist within the person and repeatedly take control of the person's behavior.
Dissociative amnesia involves loss of memory for personal information. There are five types of
dissociative amnesia: localized, selective, generalized, continuous, and systematized. In
dissociative fugue, the person travels suddenly away from home or place of work, shows a loss
of memory for his other personal past and experiences identity confusion or takes on a new
identity. Depersonalization disorders involve persistent or recurrent episodes of
depersonalization that are of sufficient severity to cause significant distress or impairment in
functioning.
Psychodynamic theorists view dissociative experiences as a form of psychological defense by
which the ego defends itself against troubling memories and unacceptable impulses by blotting
them out of consciousness. There is increasing documentation of a link between dissociative
disorders and early childhood trauma, which lends support to the view that dissociation may
serve to protect the self from troubling memories. To learning and cognitive theorists,
dissociative experiences involve ways of learning not to think about certain troubling behaviors
or thoughts that might lead to feelings of guilt or shame. Relief from anxiety negatively
reinforces this pattern of dissociation.
Within the diathesis-stress model, dissociative identity disorder may be explained in terms of a
diathesis consisting of psychological traits, such as a rich inner fantasy life and high levels of
hypnotizability interacting with traumatic stress in the form of severe childhood abuse.
Treatment of dissociative disorders from the biological approach focuses on the use of drugs to
treat the anxiety and depression often associated with the disorder; but drugs have not been able
to bring about reintegration of the personality. Learning perspectives focus on the use of
behavioral methods of reinforcement of the most well-adjusted personality.
Somatoform Disorders
In somatoform disorders, there are physical complaints that cannot be accounted for by organic
causes. Thus, the symptoms are theorized to reflect psychological rather than organic factors.
Four types of somatoform disorders are considered: conversion disorder, hypochondriasis, body
dysmorphic disorder, and somatization disorder.
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In conversion disorder, symptoms or deficits in voluntary motor or sensory functions occur
which suggest an underlying physical disorder but no apparent medical basis for the condition
can be found. Hypochondriasis is a preoccupation with the fear of having, or the belief that one
has, serious medical illness, but no medical basis for the complaints can be found and fears of
illness persist despite medical reassurances. People with body dysmorphic disorder are
preoccupied with an imagined or exaggerated physical defect in their appearance. Somatization
disorder, formerly known as Briquet's syndrome, involves multiple and recurrent complaints of
physical symptoms that have persisted for many years and began prior to the age of 30, but most
typically during adolescence.
The psychodynamic view holds that conversion disorders represent the conversion into physical
symptoms of the leftover emotion or energy that is cut off from unacceptable or threatening
impulses that the ego has prevented from reaching awareness. The symptom is functional,
allowing the person to achieve both primary and secondary gains.
Learning theorists focus on the reinforcements that are associated with conversion disorders,
such as the reinforcing effects of adopting a "sick role." A learning theory view likens
hypochondriasis to obsessive-compulsive behavior. Cognitive factors in hypochondriasis include
self-handicapping strategies and cognitive distortions.
Psychoanalysis seeks to uncover and bring to the level of awareness the unconscious conflicts,
originating in childhood, that are believed to be at the root of the problem. Once the conflict is
uncovered and worked through, the hysterical symptom should disappear because it is no longer
needed as a partial solution to the underlying conflict. Behavioral approaches focus on removing
sources of reinforcement that may be maintaining the abnormal behavior pattern. Behavior
therapists may also work more directly to help people with somatoform disorders learn to handle
stressful or anxiety-arousing situations more effectively. Cognitive techniques such as cognitive
restructuring have been very helpful in treating hypochondrias and body dysmorphic disorder.
Lecture and Discussion Suggestions
1. Differentiating dissociative identity disorder and schizophrenia. People easily confuse
these two disorders, yet they are very different disorders. The term schizophrenia comes from
two Greek words meaning "to split" "the mind." However, Bleuler, who proposed the term
schizophrenia, was not referring to a splitting of the person into different personalities, as occurs
in dissociative identity disorder. Instead, the split in schizophrenia occurs at the core of the
person, loosening the connections between the various psychic functions. Thus, in the mind of
the person with schizophrenia, ideas, perceptions, emotions, and behavior don't operate as an
integral whole; rather he or she may think and act inappropriately in a given situation.
