Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and are thought to be linked to psychological issues. Key somatoform disorders discussed include somatization disorder, conversion disorder, pain disorder, and hypochondriasis. Body dysmorphic disorder involves excessive concerns about perceived physical defects. Dissociative disorders disrupt sense of identity and can include dissociative amnesia, fugue states, and dissociative identity disorder. Treatment focuses on confronting trauma and integrating personalities.

1. Somatoform disorders Somatization and Conversion Pain and Hypochondriasis Body Dysmorphic Disorder

2. Somatoform symptoms Symptoms suggest a physical disorder Symptoms cannot adequately be explained physiologically Symptoms are often (but not always) described in dramatic ways Other disorders, such as anxiety disorders, mood disorders, and personality disorders, often co-exist

3. Somatization Disorder (Briquet’s syndrome) Many physical complaints Beginning before age 30 Must include Four different pains Two gastrointestinal symptoms One sexual symptom One pseudoneurological symptom Symptoms are unfounded or exaggerated

4. Conversion Disorder Physical symptoms suggesting neurological problems Sensory impairment: Any modality Paresthesias and paralysis (demonstrate) Sudden onset, sudden termination, sudden reappearance Mostly women; men in combat Often misdiagnosed: Overpathologized La belle indifference: 1/3 of cases

5. Pain Disorder Main symptom is pain May be exacerbated by psychosocial factors May be maintained by gain: Primary gain Secondary gain

6. Hypochondriasis No physical symptoms are necessary Preoccupied with the possibility that normal sensations are symptoms of serious disease Frequent visits to physicians Persists despite medical reassurance Over-report bodily sensations

7. Body Dysmorphic Disorder Excessive concern with real or imagined defects in appearance, especially facial marks or features. Frequent visits to plastic surgeons Culturally-influenced, but not culture-bound May be a symptom of more pervasive disorders: Obsessive-compulsive or delusional disorder, for example.

8. Do advertisements affect BDD? “ Your nose is central to the way you feel about your appearance and the way other people first perceive you. “ If you are in the slightest way unhappy about it, and feel it detracts from your looks, you will probably always be unhappy about it.”

9. More somatoform-like disorders Malingering Factitious disorder Personal By proxy Undifferentiated Somatoform Disorder Somatoform Disorder NOS Pseudocyesis (no everted umbilicus) Hypochondriacal symptoms < 6 months

10. Etiology of somatoform disorders Psychoanalytic theory Controlling repressed sexual urges Displaced anxiety or secondary gain Sackheim: Deny knowledge but use information Behavior theory Malingering Social learning and reinforcement Secondary gain

11. DISSOCIATIVE DISORDERS

12. Dissociative Disorders Disruption in sense of coherent and stable personality identity

13. Dissociative Amnesia and Fugue Loss of memory for important personal information Fugue = amnesia + flight

14. Dissociative Identity Disorder (Multiple Personality) Two or more distinct identities that control behavior Typical alter personalities = child, protector, persecutor 90% female >80% severely abused in childhood

15. Critics of Dissociative Identity Disorder Do clinicians elicit disorder? Use in insanity defense cases Can induce in normal person with hypnosis

16. Treatment of Dissociative Identity Disorder Confront trauma Develop coping skills Integrate personalities