Chapter 6 | Somatoform and Dissociative Disorders

PSY2043 | Spring 2025

What are somatoform disorders?

a cluster of disorders characterized by complaints about physical well-being that cannot be entirely explained by a medical condition, substance use, or another psychological disorder

What are examples of bodily complaints made by individuals with somatoform disorders?

• muscle and join pain

• lower back pain

• dizziness

• insomnia

• chronic fatigue

• palpitations

What is a conversion disorder?

when there is some type of psychosocial conflict or need, and rather than dealing with the problems on a conscious level, you develop issues in sensory functioning or voluntary motor movements on an unconscious level

What are examples of motor symptoms in conversion disorder?

tremors, tics, muscle spasms, swallowing problems

What are examples of sensory symptoms in conversion disorder?

blindness, double vision, deafness

When does the onset of conversion disorder usually occur?

late childhood to early adulthood

How quickly do symptoms of conversion disorder occur?

suddenly

What is the nature of people who get conversion disorder?

they are highly suggestible

How many people diagnosed with a neurological disorder are diagnosed with a conversion disorder?

around 5 in 1,000

Why is conversion disorder common in groups of people?

because one might get it genuinely, while others copy them for attention

What is somatization disorder?

when multiple physical symptoms are medically unexplained and impair an individual’s ability to function

Why do individuals with somatization disorder usually move from doctor to doctor

because no one can help

Which gender is somatization disorder more common in?

females

When does somatization disorder usually develop?

usually starting in adolescence, up until around age 30

Why is somatization disorder difficult to treat?

because the person presents with symptoms that are severe enough to receive medical attention, but never severe enough to affect their lifestyle

What is the nature of the root cause of somatization disorder?

psychological

What is pain disorder (with psychological factors)?

when psychological factors significantly affect the onset, severity, or maintenance of significant pain

Why is pain disorder associated with psychological factors usually found during treatment for addiction?

because it Is very easy to get prescribed and become addicted to painkillers

Who usually determines whether symptoms are hysterical or medical?

medical doctors

What is a differential diagnosis?

considering and comparing various conditions to determine the most likely cause of a patient’s symptoms

What must you do during a differential diagnosis to determine whether symptoms are hysterical or medical?

look for the oddities or anomalies that don’t make sense

What is an example of how hysterical and medical symptoms can be distinguished?

in glove amnesia, the person will report that from the wrist down, they don’t have any feeling in their hands, whereas in true nerve damage, the person will have sensation in some places and none in others, and atrophy will eventually occur

When are symptoms hysterical?

there is no premeditated intention in creating them; these symptoms are coming out based upon some other psychological issue; subconscious

When are symptoms factitious?

you are intentionally producing the symptoms; conscious

What is malingering?

purposely faking the continuation of your symptoms because you get an external gain from being sick; more subtle form of factitious symptoms

What is factitious disorder?

when you fake symptoms, sometimes by actually inducing things onto yourself

What are the two types of factitious disorder?

induced-on-self and induced on another (Munchausen and Munchausen by proxy)

What is factitious disorder induced on self/Munchausen syndrome?

when you make yourself sick for attention by doing extreme things, like drinking antifreeze and eating rat poison

What is the name for Munchausen syndrome based on?

a character in a book called Baron Munchausen, who told more and more outlandish stories to entertain his guests because he liked the attention

What is factitious disorder induced on another (FDIA)/Munchausen by proxy?

when you like the attention you get from taking care of someone who is sick, so you have to keep making that other person sick to continue getting the attention

What type of relationships is Munchausen by proxy most common in?

mother-child, but they can also occur when an adult is incapacitated and doesn’t have the ability to speak for themselves

What does Munchausen by proxy need to develop?

a particular environment

What is a preoccupation somatoform disorder?

when you tend to misinterpret and overreact to body symptoms, regardless of what people (family, friends, doctors) are telling you

What are the two types of preoccupation disorder?

