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ABNORMAL PSYCHOLOGY,
SIXTEENTH EDITION
James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 8
Somatic Symptom and
Dissociative Disorders
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Somatic Symptom Disorders
Somatic Symptom Disorders
• Involve physical symptoms and
complaints suggesting presence
of medical condition
• Contain no evidence of physical
pathology
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What Are Somatic Symptom Disorders?
Hypochondriasis
Somatization disorder
Somatic Symptom
disorder patterns
Pain disorder
Conversion disorder
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• Must have one of the following three
features:
• Disproportionate and persistent thoughts
about the seriousness of one’s symptoms,
• Persistently high level of anxiety about
health or symptoms, and/or
• Excessive time and energy devoted to
these symptoms or health concerns.
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Hypochondriasis
Hypochondriasis
• Preoccupation with fears of
having or getting serious
disease
• Treatment
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•Not a disorder in DSM-5, and about 75%
of people with hypochrondriasis will
meet criteria for somatic symptom
disorder
•People with hypochondriasis are
preoccupied with fears of getting a serious
disease or the idea that they already have
one
•Cognitive-behavioral views of
hypochondriasis are most widely accepted
•Cognitive-behavioral therapy can be a very
effective treatment
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Somatization Disorder
Somatization disorder
• Characterized by many
different complaints of physical
ailments
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Somatization Disorder
Lasting several years
Beginning before age 30
Somatization disorder
characteristics
Not adequately explained by
independent findings of
physical illness or injury
Leading to medical treatment
or to significant life impairment
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Somatization Disorder
Prevalence
Rates
Causal factors
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•Prevalence, Rates, and Causal Factors
• Usually begins in adolescence
• Is three to ten times more common in women
than in men
• Often occurs with other disorders such as
major depression or panic disorder
•There may be a genetic predisposition to
the disorder
•Other contributory causal factors may
include personality, cognitive, and learning
variables
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Somatization Disorder
Treatment
• Difficult to treat
• Combination of medical
management and cognitivebehavioral therapy
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Pain Disorder
Now a part of Somatic Symptom
Disorder
• Experience of persistent and
severe pain in one or more areas
of body
• Not intentionally produced or
feigned
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Pain Disorder
Cognitivebehavioral
techniques
Treatment
Used in treatment
of both subtypes
of pain disorder
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Illness Anxiety Disorder
• Experience high anxiety about having or
developing a serious illness.
• New to DSM-5.
• 25% of people who met the criteria for
hypochondriasis will be diagnosed with
this new disorder.
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Conversion Disorder
Conversion disorder
• Symptoms or deficits affecting
sensory or voluntary motor
functions
• Leads one to think patient has
medical condition
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•Freud believed that the symptoms were an
expression of repressed sexual energy
•One of the most intriguing and baffling
disorders, with much left to learn.
•In contemporary terms, the primary gain for
conversion symptoms is continued escape
or avoidance of a stressful situation
•Secondary gains include attention and
financial compensation
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Conversion Disorder
Primary gain: cont.
escape/avoidance
of stressful
situation
Gains
Secondary gains:
attention, financial
compensation
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Conversion Disorder
Prevalence: .005% of general
population
Decreasing prevalence
Two to three times more
common in women than men
Comorbidity: major depression
and anxiety disorders
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Conversion Disorder
Categories
of symptoms
Sensory symptoms or
deficits
Motor symptoms or
deficits
Seizures
Mixed presentation from
first three categories
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Conversion Disorder
True or false?
It is crucial that patients receive a thorough
medical and neurological examination to
rule out organic illness.
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Conversion Disorder
Behavioral
therapy
Treatment
Cognitivebehavioral
therapy
Hypnosis
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Malingering and Factitious Disorder
Malingering
• Motivated
by external
incentives
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Factitious
disorder
• Motivated
by benefits
of “sick
role”
•It can be difficult to distinguish between
malingering/factitious disorder and somatic
symptom disorders such as conversion
disorder
• Conscious intent can be a key distinction
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What Are Dissociative Disorders?
Dissociative disorders
• Conditions involving disruptions in
normally integrated functions
• Consciousness
• Memory
• Identity
• Perception
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Dissociative Disorders
Depersonalization/Derealization
Disorder
What Are Dissociative Disorders?
Dissociative Amnesia and
Dissociative Fugue
Dissociative Identity Disorder
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Depersonalization/Derealization Disorder
Derealization
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Depersonalization
•In derealization, one’s sense of the reality
of the outside world is temporarily lost
•In depersonalization, one’s sense of one’s
self and one’s reality is temporarily lost
•If these recur and disrupt life,
depersonalization/derealization disorder
may be diagnosed
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Dissociative Amnesia and
Dissociative Fugue
Dissociative
amnesia
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Dissociative
fugue
•Dissociative fugue now a subtype of
dissociative amnesia
•Dissociative amnesia involves a failure to
recall previously stored personal
information when that failure cannot be
accounted for by ordinary forgetting
•In a dissociative fugue the person also
departs from home surroundings
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Dissociative Identity Disorder
Dissociative identity disorder
• Patient manifests two or more
distinct identities or personality
states (not personalities)
• Formerly called multiple
personality disorder
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Controversies
Dissociative Identity Disorder
Is the disorder real or faked?
If the disorder is not faked, how does it
develop?
Are recovered memories of abuse in the
disorder real or false?
If abuse has occurred, did it play a causal
role?
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Figure 8.1: Childhood Abuse of DID Patients
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Sociocultural Factors in Dissociative
Disorders
Prevalence, Differences, Examples
Prevalence varies with cultural acceptance of
dissociative phenomena
DID identified in all racial groups, SES
classes, and researched cultures
Examples
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•Prevalence varies with acceptance of
dissociative phenomena in the culture
•DID has been identified in all racial groups,
SES classes, and cultures in which it has
been studied; No systematic controlled
research has been conducted
•In some cultures, dissociative trances or
possession trances may occur
•Amok is a dissociative rage seen in some
cultures such as Malaysia, Laos, the
Philippines, Papua New Guinea, and others
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Treatment and Outcomes in
Dissociative Disorders
Treatments
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• Hypnosis
• Integration of
separate
alters
Unresolved Issues
How might “recovered memories” be linked to DID?
“Recovered memories” of childhood abuse are thought
by some to be causal in DID, but by others to be falsely
planted by therapists
Very controversial topic that presents various legal and
ethical challenges
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