This document discusses somatoform and dissociative disorders as defined in the DSM-IV. Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and are thought to be linked to psychological issues. Dissociative disorders involve disruptions or breakdowns in consciousness, memory, identity or perception. The document provides overviews of specific disorders including their defining features, causes, prevalence and treatment approaches. These include conversion disorder, pain disorder, hypochondriasis and dissociative disorders like dissociative identity disorder.

2.  pathological concern of
individuals with the appearance
or functioning of their bodies
when there is no identifiable
medical condition causing the
physical complaints

3.  individuals feel detached from
themselves or their surroundings, and
reality, experience, and identity may
disintegrate

4.  Somatoform disorders have been around for
most of history. The ancient Egyptians reported
cases of somatoform disorders, as did the
ancient Greeks, Romans and most modern
societies.
 It was believed that somatoform disorders only
happened in women.
 Egyptian doctors suggested that perhaps the
problem was that the womb had detached and
was floating around inside the body.
 Greeks gave somatoform disorders the
name hysteria or Womb.

5.  In the 19th century, Sigmund Freud finally gave
hysteria a new name, Conversion Disorder,
because he believed that it was caused by
converting psychological pain into physical pain
 In the 20th century, the American Psychiatric
Association distinguished between the various
types of disorders and gave the group of them
the name somatoform disorders. By this time,
psychologists recognized that both men and
women could suffer from somatoform disorders.

6.  Soma – Meaning Body
◦ Overly preoccupied with health or body appearance
◦ Physical complaints without a medical condition
 Types of DSM-IV Somatoform Disorders
◦ Hypochondriasis
◦ Somatization disorder
◦ Conversion disorder
◦ Pain disorder
◦ Body dysmorphic disorder

7.  Overview and Defining Features
◦ Severe anxiety – The possibility of having a disease
◦ Strong disease conviction
◦ Medical reassurance does not seem to help
 Facts and Statistics
◦ Good prevalence data are lacking
◦ Onset at any age
◦ Runs a chronic course

8.  Causes
◦ Cognitive perceptual distortions
◦ Familial history of illness
 Treatment
◦ Challenge illness-related misinterpretations
◦ Provide more substantial and sensitive reassurance

10.  Overview and Defining Features
◦ Extended history of physical complaints before age
30
◦ Substantial social and occupational impairment
◦ Concerned with the symptoms, not what they might
mean
◦ Symptoms become the person’s identity
◦ patients have a history of many physical complaints
that can not be explained by a medical condition,
the complaints are not intentionally produced

11.  Facts and Statistics
◦ Rare condition
◦ Onset usually in adolescence
◦ Mostly affects unmarried, low SES women
◦ Runs a chronic course

12.  Causes
◦ Familial history of illness
◦ Relation with antisocial personality disorder
◦ Weak behavioral inhibition system
 Treatment
◦ No treatment exists with demonstrated
effectiveness
◦ Reduce tendency to visit numerous medical
specialists
◦ Assign “gatekeeper” physician
◦ Reduce supportive consequences of talk about
symptoms

13.  This is a less specific version of somatization
disorder.
 diagnosis requires a person to have one or more
physical complaints of unexplained symptoms
for at least six months.
 The physical complaints usually begin or worsen
when the patient is under stress .
 Undifferentiated somatoform disorder is also
sometimes referred to as somatization
syndrome.

14.  Causes are not clear.
 Problems in the family
 Depression and stress
Treatments
 Visiting physicians looking for treatments for
physical complaints
 Later, he or she may be referred to a mental
health professional.

15.  Overview and Defining Features
◦ Physical malfunctioning
◦ Lack physical or organic pathology
◦ Malfunctioning often involves sensory-motor areas
◦ Persons show “la belle indifference”
◦ Retain most normal functions, but lack awareness
 Facts and Statistics
◦ Rare condition, with a chronic intermittent course
◦ Seen primarily in females
◦ Onset usually in adolescence
◦ Not uncommon in some cultural and/or religious
groups

16.  Causes
◦ Freudian psychodynamic view is still popular
(anxiety converted into physical symptoms)
◦ Focus on past trauma and conversion
◦ Detachment from the trauma and negative
reinforcement
 Treatment
◦ Similar to somatization disorder
◦ Core strategy is attending to the trauma
◦ Reduce supportive consequences of talk about
symptoms

17.  Overview and Defining Features
◦ Previously known as dysmorphophobia
◦ Preoccupation with imagined defect in appearance
◦ Either fixation or avoidance of mirrors
◦ Suicidal ideation and behavior are common
◦ Often display ideas of reference for imagined defect
 Facts and Statistics
◦ More common than previously thought
◦ Seen equally in males and females
◦ Onset usually in early 20s
◦ Most remain single, and many seek out plastic
surgeons
◦ Usually runs a lifelong chronic course

18.  Causes
◦ Little is known
◦ Shares similarities with obsessive-compulsive
disorder
 Treatment
◦ Parallels that for obsessive-compulsive disorder
◦ Medications (i.e., SSRIs) provide some relief
◦ Exposure and response prevention is also helpful
◦ Plastic surgery is often unhelpful

19.  People who have pain disorder typically
experience pain that started with a
psychological stress or trauma.
 Pain is the focus of the disorder. But
psychological factors are believed to play a
role in the perception and severity of the
pain.
 People with pain disorder frequently seek
medical care. They may become socially
isolated and experience problems with work
and family life.

