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Chapter 8: Somatoform and Dissociative Disorders
Somatoform disorders: A group of conditions that involve physical symptoms and
complaints suggesting the presence of a medical condition but without any evidence of
physical pathology to account for them. The people with these symptoms normally focus
on one aspect of their health or appearance to the extent that they find it hard to function.
Due to this, they frequent physicians very often.
Dissociative disorders: A group of conditions involving disruptions in a person‟s normally
integrated functions of consciousness, memory, identity or perception. The people with
these conditions also may be unable to recall who they are or where they may have come
from, or may have two or more distinct identities or personality states that alternately take
control of the person‟s behaviour.
Dissociation: the human‟s mind capacity to engage in complex mental activity in channels
split off from or independent of conscious awareness.
The affected patients have no control over their symptoms and are not intentionally faking
symptoms or attempting to deceive others. They generally believe that there is something
seriously wrong with their bodies.
Somatization is common in all cultural groups and societies that have been studied.
Differences among groups may reflect cultural styles of expressing distress, which are
influenced not only by cultural beliefs and practices, but also by the nature of the culture‟s
Hypochondriasis: People with this condition are preoccupied either with fears of
contracting a serious disease or with the idea that they actually have such a disease even
though they do not. Their preoccupations are based on the misinterpretation of one or
more bodily changes, sensations, or symptoms of minor ailments (e.g., being convinced
that a slight cough is a sign of lung cancer or worrying that a blemish is a sign of skin
Most commonly seen somatoform disorder and occurs equally often in males and females.
It can start at any age, although early adulthood is the most common age of onset. If left
untreated after development, it tends to become chronic although the severity may wax
and wane over time. Individuals with this also suffer from mood disorders, panic disorder,
and/or other somatoform disorders.
Individuals are often anxious and highly preoccupied with bodily functions (e.g. heart beats
or bowel movements) or with physical abnormalities (e.g., a small sore or an occasional
cough) or with vague and ambiguous physical sensations (such as “tired heart” or “aching
veins”). They attribute these symptoms to a suspected disease and often have intrusive
thoughts about it.
These individuals do not fake symptoms to achieve a specific goal. Their relationships with
their doctors may be hostile and filled with conflict.
Criteria for Hypochondriasis
A. Preoccupation with fears of contracting, or the idea that one has, a serious disease,
based on misinterpretation of bodily symptoms.
B. Preoccupation persists despite appropriate medical evaluation and reassurance.
C. Preoccupation causes clinically significant distress or impairment.
D. Duration of at least 6 months.
Theoretical Perspectives on Causal Factors
It is believed that people‟s past experiences with illnesses (in both themselves and others,
as observed in the mass media) lead to the development of a set of dysfunctional
assumptions about symptoms and diseases that may predispose a person to developing
hypochondriasis. These dysfunctional assumptions could include things like “Bodily
changes are usually a sign of serious disease, because every symptom has to have an
identifiable cause” or “If you don‟t go to the doctor as soon as you notice anything unusual,
then it will be too late”.
These individuals have an attentional bias for illness-related information. They also
perceive their symptoms to be more dangerous than they really are and look for confirming
evidence to prove their theory. They also tend to discount evidence that may prove they
are healthy and believe that being fully healthy means they will be symptom free.
They also believe they have a lower probability of being able to cope with the illness and
believe they are unable to tolerate physical effort or exercise.
Hypochondriacs also tend to report much childhood sickness and missing of school. They
also tend to have an excessive amount of illness in their families while growing up, which
may lead to strong memories of being sick or in pain, and perhaps also of having observed
some of the secondary benefits that sick people sometimes reap.
Treatment of Hypochondriasis
Cognitive-behavioural treatment appears to be very effective for the treatment of this
illness. The cognitive components of this focus on assessing the patient‟s beliefs about
illness and modifying misinterpretations of bodily sensations. The behavioural techniques
include having patients induce innocuous symptoms by intentionally focusing on parts of
their body so that they can learn that selective perception of bodily sensations plays a
major role in their symptoms. Sometimes they are also directed to engage in response
prevention by not checking their body as they usually do and by stopping their constant
seeking of reassurance.
There is also some evidence that antidepressant medication may be effective in treating
this illness, but it is not as effective as cognitive behavioural therapy.
Criteria for Somatization Disorder
A. History of many physical complaints starting before age 30 that occur over several
years and result in treatment being sought, or significant impairment in functioning.
B. Each of the following criteria must have been met at some point:
1) Four pain symptoms in different sites
2) Two gastrointestinal symptoms other than pain
3) One sexual symptom (other than pain)
4) One pseudoneurological symptom (not limited to pain)
C. Either (1) or (2):
(1) After appropriate investigation, each of the symptoms under Criteria B cannot be
fully explained by a medical condition.
(2) When there is a related general medical condition, the physical complaints are in
excess of what would be expected.
D. Symptoms not intentionally produced or feigned.
Many similarities between hypochondriasis and somatization disorder, but only people with
hypochondriasis tend to be convinced they have an organic disease. In hypochondriasis,
the person normally has only one or few symptoms but in somatization disorder, by
definition, there are multiple symptoms.
Demographics, Comorbidity, and Course of Illness
Somatization disorder usually begins in adolescence and it believed to be 3-10 times more
common in women than men. It also tends to occur more in lower socioeconomic classes.
It also very commonly occurs with several other disorders including major depression,
panic disorder, phobic disorders, and generalized anxiety disorder. Although it has
generally been considered to be a relatively chronic condition with a poor prognosis, some
recent studies have found that a significant number of patients remit spontaneously.
Causal Factors in Somatization Disorder
There is evidence that it runs in families and that there is a familial linkage between
antisocial disorder in men and somatization disorder in women. It is possible that the two
disorders may be linked through a common trait of impulsivity, but the nature of this
relationship is not yet understood
Other contributory causal factors may include an interaction of personality (ex. people high
in neuroticism with a specific family background that socially reinforces complaining about
illnesses), cognitive and learning variables.
Patients with somatization disorder had elevated levels of cortisol (a stress hormone) and
did not show normal habituation to psychological stressors. Thus the physiological arousal
caused by psychological stressors remains elevated.
Treatment of Somatization Disorder
Considered extremely difficult to treat but recent research has indicated that cognitive-
behavioural therapy may be helpful when combined with appropriate medical
management. Here, effective treatment involves identifying one physician who will
integrate the patient‟s care by seeing the patient at regular visits and by providing physical
exams focused on new complaints. At the same time, however, the physician avoids
unnecessary diagnostic testing and minimal use of medications or other therapies. The
cognitive behavioural therapy included in the treatment focuses on promoting appropriate
behaviour such as better coping and personal adjustment, and discouraging inappropriate
Antidepressants can also sometimes be useful.
Pain disorder: Characterized by the experience of persistent and severe pain in one or
more areas of the body.
There are two coded subtypes of this disorder: (1) pain disorder associated with
psychological factors, (2) pain disorder associated with both psychological factors and a