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Chapter 8
Somatoform and Dissociative
Disorders
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociation


Normal vs. abnormal dissociation (different parts of
an individual’s identity, memories, or consciousness
become split off from one another)
When dissociation becomes chronic and a defining
feature, the person may be diagnosed with a
dissociative disorder.
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
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
Chapter 8
23
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
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociative Identity Disorder
Symptoms
Presence of two or more separate identities in the same
individual. These personalities may have different ways of
speaking and relating to others and can have different ages and
genders.
Etiology
Alters may be created by people under conditions of extreme
stress, often child abuse. Self-hypnosis may be involved.
OR
Created inadvertently by therapists
Treatment
Long-term psychotherapy to discover functions of the
personalities and to assist in “integration.”
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Sybil
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
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
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
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
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 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Dissociative Disorders (Summary)

Dissociative
Identity Disorder

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 where individual feels
detached from his or her mental state or
body
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Differentiating Somatoform
Disorders from Related Problems

Somatoform
Disorders

Subjective experience of many physical
symptoms -- no organic causes

Psychosomatic
Disorders

Physical illness present -- psychological
factors contribute to the illness

Malingering

Deliberate faking of physical symptoms
for gain (e.g., avoid military duty, get
insurance money)

Factitious Disorder

Deliberate faking of physical illness to
gain medical attention (e.g.,
Munchausen Syndrome –
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
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
Psychodynamic treatment involves helping people identify
feelings and thoughts behind the symptoms and find more
adaptive ways of coping
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
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
Chapter 8
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
“Hannah and her Sisters”
Conversion Disorder
Symptoms
Loss of functioning in some part of the body due
to psychological rather than physiological causes
Etiology
May occur after trauma or stress, perhaps
because the individual cannot face memories or
emotions associated with the trauma. Also,
Social/cultural influences (e..g, “falling
with the spirit)
Treatment
Chapter
8
Psychoanalytic
therapy focuses on
helping
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© 2007 bythe
The McGraw-Hill Companies, Inc. All rights reserved.
individual express emotions or memories.
Somatoform Disorders (Summary)
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
Hypochondriasis
Chronic
Body
Excessive
dysmorphic
disorder
Chapter 8
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
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.