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Abnormal Psychology
Leading Researcher Perspectives
Edited by Elizabeth Rieger
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Chapter 5
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Bertha Pappenheim, whose experience
of physical symptoms of supposed
psychological origin was reported in the
famous case study of “Anna O”. The
case was crucial in the development of
Freud’s psychoanalytic theory.
© Bildarchiv Preußischer Kulturbesitz
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Figure 1 An overview of the relationships between somatoform, dissociative
and related disorders
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Pain disorder is characterised by
physical pain (such as headache)
that causes significant distress and
impaired functioning. In addition,
psychological factors are believed to
have an important role in triggering
the pain.
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Figure 2 A cognitive-behavioural model of the process of somatisation
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Headpress/Kobal Collection
In television show United States of Tara, Toni Collette plays the roles
of the alternate identities experienced by a woman with dissociative
identity disorder (DID). DID is a severe form of dissociation
in which a person appears to have two or more distinct identities.
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iStock Photo
Childhood trauma is theorised to have an important role in the
aetiology of dissociative identity disorder.
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Proposed changes for somatoform
and dissociative disorders in DSM-V
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Conversion disorder is to be moved to the dissociative disorders section.
A new category referred to as ‘complex somatic symptom disorder’ is to
be created, including the previous diagnoses of pain disorder associated
with psychological factors, somatisation disorder, undifferentiated
somatoform disorder and hypochondriasis. The proposed criteria include
the existence of at least one somatic symptom that is distressing and
results in significant impairment in daily functioning, and that the
individual manifests a high degree of preoccupation with the symptom/s.
The symptom/s must have been present for at least six months.
Body dysmorphic disorder is to be reclassified as an ‘Anxiety and
Obsessive-Compulsive Spectrum Disorder’, including delusional and
nondelusional subtypes, eliminating the delusional variant from the
‘Psychotic Disorders’ section.
For the remaining somatoform disorders (e.g., somatisation disorder), it
has been suggested that they no longer be classified as mental
disorders, but rather be included with other medical conditions such as
chronic fatigue syndrome or unexplained gastrointestinal symptoms.
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Chapter 5 Summary
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Somatoform and dissociative disorders are a complex and
sometimes controversial range of disorders that are difficult to
categorise in that they span body and mind.
The primary DSM-IV-TR somatoform disorders are conversion
disorder, pain disorder, somatisation disorder, multi-somatoform
disorder, hypochondriasis and body dysmorphic disorder.
Although these categories are helpful in distinguishing normal
somatisation from more severe manifestations, they are limited in
that they describe dimensional phenomena using categories
separated by arbitrary boundaries and they perpetuate the mind–
body dichotomy.
In the area of somatisation, the focus is much less on symptom
counting and more on understanding the psychology of the need for
care, cognitive attributional styles, and the role of the health system
in contributing to abnormal illness behaviour.
In the future, the category of somatoform disorders may be
dispensed with altogether, reducing the artificial mind–body split.
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Chapter 5 Summary (continued)
• The primary DSM-IV-TR dissociative disorders are depersonalisation
disorder, dissociative amnesia, dissociative fugue and dissociative
identity disorder.
• In terms of aetiology and treatment, most focus has been on the role
of trauma in causing the fragmentation of personality characteristic
of dissociative identity disorder.
• Although the diagnosis of dissociative identity disorder has been
associated with considerable controversy, available research
supports its validity and its connection with trauma.
• Much remains to be understood regarding the dissociative disorders,
particularly with regards to their treatment.
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