Chapter 7: Somatoform and Dissociative Disorders
7.1 Somatoform Disorders
Somatoform disorders: the individual complains of bodily symptoms that
suggest a physical defect or dysfunction but with no physiological basis.
Dissociative disorders: the individual experiences disruptions of
consciousness, memory and identity.
Complex Somatic Symptom Disorder (CCSD): The common rubric for all the
somatoform disorders suggested by the work group (for DSM V).
The person experiences (physical) pain that causes significant distress and
impairment because of psychological factors.
Hard to diagnosis accurately because the subjective experience of pain is
always a psychologically influenced phenomenon.
Central changes in pain disorder: a recent case of a woman whose prefrontal,
cingulated, and insular cortex regions are decreased, which caused pain
Body Dysmorphic Disorder
A person is preoccupied with an imagined or exaggerated defect in
Women: skin, hips, breasts and legs
Men: height, penises, and body hair
Eliminating mirrors from homes/ wearing loose clothing/frequent plastic
Usually happens on late adolescent women; co-exists with depression, social
phobia, eating disorders, thoughts of suicide, and substance/personality
Some people believe it should be the subtype of OCD; some people belive
that it should be double-coded with delusion (psychotic variant)
“Anxiety and obsessive-compulsive spectrum disorders” (DSM-V)
Individuals are preoccupied with persistent fears of having a serious disease,
despite medical reassurance to the contrary
Usually happens on early adulthoods that have chronic courses
Accompany with mood/anxiety disorders Overreact to ordinary physical sensations and minor abnormalities.
Case of Mr. V, who kept scratching himself due to hypochondriasis and died
at age 25
5% of the general population has hypochondriasis
Health anxiety = hypochondriasis (fear of having an illness) + illness phobia
(fear of contracting an illness)
Health anxiety is heritable, but most of the variance was due to
environmental factors (mostly learned)
Cognitive model for healthy anxiety: 1. Critical precipitating incident 2.
previous experience of illness 3. the presence of negative cognitive assumption
4. The severity of anxiety
Perceiving likelihood of illness and cost, awfulness and burden of illness will
increase health anxiety; perceiving the ability to cope and presence of rescue
factors will decrease health anxiety.
Conversion Disorder (Hysteria)
Physiologically normal people experience sensory or motor symptoms.
Anesthesias: loss or impairment of sensations (the symptom of conversion
disorder) (Aphonia, losing voice; anosmia, losing sense of smell)
Appear suddenly in stressful situations to allow the individual to avoid
certain activity or responsibility.
“Conversion” is coined by Freud, who thought that the energy of a repressed
instinct was diverted into sensory-motor channels and blocked function; in the
other words, anxiety and psychological conflict were believed to be converted
into physical symptoms.
Fraser’s military client’s case of being blind
Hysteria: coined by Hippocrates, who believed that it’s an affliction limited
solely to women. It’s the conversion disorder today.
Case of five Amish girls
Conversion Disorder often develops in adolescence or early adulthood with
undergoing life stress.
Prevalence of conversion disorder is less than 1%; more women than men
Comorbid with depression, substance abuse, anxiety, dissociative disorders,
and personality disorders such as borderline and histrionic disorders
Glove anesthesia: a rare syndrome that individual experiences little or no
sensation in the part of the hand that would be covered by a glove, which does
not make anatomical sense
Across both genders and all age groups Somatization Disorder (Briquet’s Syndrome)
It’s characterized by recurrent, multiple somatic complaints with no apparent
1. Four pain symptoms in different locations
2. Two gastrointestinal symptoms
3. One sexual symptom other than pain
4. One pseudo-neurological symptom
Usually cause impairment, behavioural and interpersonal problems.
Co-exists with conversion disorder and comorbid with anxiety, mood
disorders, substance abuse and several personality disorders
Visit physicians and use medication often; have menstrual difficulties and
Individuals often reject psychosomatic explanation because they do not
experience sufficient correlation between symptoms and psychological states
Lifetime prevalence of somatization disorder is less than 0.5% of the
population. More women than men
Vary across cultures, i.e. burning hands of ants crawling under the skin are
more frequent in Asia and Africa than in North America
Because it’s varying from culture to culture, the treatments are not
universally accepted. It is more reasonable to view person’s culture as providing
a concept of what distress is and how it should be communicated.
Begin in early adulthood.
Heritable in the family
It should be more inclusive as “abridged somatization disorder” (DSM-V)
because many people (at least 10%-15%) are with clinically meaningful
medically unexplained symptoms but not diagnosed with somatization disorder.
Etiology of Somatoform Disorders
Etiology of Somatization Disorder
Somatoform clients had memory bias and greater supraliminal
interferences for physical threat words presented in a Stroop task.
Clients have high levels of cortisol – they are under stress.
Children can acquire/learn somatization disorders’ responses from their
Psychoanalytic theory of conversion disorder
Freud: Studies in Hysteria indicates that specific conversion symptoms
were said to be related causally to the traumatic event that preceded them.
Case of Anna O., who’s right arm was chronic paralysis due to
psychological stress (dreaming).
Sackeim: Two-stage defensive reaction to account for the conflicting
findings (base on the cases of two adolescent girls):
1. Perceptual representations of visual stimuli are blocked from
awareness. People then report themselves blind.
2. Information is n