Consequently, schizophrenia is a psychotic disorder that usually requires periods of
hospitalization and medication as well as a prolonged time for recovery. People who have
recovered from an acute episode of schizophrenia often remain loners or underemployed in the
workplace. In contrast, many people with dissociative identity disorder may go unrecognized or
be alternatively diagnosed for years after the initial evaluation. Some of them lead accomplished
lives. Well-functioning people with multiple personalities may elude diagnosis because
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clinicians are not likely to probe for evidence among those who function so well. Also, such
people may have developed elaborate strategies for concealing their alternate personalities, aided
by the stabilizing influences of their careers.
An analogy I have used in my classes to help students visualize the differences between the two
disorders is that dissociative identity disorder is somewhat like taking a large mirror and neatly
cutting it into several small mirrors. They are smaller but they are still clearly mirrors.
Schizophrenia, however, is like taking that same large mirror and shattering it with repeated
hammer blows. What you have left is a collection of glass fragments, none of them comprising a
recognizable mirror. While this analogy is not perfect, students typically find it helpful.
2. Child sexual abuse and the dissociative and somatoform disorders. Freud first identified
childhood experiences of sexual abuse as a significant factor in the psychoneuroses, though he
eventually dismissed them as fantasies. Today, however, there is increasing documentation of
childhood sexual abuse in the lives of those who develop dissociative identity and somatization
disorder. For instance, it has been estimated that as many as one out of four or five girls and one
out of nine or ten boys are sexually abused before they reach 18. Certainly, only a few of these
children who suffer such childhood traumas develop multiple personalities. Yet, recent
recognition that this disorder is not as rare as once thought suggests that we not overlook the link
between child sexual abuse and dissociative identity disorder. Similarly, one study of women
with somatization disorder, compared to those who suffered from a mood disorder, showed
significant differences. Although women in both groups reported similar childhood sexual
experiences, such as masturbating and kissing games, women with somatization disorder were
more likely to report experiences of childhood sexual abuse. More than one out of two women
with somatization disorder had been sexually abused, compared to only one out of six of those
with a mood disorder (Morrison, American Journal of Psychiatry, 1989, 146, 239-241).
3. Hypochondriasis. Estimates of anywhere from one-fourth to three-fourths of the patients
who consult physicians resemble those with hypochondriasis or some other somatoform disorder.
A disproportionate number of these people are from the lower socioeconomic groups, who
complain more about physical symptoms than psychological discomforts. Also, people coping
with bereavement over the loss of loved ones are especially prone to symptoms that mimic signs
of physical illnesses. Even though older people are susceptible to genuine age-related changes in
their health, their complaints often reflect the changing health status of older people. Because
people with hypochondriasis are often offended at the suggestion that their beliefs or fears may
be unwarranted, they frequently become "doctor shoppers" and complain that they are not getting
proper care, thereby alienating themselves from doctors. Furthermore, they frequently refuse
referral for psychotherapy, and are not often seen in mental health facilities. In some instances,
past experience with a true organic disease, either in one's self or family member, predisposes
one to this illness. At the same time, because many complaints may be manifestations of early
stages of neurological or endocrine disorders, the most important differential diagnosis is the
lack of a true organic disease. However, according to the DSM-IV, even the presence of a
genuine physical illness doesn't preclude the coexistence of hypochondriasis.
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4. Differential development of dissociative disorders. Ask students why some people who are
sexually abused as children develop dissociative identity disorder while most do not. Certain
personality traits have been associated with the development of dissociative identity disorder,
such as proneness to fantasize, increased susceptibility to hypnotic suggestion, and openness to
altered states of consciousness. These factors may predispose them to dissociative responses to
extreme stress. Although these factors explain why some develop dissociative identity disorder,
it does not explain why females are more likely to develop it than males.
5. Multiple personalities. Pose the question, "Don't all of us have multiple personalities to
some extent?" Some people question whether multiple personality disorders represent more than
an extreme form of the multiple selves found in all of us. That is, our self-concept includes
hundreds of self-perceptions of varying degrees of clarity and intensity, which represents various
self-images, needs, interests, and social roles integrated within our personality in varying
degrees. Expression of these various selves may account for much of the inconsistency in our
behavior on occasions.
