Lecture 7: somatoform and dissociative disorders
- Bodily symptoms that suggest a physical defect or dysfunction, but no
physiological basis can be found.
- No physical reason for any of these disorders.
- This category is controversial ever since the release of the DSM-IV. Releasing
o The terminology is often unacceptable to patients
o The distinction between disease – based symptoms versus those that
are psychogenic may be more apparent than real
o There is great heterogeneity among the disorders – the only common
link is physical illness that is not attributable to an organic cause
o The disorders are incompatible with other cultures
o There is ambiguity in the stated exclusion criteria
o The subcategories fail to achieve accepted standards of reliability
o The disorders lack clearly defined thresholds in terms of the
symptoms needed for a diagnosis.
- Work suggested that three optional specifiers could be applied to the
o Multiplicity of somatic complaints ( previously somatization disorder)
o High health anxiety ( previously hypochondriasis)
o Pain disorder
- Individual who defines the way they function because of their pain. “ are you
frustrated? Yes because of my pain” “do you have any suicidal thoughts? Yes I
cant deal with this pain anymore” everything is interpreted in the contents of
- They will be disabled to some asses because of this pain perception.
- They engage in other results to other disorders. Example they may result to
pain killers that make them become a substance user.
- The one we always use is the pain disorder associated with both
psychological factors and a general medical condition.
- Iatrogenic disability: unconscious motive that is reinforcing sympathy from
others, attention from others, and sometimes an excuse to not have to deal
with life's problems.
- Psychological factors play a significant role on the onset and maintenance of
- DSM includes three subtypes:
o Pain Disorder associated Psychological Factors
o Pain Disorder associated with both Psychological Factors and General
o Pain Disorder associated with a General Medical Condition
- DSM Specifies: acute (<6 months) chronic (>6) - Many experts in the pain field do not favor the pain disorder diagnosis. The
CISSD recommendation was to code pain symptoms on Axis III, with
comorbid psychiatric disorders coded on Axis I
Body Dysmorphic Disorder (BDD)
- Preoccupation with imagined or exaggerated defects in physical appearance
- Typically in women more often than in men. They will stand in front of a
mirror and stare and wonder why their nose is so ugly, or if its extreme they
will get rid of mirrors, or will wear very loose clothing if they think they are
too fat. Often get plastic surgery but that doesn’t help them.
- Late adolescence.
- Comorbid with other disorders such as depression, social phobia, they will
also think about suicide, substance abuse, personality disorder, avoidant
personality disorder, OCD, and eating disorders
- The condition is chronic, once you have it it is very difficult to seek help or
get rid of it. Only 9% of people are able to experience remission over the
course of one year.
- Some experts believe that BDD should be subsumed as a subtype of OCD ex:
people who are excessively preoccupied with their appearance and
frequently check their looks.
- DSM- 5 work group recommended that BDD be reclassified from the
somatoform disorders to the “anxiety and obsessive-compulsive spectrum
- Muscle dysmorphia: the belief that one’s of body build is too small or is
- Preoccupation with fears of having a serious illness
- Usually starts in early adulthood
- It is chronic, and very hard to cure. Study shows after 5 years 60% of
diagnosis cases still had the disorder.
- Likely have mood or anxiety disorder.
- The theory is they overact to ordinary physical sensations and minor
abnormalities, such as irregular heart- beat, occasional coughing or stomach
ache, seeing these as evidence for their beliefs and indeed, people with high
schools on a measure of hypochondriasis are more likely than others to
attribute physical sensations to an illness.
- 5% of the general population.
- Cognitive model has 4 contributing factors
- A critical precipitating incident
- A previous experience of illness and related medical factors
- The presence of inflexible or negative cognitive assumptions
(believing strongly that unexplained bodily changes are always a sign
of serious illness)
- The severity of anxiety Somatization Disorder:
- How does this differ from pain disorder?
- More common in women,
- Usually seek medical conditions, admit them to the hospital, and go through
- Early adulthood
- Comorbid with anxiety disorder, or substance abuse (too much pain killers,
etc), and several personality disorder
- Characterized by re