Somatoform and Dissociative Disorders
Somatoform and Dissociative Disorders
Somatoform and Dissociative Disorders
Types of somatoform
disorders
• Somatization disorder: chronic
syndrome of multiple somatic
symptoms that cannot be explained
medically and are associated with
psychosocial distress and long-term
seeking of assistance from health-
care professionals
• Somatization disorder
(cont.)
– The disorder is chronic
– Anxiety, depression, and suicidal
ideations are frequently
manifested
– Drug abuse and dependence
are not uncommon
• Somatization disorder (cont.)
– Personality characteristics
• Heightened emotionality
• Strong dependency needs
• A preoccupation with symptoms and
oneself
Pain disorder
• Predominant disturbance in pain disorder is
severe and prolonged pain that causes clinically
significant distress or impairment in social,
occupational, or other areas of functioning
Pain disorder (cont.)
• Even when organic pathology is detected, the
pain complaint may be evidenced by the
correlation of a stressful situation with the onset
of symptoms
Pain disorder (cont.)
– Pain disorder may be maintained by
• Primary gains: symptom enables the client to
avoid some unpleasant activity
• Secondary gains: symptom promotes
emotional support or attention
for the client
Pain disorder (cont.)
• Tertiary gains: in dysfunctional
families, the physical symptom
may take such a position that the
real issue is disregarded and
remains unresolved even though
some of the conflict is relieved
• Symptoms of depression and
substance abuse are common
Hypochondriasis
• A preoccupation with the fear of
contracting, or the belief of having,
a serious disease
• The fear becomes disabling and
persists despite reassurance that
no organic pathology can be
detected
Hypochondriasis (cont.)
• Even in the presence of disease, the
symptoms are excessive in relation to
the degree of pathology
• Anxiety and depression are common,
and obsessive–compulsive traits
frequently accompany the disorder
Conversion disorder
• A loss of or change in body function
resulting from a psychological conflict,
the physical symptoms of which cannot
be explained by any known medical
disorder or pathophysiological
mechanism
Conversion disorder (cont.)
• The most obvious and “classic” conversion
symptoms are those that suggest neurological
disease and occur following a situation that
produces extreme psychological stress for the
individual
Conversion disorder (cont.)
• Client often expresses a relative lack of concern
that is out of keeping with the severity of the
impairment
• This lack of concern is identified as la belle
indifference and may be a clue
to the physician that the
problem is psychological rather
than physical
Body dysmorphic disorder
• This disorder is characterized by an
exaggerated belief that the body is deformed or
defective in some specific way
• Symptoms of depression and
characteristics associated with
obsessive-compulsive
personality are common
Etiological Implications
Somatoform disorders
• Genetic: hereditary factors are
possibly associated with
somatization disorder, conversion
disorder, and hypochondriasis
• Biochemical: decreased levels
of serotonin and endorphins may
play a role in the etiology of pain
disorder
Etiological Implications (cont.)
• Ineffective coping
• Chronic pain
• Fear
• Disturbed sensory perception
• Disturbed body image
Outcomes
The client
– Copes effectively without resorting to physical
symptoms
– Verbalizes relief from pain
– Has decreased frequency of physical complaints and
interprets bodily
sensations rationally
– Is free of physical disability
– Verbalizes realistic perception of
appearance and expresses positive
body image
Planning/Implementation
Somatoform disorders
• Individual psychotherapy
• Group psychotherapy
• Behavior therapy
• Psychopharmacology
Assessment
Dissociative disorders
• Dissociative amnesia involves
– An inability to recall important
personal data that is too extensive to
be explained by ordinary
forgetfulness
– Not due to the direct effects of
substance use or a general medical
condition
Assessment (cont.)
Dissociative fugue
– A sudden, unexpected travel away from
home or customary workplace
– The individual is unable to recall
personal identity and assumption
of a new identity is common
Assessment (cont.)
• Depersonalization disorder
– Characterized by persisten
feelings of
• Unreality
• Detachment from oneself or
one’s body
• Observing oneself from outside
the body
Assessment (cont.)
• Psychological trauma
– A growing body of evidence points to the
etiology of DID as a set of traumatic
experiences that overwhelms the individual’s
capacity to cope by any means other than
dissociation
Etiological Implications (cont.)
The client
– Can recall events associated with stressful situation
– Can recall all events of past life
– Can verbalize anxiety that precipitated the dissociation
– Can demonstrate coping methods to avert
dissociative behaviors
– Verbalizes existence of multiple
personalities
– Is able to maintain a sense of reality
during stressful situations
Planning/Implementation
• Individual psychotherapy
• Hypnosis
• Supportive care
• Integration therapy (DID)