SOMATOFORM AND DISSOCIATIVE
A Report on Abnormal Psychology
Roa, Francis Carlo
Rosales, Jonel Joshua
Pascua, Abby Grace
Somatoform and Dissociative Disorders
• Physical symptoms that mimic medical conditions with no physiological basis.
• Symptoms are not under voluntary or conscious control
• Somatoform disorders:
• Somatization Disorder
• Conversion Disorder
• Pain Disorder
• Body DysmorphicDisorder
• Comorbid disorders: Mood, personality, and substance use disorders.
• Differentiated from malingering or factitious disorders.
• Cultural differences: Psychosomatic versus somatopsychic perspectives
• Chronic complaints of many bodily symptoms with no physical basis.
• Complaints include at least four pain symptoms in different sites (DSM-IV-TR):
• Two gastrointestinal
• One sexual
• One pseudoneurological
• Undifferentiated Somatoform Disorder
• Relatively rare diagnosis world-wide
a. Conversion Disorder
Conversion Disorder: Complaints of physical problems or impairments of sensory or motor
functions controlled by voluntary nervous system, suggesting neurological disorder, with no
underlying physical cause.
Often related to stress
Most common conversion symptoms:
• Psychogenic pain
• Disturbances of stance and gait
• Sensory symptoms
• Psychogenic seizures
Some symptoms are easily diagnosed as conversion disorders, while others require extensive
neurological and physical examination.
b. Pain Disorder
Pain Disorder: Reports of severe pain, but:
• No physiological or neurological basis (vague descriptions)
• Pain is greatly in excess of that expected with an existing condition, OR
• Pain lingers long after a physical injury has healed
Frequent visits to doctors with numerous physical complaints; potential for drug or medication
Hypochondriasis: Persistent preoccupation with one’s health and physical condition, despite
physical evaluations that reveal no organic problems.
Prevalence: 2-7% of general medical population
• History of physical illness
• Parental attention to somatic symptoms
• Low pain threshold
• Greater sensitivity to somatic cues
• Anxiety/stress-arousing event, plus perception of somatic symptoms, plus fear that
sensations reflect disease = greater attention to somatic cues.
d. Body Dysmorphic Disorder
Body Dysmorphic Disorder: Preoccupation with imagined physical defect in a normal-appearing
person, or excessive concern with slight physical defect.
May be underdiagnosed due to embarrassment to discuss the problem
Comorbid: Functional impairment, mood disorders, social phobia, low self-esteem; may be
Possibly related to obsessive-compulsive disorder
Etiology of Somatoform Disorders
• Predisposition may be learned or “hard-wired”
• Predisposition involves hypervigilance or exaggerated focus on bodily sensations,
increased sensitivity to weak bodily sensations, and disposition to react to somatic
sensations with alarm.
• Predisposition becomes fully developed disorder when person can’t deal with trauma or
Psychodynamic perspective: Somatic symptoms defend against awareness of unconscious
• Freud: Hysterical reactions result from repression of conflict (usually sexual)
• Two mechanisms produce and sustain symptoms:
• Primary gain (protection from anxiety)
• Secondary gain (dependency needs fulfilled)
• Cognitive styles
• Combination of all three
• Societal restrictions on women
• There may be innate physical bases
• Hypochondriacs are more sensitive to bodily sensations
Treatment of Somatoform Disorders
Psychodynamic: Psychoanalysis and hypnosis to help person relive feelings associated with
• Determining the validity of memories dating from an early age is very difficult.
Behavioral: Many strategies, including exposure and response prevention (extinction and
nonreinforcement of complaints); systematic desensitization.
Cognitive-behavioral: Correct cognitive distortions and reattribution training
Treatment of Somatoform Disorders
Biological: Antidepressant medications, increased physical activity, SSRIs
Family systems treatment: Place identified patient’s disorder in perspective, teach family
adaptive ways of support, prepare family members to deal with problems.
Dissociative Disorders: Mental disorders in which a person’s identity, memory, or consciousness is
altered or disrupted:
• Dissociative Amnesia
• Dissociative Fugue
• Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder or MPD)
• Depersonalization Disorder
• Dissociative Amnesia: Partial or total loss of important personal information, may occur
suddenly after stressful/traumatic event.
• Localized: Failure to recall all the events that happened during a specific period.
• Selective: Inability to remember certain details of an incident.
• Generalized: Inability to remember anything about one’s past life.
• Systematized: Loss of memory for selected types of information.
• Continuous: Inability to recall events occurring between specific time in the past and the
• Possibly due to repression (or closely related process) of a traumatic event:
• Posthypnotic Amnesia: Individual cannot recall events occurring during hypnosis with
hypnotist suggesting what is to be forgotten.
• Dissociative Amnesia: Both the source and content of the amnesia are unknown (not
caused by physical injury).
• In posthypnotic and dissociative amnesia, lost material can sometimes be retrieved with
• Dissociative Fugue: Confusion over personal identity, together with unexpected travel away
• Also called “fugue state”
• Usually involves only short periods of time with incomplete change of identity.
• Depersonalization Disorder: A dissociative disorder in which feelings of unreality concerning the
self or the environment cause major impairment in social or occupational functioning.
• Depersonalization is the most common dissociative disorder.
• Precipitated by physical or psychological stress; evidence that it may be related to emotional
abuse, especially by parents.
• Dissociative Disorders
Dissociative Identity Disorder (DID)
Formerly called Multiple Personality Disorder
Dissociative Identity Disorder: Dissociative disorder in which two or more relatively independent
personalities appear to exist in one person, with only one evident at a time.
• Tone of voice, mannerisms, and other personality characteristics change.
Dissociative Identity Disorder (DID)
• Originates in childhood: Reports of extreme physical or sexual abuse
• Comorbid with conversion symptoms, depression, and anxiety
• Diagnostic controversy
• Number of personalities has increased.
• Much higher in highly suggestible patients.
• Often “discovered” in hypnosis.
Etiology of Dissociative Disorders
• Psychodynamic perspective: Repression blocks unpleasant/traumatic events from
• Amnesia and fugue: Part of personal identity blocked
• DID: Conflicts in personality structure; opposing personality components disable ego’s
ability to control incompatible elements
• Behavioral perspective: Indirect avoidance of stress.
• Sociocognitive model: Rule-governed/goal-directed experiences and displays created,
legitimized, and maintained by social reinforcement.
• Learn behaviors from observing what works for others.
• Reinforced by the removal of unpleasant memories.
• Iatrogenic: Created by the therapeutic situation (hypnotic suggestibility).
• Treatment of Dissociative Disorders
• No specific medication, but medications can treat accompanying anxiety or depression.
• Survivors of childhood sexual abuse who have dissociated are often treated with
psychoeducation, use of group resources, and cognitive/social skills training.
• Amnesia and fugue (usually spontaneously remit):
• Supportive counseling
• Treat depression and stress
• Depersonalization disorder (slower spontaneous remission)
• Alleviate feelings of anxiety, depression, fear of going insane.
• Occasionally behavioral therapy (reinforcement of appropriate responses)
• Dissociative identity disorder (DID):
• Controversial treatments, not always successful
• Psychotherapy and hypnosis
• Personalities introduce selves to patient (in hypnosis) and recall traumatic
experiences/memories which developed them
• Therapist suggests personalities served a purpose but now alternative coping
strategies will be more effective
• Integrate personalities