6. Malingering. Ask students how they can tell when someone is faking a dissociative disorder
or an illness. According to the DSM-IV, the essential feature of malingering (pretending) is
intentional production of false or grossly exaggerated physical or psychological symptoms,
motivated largely by external incentives such as avoidance of work or military duty, or obtaining
financial compensation or drugs. Also, the presenting symptoms are less likely to be
symbolically related to underlying emotional conflicts, as they are in dissociative and
somatoform disorders, nor relieved by hypnosis or suggestion.
7. Out of body experiences. Two of the most well-publicized types of dissociation are the socalled "out of body" experiences and "near death experiences." You might ask students to relate
any knowledge they have of these experiences and then explore how various theoretical
viewpoints might scientifically explain them. You might also point out that while most scientists
remain skeptical about people actually leaving their bodies, many readily admit that the people
claiming to have had the experiences appear to be truthful in their belief that the experience was
real. What scientific evidence is there to support or refute claims that one's soul has left one's
body? What alternative explanations are there and what scientific evidence is there to support
them? This topic makes for an interesting discussion as it is an area that many students are
keenly curious about.
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8. Depersonalization experiences. The text describes some of the forms depersonalization can
take. Some of these forms occur from time to time in otherwise normal individuals. Because
your students might read this section and wonder "Do I have depersonalization disorder?", it is
useful to point out how common such episodes are. Ross, Joshi, and Currie (1990) found that
these were especially reported by people age 25-44. For instance, 28 percent of those 25-34 and
about 27 percent of those 35-44 indicated they had experienced depersonalization. Rates were
from 8-10 percent for most other age groups. It is also important to remind students that DSM-IV
considers depersonalization disorder only when it is persistent and results in significant
impairment of functioning.
Ross, C. A., Joshi, S., & Currie, R. (1990). “Dissociative experiences in the general population.”
American Journal of Psychiatry, 147, 1547-1552.
9. Repressed memories? The topics of dissociative identity disorder and amnesia discussed in
this chapter lead well into one of the major controversies of the day – repressed memory therapy.
The roots of this issue go back at least to Sigmund Freud, who originally felt that many of the
problems reported to him by female patients were due to childhood experiences of incest. These
women were telling Freud, often while under hypnosis, that they had begun to remember these
acts. Freud believed this for awhile, but gradually became convinced most of these incestual
experiences were fantasized. This was a widely held opinion until about 1980, when it became
clear that incestuous child abuse was much more common than thought. Then, as writer Martin
Gardner tells it, "In the latter 1980s a bizarre therapeutic fad began to emerge in the United
States. Hundreds of poorly trained therapists, calling themselves "traumatists" began to practice
the very techniques Freud discarded."
What began was a wave of incidents in which patients, generally women 25-45 years old, began
to recall childhood sexual traumas that had allegedly lain buried in the unconscious, often for
decades. In 1990, the first conviction based on repressed memories was handed down to a man
for murdering a young girl in 1969. Observers of the trial felt that the conviction was obtained
almost entirely on the basis of his daughter's memories that had lain buried until a sudden
awakening of them. Gardner summarizes the thoughts of psychologists and others who are quite
concerned about what they feel is false memory syndrome. These critics allege that wellmeaning and sincere therapists begin treating patients with the assumption that a sexual or other
trauma had occurred early in the patients' early life, and then these therapists use leading
questions to slowly implant memories of events that never really happened.
There are, of course, therapists who argue that such repressed memories are real. This is an
interesting topic to discuss with students. Ask students to collect examples and also to search for
empirical evidence to support repressed memories. Many psychologists doubt that such
repression as takes place in these cases is possible.
Gardner, M. (1993). “The false memory syndrome.” Skeptical Inquirer, Summer.
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10. Women and somatization. Women, in general, use health services more than men, even
after use related to pregnancy and childbirth is accounted for. Most somatization disorder
patients are women. Discuss with the class what they think explains these facts. It may be that
traditional sex roles have made it more acceptable for women to admit problems and seek
treatment, while for men, being sick violates the strong, sometimes "macho" image assigned to
their gender. If so, though, why are there at least as many males as females with
hypochondriasis? This topic can provoke a lively class discussion.
