Chapter 6: Somatoform and Dissociative Disorders

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V.
Mark Durand
Chapter 6: Somatoform and Dissociative Disorders
Chapter 6
Somatoform and Dissociative Disorders
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
An Overview of Somatoform Disorders
Soma Meaning Body

Overly preoccupied with health or body
appearance
Physical complaints without a medical condition
Types of DSM-IV Somatoform Disorders
Hypochondriasis
Somatization disorder
Conversion disorder
Pain disorder
Body dysmorphic disorder
Hypochondriasis: An Overview
Overview and Defining Features

Severe anxiety The possibility of having a disease
Strong disease conviction
Medical reassurance does not seem to help
Facts and Statistics
Good prevalence data are lacking
Onset at any age
Runs a chronic course
Hypochondriasis: Causes and Treatment
Causes
Cognitive perceptual distortions
Familial history of illness
Treatment
Challenge illness-related misinterpretations
Provide more substantial and sensitive
reassurance
Somatization Disorder (Briquets Syndrome):

An Overview
Extended history of physical complaints before age
30
Substantial social and occupational impairment
Concerned with the symptoms, not what they might
mean
Symptoms become the persons identity
Rare condition
Onset usually in adolescence
Mostly affects unmarried, low SES women
Runs a chronic course
Somatization Disorder: Causes and Treatment
Causes
Familial history of illness
Relation with antisocial personality disorder
Weak behavioral inhibition system
Treatment
No treatment exists with demonstrated
effectiveness
Reduce tendency to visit numerous medical
specialists
Assign gatekeeper physician
Reduce supportive consequences of talk about
symptoms
Conversion Disorder: An Overview

Physical malfunctioning
Lack physical or organic pathology
Malfunctioning often involves sensory-motor areas
Persons show la belle indifference
Retain most normal functions, but lack awareness
Rare condition, with a chronic intermittent course
Seen primarily in females
Onset usually in adolescence
Not uncommon in some cultural and/or religious groups
Conversion Disorder: Causes and Treatment
Causes
Freudian psychodynamic view is still popular
Focus on past trauma and conversion
Address primary / secondary gain
Detachment from the trauma and negative reinforcement
Treatment
Similar to somatization disorder
Core strategy is attending to the trauma
Remove sources of secondary gain
Reduce supportive consequences of talk about symptoms
Body Dysmorphic Disorder

(Imagined Ugliness): An Overview
Previously known as dysmorphophobia
Preoccupation with imagined defect in appearance
Either fixation or avoidance of mirrors
Suicidal ideation and behavior are common
Often display ideas of reference for imagined defect
More common than previously thought
Seen equally in males and females
Onset usually in early 20s
Most remain single, and many seek out plastic surgeons
Usually runs a lifelong chronic course
Body Dysmorphic Disorder: Causes and Treatment

Causes
Little is known
Shares similarities with obsessive-compulsive
disorder
Treatment
Parallels that for obsessive-compulsive disorder
Medications (i.e., SSRIs) provide some relief
Exposure and response prevention is also helpful
Plastic surgery is often unhelpful
An Overview of Dissociative Disorders
Overview
Involve severe alterations or detachments
Affect identity, memory, and/or consciousness
Severe form of normal perceptual experiences
Depersonalization Distortion in perception of reality
Derealization Losing a sense of the external world
Types of DSM-IV Dissociative Disorders
Depersonalization Disorder
Dissociative Amnesia
Dissociative Fugue
Dissociative Trance Disorder
Dissociative Identity Disorder
Depersonalization Disorder: An Overview

Severe and frightening feelings of unreality and
detachment
These dominate and interfere with life functioning
Problem involves depersonalization and
derealization
High comorbidity with anxiety and mood disorders
Onset is typically around age 16
Usually runs a lifelong chronic course
Depersonalization Disorder: Causes and Treatment

Causes
Cognitive deficits in attention
Cognitive deficits in short-term memory
Cognitive Deficits in spatial reasoning
Deficits related with tunnel vision and mind
emptiness
Such persons are easily distracted
Treatment
Little is known
Dissociative Amnesia and

Dissociative Fugue: An Overview
Dissociative Amnesia: Overview and Defining Features
Several forms of psychogenic memory loss
Generalized type Inability to recall anything, including
their identity
Localized or selective type Failure to recall specific
(usually traumatic) events
Dissociative Fugue: Overview and Defining Features
Related to dissociative amnesia
Take off to a new place
Unable to remember the past
Unable to remember how they arrived at a new location
Often assume a new identity
Dissociative Amnesia and Fugue:

Causes and Treatment
Facts and Statistics -- Dissociative Amnesia and Fugue
Usually begin in adulthood
Both show rapid onset and dissipation
Both are mostly seen in females
Causes
Little is known
Trauma and life stress can serve as triggers
Treatment
Most get better without treatment
Most remember what they have forgotten
Dissociative Trance Disorder: An Overview

Symptoms resemble those of other dissociative disorders
Dissociative symptoms and sudden changes in personality
Changes are often attributed to possession of a spirit
Presentation differs in important ways across cultures
More common in females
Causes
Often attributable to a life stressor or trauma
Only abnormal if the trance is considered
undesirable/pathological by the culture
Treatment
Little is known
Dissociative Identity Disorder (DID): An Overview

Formerly known as multiple personality disorder
Defining feature Dissociation of personality
Adopt several new identities (as many as 100)
Identities show unique behaviors, voice, and
posture
Unique Aspects of DID
Alters The different identities
Host The identity that keeps other identities
together
Switch Quick transition from one personality to
another
Dissociative Identity Disorder (DID):

Causes and Treatment
Average number of identities is close to 15
Ratio of females to males is high (9:1)
Onset is almost always in childhood
High comorbidity rates, with a lifelong chronic course
Causes
Most have histories of horrible, unspeakable, child abuse
Most are also highly suggestible
DID Mechanism to escape from impact of trauma
Closely related to PTSD
Treatment
Focus is on reintegration of identities
Identify and neutralize cues/triggers that provoke memories of
trauma/dissociation
Diagnostic Considerations in Somatoform

and Dissociative Disorders
Separating Real Problems from Faking
Malingering Deliberately faking symptoms
Related Conditions Factitious disorders
Factitious disorder by proxy
False Memories and Recovered Memory Syndrome

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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V.