1. Somatoform and Dissociative Disorders
Chapter 6
Somatoform and Dissociative Disorders

2. 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.

3. Dissociative Experiences in the General Population

4. 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

5. Somatoform Disorders 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

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

7. Somatoform Disorders Conversion disorder Somatization 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

8. Conversion Disorder Symptoms
Loss 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
Treatment
Psychoanalytic therapy focuses on helping the individual expression of emotions or memories. Behavioral therapy uses systematic desensitization and other techniques

9. Somatization & Pain Disorders
Symptoms
Somatization 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
Etiology
These 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
Treatment
Psychoanalytic treatment involves helping people identify feelings and thoughts behind the symptoms and find more adaptive ways of coping

10. Hypochondriasis Symptoms
Chronic worry that one has a serious medical disease despite evidence that one does not; frequent consultations with physicians over this worry
Etiology
A family history of depression or anxiety is common. These people may suffer from chronic distress and cope with this distress by exaggerating physical symptoms
Treatment
Same as somatization disorder, involving helping people identify feelings and thoughts behind the symptoms and find more adaptive ways of coping

11. Body Dysmorphic Disorder

12. 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.

13. 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

14. Dissociative Identity Disorder
Symptoms
Presence 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
Etiology
Alters may be created by people under conditions of extreme stress, often child abuse. Self-hypnosis may be involved. Some evidence it runs in families
Treatment
Long-term psychotherapy and use of hypnosis to discover functions of the personalities and to assist in “integration.” Antidepressants and antianxiety drugs may be used

15. Dissociative Fugue Symptoms Etiology Treatment
Person suddenly moves away from home and assumes an entirely new identity, with no memory of previous identity
Etiology
Fugue states usually occur in response to some stressor, but because they are extremely rare, little is known about etiology
Treatment
Psychotherapy to help the person identify the stressors leading to the fugue state and learn better coping skills

16. Help the individual remember traumatic events and accept them
Dissociative Amnesia
Symptoms
Loss of memory due to psychological rather than physiological causes. The memory loss is usually confined to personal information only
Etiology
Typically 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
Treatment
Help the individual remember traumatic events and accept them

17. Depersonalization Disorder
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.