11. Reporting bodily symptoms. Ask students whether they feel that they tend to overreport
bodily aches and pains as symptoms of illness, often seeking out medical assistance, or tend to
underreport them, shrugging them off and going about business as usual. Then, have them relate
their tendencies to the following finding. According to Paul Costal and Robert McGraw
(American Psychologist, 40, 1985, 19-28), each of us differs in the tendency to label our bodily
aches and pains as a symptom of illness. People who habitually complain of unfounded ailments
exhibit a cluster of personality traits labeled neuroticism. Those high in neuroticism tend to be
anxious, overly self-conscious, hostile, depressed, impulsive, and usually have low self-esteem.
In contrast, people who underreport their bodily aches and pains exhibit another cluster of traits
labeled extroversion and tend to be warm and outgoing and sufficiently involved in life that they
don't have time to complain of their ailments.
After you have presented these descriptions, ask students which tendency is dominant in their
particular personality and the degree to which it is manifested in under- or overreporting bodily
aches and pains.
Think About It
What is the hypothesized role of anxiety in the dissociative and somatoform disorders? In
the early versions of the DSM, the dissociative and somatoform disorders were grouped with the
anxiety disorders under the general category of neurosis. The common grouping was based on
the psychodynamic model, which holds that various disorders involve maladaptive ways of
managing anxiety. In anxiety disorders, the appearance of disturbing levels of anxiety was
expressed directly, but the role of anxiety in dissociative and somatoform disorders was inferred
rather than expressed in behavior. It was theorized that symptoms mask unconscious sources of
anxiety. The DSM now separates the anxiety disorders from the other categories of neurosis--the
dissociative and somatoform disorders-- with which they were historically linked.
Why is the diagnosis of dissociative identity disorder controversial? Do you believe that
people with dissociative identity disorder are merely playing a role they have learned?
Why or why not? This is an opinion question. Students should be familiar with the symptoms
and features of dissociative identity disorder. Encourage them to 1) maintain a skeptical attitude,
2) consider the definitions of the terms, 3) weigh the assumptions or promises on which
arguments are based, 4) bear in mind that correlation is not causation, 5) consider the kinds of
evidence on which conclusions are based, 6) do not oversimplify, 7) do not overgeneralize.
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What is the difference between dissociative amnesia and ordinary forgetfulness?
The definition of dissociative amnesia excludes ordinary forgetfulness. Dissociative amnesia is
when a person becomes unable to recall important personal information, usually involving
traumatic or stressful experiences, in a way that cannot be accounted for by simple forgetfulness.
Amnesia is not ordinary forgetfulness, such as forgetting someone’s name or where you left the
car keys. Memory loss in amnesia is more profound or wide-ranging. Most cases of dissociative
amnesia take the form of localized amnesia in which events occurring during a specific period of
time are lost to memory.
What role does childhood physical and sexual abuse play in dissociative disorders? The
most widely held view of dissociative identity disorders is that it represents a means of coping
with and surviving severe, repetitive childhood abuse, generally beginning before the age of 5.
The great majority of people with dissociative identity disorder report being physically or
sexually abused as children. The severely abused child may retreat into alter
personalities as a psychological defense against unbearable abuse. In the face of continued abuse,
these alter personalities may become stabilized, making it difficult for the person to maintain a
unified personality.
What psychological formulations have been proposed to explain the development of
dissociative disorders? What do they have in common? To psychodynamic theorists,
dissociative disorders involve the massive use of repression, resulting in the “splitting off” from
consciousness of unacceptable impulses and painful memories. Learning and cognitive theorists
view dissociation as a learned response that involves not thinking about disturbing acts or
thoughts in order to avoid feelings of guilt and shame evoked by such experiences. Biological
theorists have found evidence that shows differences in brain metabolic activity between people
with depersonalization disorder and healthy subjects. The commonality appears to be the
recognition that a history of childhood abuse plays a pivotal role.
Why is it so difficult to distinguish psychological pain from medical pain? What criteria
would you use to determine whether someone has psychological pain associated with pain
disorder or medical pain associated with a physical/biological condition? Often, the
underlying cause of medical pain is difficult to determine, but this does not mean the pain is
purely psychological. The pain one feels, even if physical, can be heightened or lessened by
psychological factors, such as one’s style of coping, making the experience of medical pain a
psychological phenomenon as well as a physical one. As a result of this diagnostic quandary,
many debate whether somatoform pain disorder should be a separate diagnosable psychological
condition.