20.  People who have a history of physical or
sexual abuse are more likely to have this
disorder. However, not every person with
somatoform pain disorder has a history of
abuse.
 Emotional well-being affects the way in which
pain is perceived.
Treatments
 Cognitive-Behavior therapy
 Medication

21.  is a general diagnosis given when a person
has physical symptoms without physical
illness but does not fit the criteria for one of
the other somatoform disorders.
 Conditions that fall into this category include
pseudocyesis. This is the mistaken belief of
being pregnant based on other signs of
pregnancy, including an expanding abdomen;
feeling labor pains, nausea, breast
changes, fetal movement; breast changes;
and cessation of the menstrual period.

22.  Overview
◦ Involve severe alterations or detachments
◦ Affect identity, memory, and/or consciousness
◦ Severe form of normal perceptual experiences
◦ Depersonalization – Distortion in perception of reality
◦ Derealization – Losing a sense of the external world
 Types of DSM-IV Dissociative Disorders
◦ Depersonalization Disorder
◦ Dissociative Amnesia
◦ Dissociative Fugue
◦ Dissociative Trance Disorder
◦ Dissociative Identity Disorder

23.  Overview and Defining Features
◦ Severe and frightening feelings of unreality and
detachment
◦ These dominate and interfere with life functioning
◦ Problem involves depersonalization and
derealization
 Facts and Statistics
◦ High comorbidity with anxiety and mood disorders
◦ Onset is typically around age 16
◦ Usually runs a lifelong chronic course

24.  Causes
◦ Cognitive deficits in attention
◦ Cognitive deficits in short-term memory
◦ Cognitive Deficits in spatial reasoning
◦ Deficits related with tunnel vision and mind
emptiness
◦ Such persons are easily distracted
 Treatment
◦ Little is known

25. ◦ Several forms of psychogenic memory loss:
◦ Generalized type – Inability to recall anything,
including their identity
◦ Localized or selective type – Failure to recall specific
(usually traumatic) events

26.  Retrograde amnesia is when a patient forgets
their past, up to a certain point, but is able to
form new memories.
 This kind of patient would basically be
starting a new life as a new person,
functioning in most ways except totally
unable to remember the past.
 Retrograde amnesia, which literally means
forward moving .

27.  Anterograde amnesia is the opposite of
retrograde
 Literally means moving backward.
 Patients with Anterograde amnesia can't
form new memories, but do remember
everything before the amnesia set in.

28.  Dissociative Fugue: Overview and Defining
Features
◦ Related to dissociative amnesia
◦ Take off to a new place
◦ Unable to remember the past
◦ Unable to remember how they arrived at a new
location
◦ Often assume a new identity

29.  Facts and Statistics -- Dissociative Amnesia
and Fugue
◦ Usually begin in adulthood
◦ Both show rapid onset and dissipation
◦ Both are mostly seen in females
 Causes
◦ Little is known
◦ Trauma and life stress can serve as triggers
 Treatment
◦ Most get better without treatment
◦ Most remember what they have forgotten

30.  Overview and Defining Features
◦ Symptoms resemble those of other dissociative
disorders
◦ Dissociative symptoms and sudden changes in
personality
◦ Changes are often attributed to possession of a spirit
◦ Presentation differs in important ways across cultures
 Facts and Statistics
◦ More common in females
 Causes
◦ Often attributable to a life stressor or trauma
◦ Only abnormal if the trance is considered
undesirable/pathological by the culture
 Treatment
◦ Little is known

31.  Overview and Defining Features
◦ Formerly known as multiple personality disorder
◦ Defining feature – Dissociation of personality
◦ Adopt several new identities (as many as 100)
◦ Identities show unique behaviors, voice, and
posture
 Unique Aspects of DID
◦ Alters – The different identities
◦ Host – The identity that keeps other identities
together
◦ Switch – Quick transition from one personality to
another

32.  Facts and Statistics
◦ Average number of identities is close to 15
◦ Ratio of females to males is high (9:1)
◦ Onset is almost always in childhood
◦ High comorbidity rates, with a lifelong chronic course
 Causes
◦ Most have histories of horrible, unspeakable, child abuse
◦ Most are also highly suggestible
◦ DID – Mechanism to escape from impact of trauma
◦ Closely related to PTSD
 Treatment
◦ Focus is on reintegration of identities
◦ Identify and neutralize cues/triggers that provoke
memories of trauma/dissociation

33.  These categories are used for forms of
pathological dissociation that do not
fully meet the criteria of the other
specified dissociative disorders, or if
the correct category has not been
determined.

34. 1. Other Specified Dissociative Disorder
 This disorder is characterized by a complete loss
(or near loss) of awareness of one’s immediate
surroundings or of one’s identity.
2. Unspecified Dissociative Disorder
 Sometimes, one may show signs of a noteworthy
dissociative condition or an event that does not
fit neatly into the typical presentation of a known
dissociative disorder. At other times, the source
of dissociative symptoms may be unclear


35.  Separating Real Problems from Faking
◦ Malingering – Deliberately faking symptoms
 Related Conditions – Factitious disorders
◦ Factitious disorder by proxy
 False Memories and Recovered Memory
Syndrome