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Chapter 6
Somatoform and Dissociative
Disorders
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.
Chapter 6
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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Dissociative Experiences in the General
Population
90
80
Percent
acknowledging
Percent in pathological
range
83
70
60
56
47
50
45
40
29
30
26
18
20
10
12
11
0
Missing part of Talking outloud to
Feeling as
Fantasy seems
conversation
oneself
thought one were
real
two different
people
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14
7
4
1
Hearing voices Feeling as though Not recognizing
one's body is not one's reflection in
one's own
a mirror
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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
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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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
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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Distinguishing Somatoform from
Related Disorders




Psychosomatic Disorders
Malingering
Factitious Disorders
Factitious Disorders by Proxy
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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Somatoform Disorders
Conversion
disorder
Somatization
Pain
disorder
disorder
Loss
of functioning in some part of the body for
psychological rather than physical reasons
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
History
of complaints about pain, for which medical
attention has been sought but that appears to have no
physical cause
Hypchondriasis
Chronic
Body
Excessive
dysmorphic
disorder
Chapter 6
worry that one has a physical disease in the
absence of evidence that one does; frequently seek
medical attention
preoccupation with some part of the body
the person believes is defective
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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
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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
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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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
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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Body Dysmorphic Disorder
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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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.
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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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

Depersonalizati
on Disorder

Frequent episodes in which individual
feels detached from his or her mental
state or body
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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
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Dissociative Fugue
Symptoms
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
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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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
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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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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.
Chapter 6
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
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