Why is conversion disorder considered a treasure trove in the annals of abnormal
psychology? What role did the disorder play in the development of psychological models of
abnormal behavior? Conversion disorder used to be called hysterical neurosis and, as such, is
considered classic in the history of abnormal psychology. It played an important role in the
development of Freud’s psychoanalysis. Freud presented several classic cases of conversion
disorder including the famous “Anna O.” Hysterical or conversion disorders seem to have been
much more common in Freud’s day than they are today, when they are relatively rare.
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Do you know anyone you would consider to be a “hypochondriac”? What is the basis of
your opinion? Did reading the text change your view? This is a personal experience opinion
question. Students need to know the symptoms of hypochondriasis and that the main issue in
hypochondrias is fear of illness.
Does koro or dhat syndrome seem strange to you? How might your feelings depend on the
culture in which you were raised? How might behaviors found in your culture be viewed
as strange by members of other cultures? This is a personal opinion question. Students should
know the symptoms of both koro and dhat as well as the cultural factors that contribute to the
manifestation of these disorders, such as the cultural belief in the life-preserving nature of semen
contributing to dhat. Similarly, students should know which individual factors make it more or
less likely that one will develop either disorder. For example, Guangdong residents who are less
superstitious and more highly educated are significantly less likely to develop koro.
Why is it so difficult to distinguish malingering from somatoform and dissociative
disorders? How might secondary gain contribute to the development or maintenance of
these conditions? Those with somatoform and dissociative disorders are often accused of
malingering, or faking illness. To date, few methods exist to distinguish the two. Moreover,
there may be unseen benefits, or secondary gains, to having such a condition. Imagine the man
with pain disorder who does not have to do any housework or heavy lifting as a result – so a real
experience of pain is reinforced because the person experiences some benefit from its presence.
There are also numerous accounts of World War II soldiers developing “night blindness” that
prevented them from going on dangerous nighttime missions. In these cases, how might you go
about distinguishing these conditions?
Activities/Demonstrations
1. The Dissociative Experiences Scale. Ask students to look over the Dissociative Experiences
Scale presented in this chapter and to share their responses. One way to use the scale is to have
students go down the list, marking the frequency with which each item occurs, such as "often,"
"occasionally," or "rarely." Then, determine which types of dissociative experiences occur most
often or most rarely. Or you might simply go down the list getting a show of hands for each item.
Either way, ask students how they feel when they become aware of such discrepancies in their
experience. Do most of them accept such occasional lapses in consciousness as normal?
2. Hypnosis. Have someone skilled in hypnosis conduct a class demonstration to determine
how susceptible to hypnosis your students are. You might point out that individuals with
multiple personality disorder are quite susceptible to self-hypnosis and are especially likely to
dissociate in coping with trauma. However, hypnotic suggestibility has many constructive uses,
such as enhancing relaxation, creativity, weight loss programs, and smoking cessation.
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3. Right-left hemisphere differences. Researchers have found that conversion symptoms are
more likely to occur on the left side of the body than the right (leading to the hypothesis that they
relate to the functioning of the right hemisphere and emotional arousal). A simple demonstration
of the differential functioning of the hemispheres can be done by having students briefly
interview one or two people outside of class. The question asked should be a problem, which
most college students could accomplish with concentration. For instance: "How many letters are
there in the word Washington?" or "Multiply 12 by 13." The interviewer's task is to record the
direction of the subject's eye movements when he or she pauses to think about the question. It
has been reported that when people concentrate on a reasoning problem, their eyes tend to shift
up and to the right.
4. Multiple personality in film. Two of the most famous film examples of multiple personality
(now called dissociative identity disorder in the DSM-IV) are Three Faces of Eve and Sybil.
These are generally too long to show in class, but it is possible to have students rent the videos of
these films and have a get-together where they can view one or the other. They can report to
class on the behavior of Eve and Sybil, and how it corresponds to the text discussion.
5. Is multiple personality real? Organize a class debate. Divide the class into pro and con
positions. Have your students do a bit of research before the next class. Assign students to read
The Case of Billy Milligan or recall an old talk show where “multiples” appeared. Using their
“evidence” allow a 20 minute mock debate, presenting and refuting findings.
