Somatoform and Dissociative
Disorders
Chapter five
Somatoform Disorders
• Overly preoccupied with health and or
body appearance
• Usually no identifiable medical condition
causing the physical complaints
Somatoform Disorders
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Hypochondriasis
Somatization disorder
Conversion disorder
Pain disorder
Body dysmorphic disorder
Hypochondriasis
• Physical complaints without a clear
medical cause and severe anxiety
focused on the possibility of having a
serious illness
• Medical reassurance does not seem to
help
• Comorbidity with anxiety and mood
disorders
Hypochondriasis
• Anxiety and features of panic disorder
• Expression of anxiety is different
– Preoccupation with physical symptoms
• Reassurance seems to have temporary
impact at best
• Disease Conviction: core diagnostic
feature
Hypochondriasis
• Differs from illness phobia: fear of
getting a disease
• Hypochondriasis: fear they already have
a disease
• Chronic course
Hypochondriasis
• Distortions in cognition, perception and
emotion
• Interpret minor pain as threatening
• Self focusing creates anxiety which leads
to more symptoms
• View of health as being completely
symptom-free
Hypochondriasis
• Treatment?
• CBT with focused reassurance
Somatization Disorder
• Extended history of physical complaints
starting before age 30 and substantial
impairment in social or occupational
functioning
• Multitude of symptoms
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4 pain
3 gastrointestinal
1 sexual
1 neurological
Somatization Disorder
• Focus on symptoms instead of what they
might mean
• Often show little urgency to do anything
about symptoms
• Symptoms become major part of
indentity
• Most are unmarried women, lower SES
• chronic
Somatization Disorder
• Family studies: link to antisocial
personality disorder
• Males more likely to show aggression
• Females more likely to display
dependence
• No known effective treatment
• Physician as “gatekeeper”
Conversion Disorder
• Physical malfunctioning without
apparent physical cause
• Often resemble neurological diseases
• Usually apathy towards symptoms
• Usually stressful precipitator
• Extremely rare
Pain Disorder
• Psychological factors play a role in the
persistence of pain
• Pain is real
Body Dysmorphic Disorder
• Preoccupation with imagined defect
• Fixated on mirrors, engage in suicidal
behavior, display ideas of reference and
avoidance
• Severe disruption of daily functioning
• CBT and SSRI’s
• Big business for plastic surgeons
Dissociative Disorders
• Depersonalization
– Distortion in perception
– Sense or reality is lost
– Person dissociates from reality
• Derealization
– Losing sense of external world
• Both can be panic and acute stress
disorder
Dissociative Disorders
• Alterations or detachments in
consciousness or identity involving either
dissociation or depersonalization
• Extreme variants on normal phenomena
Depersonalization Disorder
• Severe and frightening feelings of
detachment and unreality
• Very rare
• Cognitive deficits
– Attention, short-term memory, spatial
reasoning
– Reports of tunnel vision and mind emptiness
Dissociative Amnesia
• Psychogenic memory loss
• Usually in females
• Generalized
– Unable to recall anything including identity
• Selective (localized)
– Selective forgetting related to trauma
Dissociative Fugue
• Leaves and may set up another identity in
another place
• Very rare
• Inability to recall why or how they got
there and little memory of the past
Dissociative Trance Disorder
• Attributed to spirit posession
Dissociative Identity Disorder (DID)
• Adoption of new identities
• Often display unique behaviors, voice
and posture
• As many as 100 “Alters”
• Host: identity that seeks treatment
• Switch
• Mostly female
• Severe, chronic sexual abuse
Dissociative Identity Disorder (DID)
• Natural tendency to dissociate from
negative affect related to abuse
• Survival mechanism
• Lack of social support while abuse is
going on
• Thought to be extreme subtype of PTSD