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Chapter 8

PSYC 305 Chapter 8: Chapter 8 – Somatic Symptom and Dissociative Disorders

Course Code
PSYC 305
Laura Hanson

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Chapter 8 – Somatic Symptom and Dissociative Disorders
Somatic Symptom Disorders: A group of conditions that involve physical
symptoms combined with abnormal thoughts, feelings, and behaviours in
response to those symptoms
Involves patterns in which individuals complain of bodily symptoms that
suggests the presence of a medical condition without an obvious medical
explanation to explain the symptom
Affected patients have no control over their symptoms
Factitious Disorder: Where the person intentionally produces
psychological or physical symptoms to obtain the benefits one gets from
being sick (no tangible external rewards)
Malingering: Where the person is intentionally producing or grossly
exaggerating physical symptoms motived by external incentives such as
avoiding work or military service
Four disorders in the somatic symptom and related disorders category:
(1) somatic symptom disorder, (2) illness anxiety disorder, (3) conversion
disorder, and (4) factitious disorder
Somatic Symptom Disorder
Used to be hypochondriasis, somatization disorder, and pain disorder but
now they are all just called somatic symptom disorder
To diagnose the patient must have one of the three features: (1)
disproportionate and persistent thoughts about the seriousness of one’s
symptoms, (2) persistently high level of anxiety about health or symptoms,
or (3) excessive time and energy devoted to symptoms or health concerns
Most likely female, nonwhite, and less educated
Frequently engage in illness behaviour that is dysfunctional
Likely to think the doctor missed something and seek help from other
doctors, racking up medical bills due to unnecessary tests and hospital
stays, etc.
Research shows they have cognitive style that leads to them being
hypersensitive to their bodily sensations and experience sensations as
intense, disturbing, and highly aversive
Tend to think catastrophically about their symptoms
DSM-5 has dropped hypochondriasis, somatization disorder, and pain
disorder and they are now all called somatic symptom disorders
Hypochondriasis: Where the person is preoccupied either with fears of
contracting a serious disease or with the idea of having the disease even
though they do not
Usually a misinterpretation of one or more bodily signs or symptoms

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Cannot be reassured by results of a medical test
Condition has to persist for at least 6 months before a diagnosis can be
made (as to not diagnose relatively transient health concerns)
Occur equally in men and women and can occur at any age
Often also suffer from mood disorders, panic disorders, or other somatic
symptom disorders
Major Characteristics
Highly preoccupied with bodily functions, vague physical sensations, or
physical abnormalities
Not consciously faking symptoms to gain attention
Often hostile and have conflict to/with their doctors because they don’t
believe their diagnosis or recommendations
Causal Factors
Cognitive-behavioural views are most widely accepted
Usually say the disorder is of cognition and perception
Says the misinterpretations of bodily sensations may play casual role
Believed that individuals past experience with illness lead to development
of a set of dysfunctional assumptions about symptoms and diseases that
may predispose a person to developing hypochondriasis
Attentional bias for illness-related information and once they find it they
look for reasons why they aren’t in good health
Perceive their probability of being able to cope with illness as very low
A lot of patients with the disorder reported being sick a lot as a child or
with a lot of illness in their families (very aware of the benefits from being
sick – no school, no work, less responsibilities, lots of attention)
One study showed patients with hypochondriacal tendencies were
reduced by the occurrence of serious medical conditions
Cognitive-behavioural treatment is the most effective according to more
than a dozen studies
Focuses on the patient’s beliefs about an illness and modifies their
interpretations of bodily sensations
Help them learn selective perception of bodily sensations
Usually brief (6-16 sessions) treatment and usually very effective
Somatization Disorder
Somatization Disorder: A long-term condition in which a person has
physical symptoms that involve more than one part of the body, but no
physical cause can be found
Characterized by many different physical complaints

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To qualify for diagnosis the complaints have to begin before age 30 not
adequately explained by findings of physical illness or injury and have led
to medicate treatment or to significant life impairment
Demographics, Comorbidity, and Course of Illness
Usually begins in adolescence
3-10 x more common in women than men
Somatic symptoms and antisocial disorder tend to co-occur but we do not
know why (could be linked through a common trait of impulsivity)
People with somatization disorder selectively attend to bodily sensations
and see them as somatic symptoms
Tend to catastrophize about their symptoms and think of themselves and
physically weak and unable to tolerate stress or physical activity
Very difficult to treat – often leads to frustration and uncertainty among
physicians trying to work with these patients
Medical management and cognitive behavioural treatments can be helpful
Usually helps to have a physician visit the patient regularly and avoid
unnecessary diagnostic tests
Promote appropriate behaviour like coping and personal adjustment
Pain Disorder
Characterized by persistent and severe pain in one or more areas of the
body that is not intentionally produced or feigned
Can be acute or chronic
Pain in these patients is very real and can hurt as much as pain that
comes from other sources
Prevalence among the general population is unknown
Diagnosed more frequently in men than women and often combined with
anxiety or mood disorder
Often unable to work or perform daily activities resulting in inactivity and
social isolation
Pain can increase when it is reinforced by attention, sympathy, or
avoidance of unwanted activities
People who have it can catastrophize about the meaning and effects of
pain are the ones most likely to progress to a state of chronic pain
Cognitive-behavioural techniques are widely used
Usually involves relaxation training, support and validation that the pain is
real, scheduling of daily activities, cognitive restructuring, and
reinforcement of “no-pain” behaviours
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