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Chapter 6
Somatoform and Dissociative Disorders
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 62
Somatoform and Dissociative Disorders Considered by some to be the result of
psychological process known as dissociation, in which different parts of an individual’s identity, memories, or consciousness become split off from one another.
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 63
Dissociative Experiences in the General Population
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Missing part ofconversation
Talking outloud tooneself
Feeling asthought one were
two differentpeople
Fantasy seemsreal
Hearing voices Feeling as thoughone's body is not
one's own
Not recognizingone's reflection in
a mirror
Percentacknowledging
Percent in pathologicalrange
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 64
Somatoform Disorders
A group of disorders in which people experience significant physical symptoms for which there is no apparent organic cause
Symptoms are often inconsistent with possible physiological processes
Strong reason to believe that psychological factors are involved
People do not consciously produce or control the symptoms but truly experience the symptoms
Symptoms pass only when the psychological factors that led to the symptoms are resolved
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 65
Somatoform Disorders
Somatoform and Pain Disorders
Subjective experience of many physical symptoms, with no organic causes
Psychosomatic Disorders
Actual physical illness present and psychological factors seem to be contributing to the illness
Malingering Deliberate faking of physical symptoms to avoid an unpleasant situation, such as military duty
Factitious Disorder
Deliberate faking of physical illness to gain medical attention
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 66
Distinguishing Somatoform from Related Disorders Psychosomatic Disorders Malingering Factitious Disorders Factitious Disorders by Proxy
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 67
Somatoform Disorders
Conversion disorder Loss of functioning in some part of the body for psychological rather than physical reasons
Somatization disorder 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
Pain disorder History of complaints about pain, for which medical attention has been sought but that appears to have no physical cause
Hypchondriasis Chronic worry that one has a physical disease in the absence of evidence that one does; frequently seek medical attention
Body dysmorphic disorder
Excessive preoccupation with some part of the body the person believes is defective
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 68
SymptomsLoss of functioning in some part of the body due to
psychological rather than physiological causes—there may be indifference to the loss of functioning (la belle
indifference)Etiology
Often can occur after trauma or stress, perhaps because the individual cannot face memories or emotions
associated with the trauma
TreatmentPsychoanalytic therapy focuses on helping the individual expression of emotions or memories. Behavioral therapy
uses systematic desensitization and other techniques
Conversion Disorder
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 69
SymptomsSomatization 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
EtiologyThese 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
TreatmentPsychoanalytic treatment involves helping people identify
feelings and thoughts behind the symptoms and find more adaptive ways of coping
Somatization & Pain Disorders
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 610
SymptomsChronic worry that one has a serious medical disease
despite evidence that one does not; frequent consultations with physicians over this worry
EtiologyA family history of depression or anxiety is common.
These people may suffer from chronic distress and cope with this distress by exaggerating physical symptoms
TreatmentSame as somatization disorder, involving helping people identify feelings and thoughts behind the symptoms and
find more adaptive ways of coping
Hypochondriasis
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 611
Body Dysmorphic Disorder
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 612
Dissociative Disorders
Process in which different parts of an individual’s identity, memories, or consciousness become split off from one another.
Most people experience some form of dissociation— daydreaming is one example of dissociation.
When dissociation becomes chronic and a defining features of people’s lives, people may be diagnosed with a dissociative disorder.
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 613
Dissociative Disorders
Dissociative Identity Disorder
There are 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 in which individual feels detached from his or her mental state or body
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 614
SymptomsPresence of two or more separate personalities or identities in
the same individual. These personalities may have different ways of speaking and relating to others and may even have
different ages, genders, and physiological responses
EtiologyAlters may be created by people under conditions of extreme
stress, often child abuse. Self-hypnosis may be involved. Some evidence it runs in families
TreatmentLong-term psychotherapy and use of hypnosis to discover functions of the personalities and to assist in “integration.”
Antidepressants and antianxiety drugs may be used
Dissociative Identity Disorder
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 615
SymptomsPerson suddenly moves away from home and assumes an entirely new identity, with no memory of previous identity
EtiologyFugue states usually occur in response to some stressor, but because they are extremely rare, little is known about etiology
TreatmentPsychotherapy to help the person identify the stressors leading
to the fugue state and learn better coping skills
Dissociative Fugue
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 616
SymptomsLoss of memory due to psychological rather than physiological causes. The memory loss is usually
confined to personal information only
EtiologyTypically 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
TreatmentHelp the individual remember traumatic events and
accept them
Dissociative Amnesia
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 617
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.
Depersonalization Disorder