6. Munchausen Syndrome by Proxy. M. Night Shyamalan’s 1999 film, The Sixth Sense tells
the story of a boy who communicates with spirits that either do not know they are dead, or have a
message to pass to the living. One of the spirits is a victim of Munchausen Syndrome by Proxy
who wants to expose her mother’s abuse in order to save her younger sister. Show the segment
of the movie depicting the child’s funeral and the showing of a secret video that shows the
mother poisoning her daughter. Ask students to note the mother’s behaviors (such as the red
dress she wore at the funeral) that may appear to be odd and/or attention-seeking. This movie
also provides an opportunity to discuss important facts associated with this disorder, such as the
6 percent mortality rate for victims.
Video Resources
Case Study of a Multiple Personality, 30 min. (Penn State). Cleckley's "classic" case study of
the three personalities of "Eve," including an interview with the patient herself.
Child Abuse, 19 min. color (Films for the Humanities and Sciences). Describes the common
characteristics of offenders and the effects of abuse on children.
Childhood Sexual Abuse, 26 min. color (Films for the Humanities and Sciences). Shows how
adult women learn to work out the problems caused by sexually abusive fathers.
Experts explain how the pattern of abuse spreads and is kept secret.
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Cyrano de Bergerac, this 1990 Metro-Goldwyn-Mayer film depicts Cyrano as a man
obsessed with the size of his nose, which he believes is so deformed that it renders
him unlovable. This movie can be used to discuss body dysmorphic disorder.
Hypochondriasis and Health Care: A Tug of War, 38 min. color (Workshop Films).
Lecture and simulated interviews with people with hypochondriasis and ways of
dealing with it.
Speaking Out Videos in Abnormal Psychology CD-ROM
5 - Henry: Hypochondriasis
VIDEO BACKGROUND:
In this interview, Henry talks about his health problems, both real and psychologically imagined.
He notes that he is hyperaware of his physical health and has possibly seen over seventy doctors
since his twenties to help him relieve the worries he has about getting sick and losing physical
functionality. Henry discusses how his perceived diseases cause him anxiety and although he
studies medical issues, contradictory information makes him confused and distressed about how
to be healthy. His strongest concerns are that he is “afraid of being sick” and that his disorder
prevents him from enjoying life or being able to talk about other people’s problems without
internalizing them. Of particular interest in this interview are the disorders that Henry perceives
he has experienced and/or worries about including: asthma, high cholesterol, respiratory
problems, colon and lung cancer, heart disease, a heart attack, bloody urine/stool and malaria.
DISCUSSION QUESTIONS:
1. People with Hypochondriasis:
a) are preoccupied with fears of having serious diseases
b) often refuse to accept a clean bill of health from a doctor
c) often seek excessive reassurance from physicians
d) all of the above
Answer: d.
Choice A is a partial definition of Hypochondriasis and choices B and C are common behaviors
of people with Hypochondriasis.
2. The most important factor of Hypochondriasis that results in a fear of diseases is:
a) being told that someone you know is ill
b) learning about diseases from medical books
c) misinterpreting bodily symptoms
d) doing research about a particular disease that is popular in the media
Answer: c.
Although the other choices may influence Hypochondriasis, a person with Hypochondriasis
misinterprets bodily symptoms and feelings, which leads her to believe she is sick.
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3. Why do people with Hypochondriasis go to doctors frequently? Does this help them?
Suggested answers: They go to doctors to relieve the fear they feel about their perceived
sickness. Hypochondriasis, however, requires that their preoccupation with the disease continue
despite medical evaluations and reassurance.
4. In addition to physical symptoms, what other factors do you think contribute to
Hypochondriasis?
Suggested answers: the media, knowledge of medicine, friends or family being diagnosed with
disorders, etc.
5. How are Hypochondriasis beliefs different from psychotic delusions?
Suggested answer: People with Hypochondriasis are able to acknowledge that they may be
exaggerating the extent of the feared disease or that there may be no disease at all.
CLASS ACTIVITY:
1. People with Hypochondriasis experience numerous problems because of their fears of
disease. In addition to anxiety arising from this particular worry, what other problems might
people with Hypochondriasis experience?
Suggested answers: rejection or belittling by doctors, ridicule by associates, difficulty with work
or relationships, etc.
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