hypochondriasis and body dysmorphic disorder

What is hypochondriasis?

when you have one or two symptoms and believe you have a disorder

When does hypochondriasis often start?

late adolescence to early adulthood

How do diagnosis rates of hypochondriasis compare between genders?

males and females are equally diagnosed

Why is hypochondriasis often untreated?

because it’s hard to convince the person that the problem comes from the mind, not the body; the person doesn’t respond to logic

What is body dysmorphic disorder?

one of your physical features causes you to have excessive worry; you think that all anybody sees when they look at you is this flaw you’ve identified in yourself

What do people with body dysmorphic disorder go great lengths to do?

conceal or hide the feature they believe is flawed, possibly even seeking out plastic surgery

Which gender is body dysmorphic disorder more common in?

females

When does body dysmorphic disorder often become noticeable?

in teenage years

When does body dysmorphic usually start to become a problem?

early adulthood

What are the causes of preoccupation somatoform disorder?

really poor coping skills and inability to handle daily stressors

When does psychotherapy work really well for treating preoccupation somatoform disorder?

when the person realizes they have a problem and doesn’t want to be that way anymore

What are dissociative disorders?

when there are major changes in your memory that do not have physical causes, leading to altered states of memory, consciousness and personality

What does dissociate mean?

to split

What does the dissociate refer to in dissociative disorders?

the splitting of the consciousness

What are the three types of dissociative disorders?

• dissociative amnesia

• dissociative fugue

• dissociative identity disorder (DID)

What is dissociative amnesia?

when the only information you’re missing is personal; you still have the knowledge to be able to do things like read, write and do math

What are the four types of dissociative amnesia?

• localized

• selective

• generalized

• continuous

When does dissociative amnesia often develop?

when there is an overwhelming threat to your safety; for kids, it’s usually sexual abuse and for late adolescents, teenagers and adults, it’s usually sudden loss of a loved one or intense rejection from a relationship

What is localized dissociative amnesia?

when the memory loss starts when that even begins and goes on for a limited time past the event

What is the amnesic period?

the period of time your memory can’t access

What is the most common form of dissociative amnesia?

localized

What is selective dissociative amnesia?

when you can remember some parts of the event but not all

What is a possible explanation for selective dissociative amnesia?

some parts of the event were more traumatic than others, and the brain blocked out those more traumatic parts

What is common in localized and selective dissociative amnesia?

the person feeling disoriented, as if they have a concussion

What is generalized dissociative amnesia?

when you block out the event and earlier time periods; you block out anything related to the memory that might remind you of it

What is continuous dissociative amnesia?

when you block the event and all future events and learning (John Doe)

What is dissociative fugue (traveling amnesia)?

when you enter a state of continuous amnesia and temporarily block out anything new, until it stops and becomes more generalized, blocking out everything from your past; you take on a new identity and start a new life as that identity

What happens if someone with dissociative fugue isn’t brought back to reality?

they become that new person they create

When does dissociative fugue often start?

in teenage years to runaways that experience traumatic events that are too overwhelming

What is dissociative identity disorder (DID)?

when you have issues with both memory and consciousness; you go through blackout periods in which you take on a brand-new personality

Who is the host in DID?

the person that truly exists

What are the alters in DID?

all the personalities that live in the head

What is switching in DID?

when the host changes to an alter and vice versa

How does DID occur?

it usually starts on a purely unconscious level, and over time, you become aware that you have a problem because you have segments of time that are unaccounted for, and you usually seek out help because you think something biologically is wrong with you

What is the average number of alters in males with DID?

8

What is the average number of alters in females with DID?

15, but then can have 30 or more

What are the three types of relationships that can exist between host and alters?

• mutually amnesic

• mutually cognizant

• one-way

What is a mutually amnesic relationship in DID?

when the alters have no awareness of each other and each has its own unique identity

What is a mutually cognizant relationship in DID?

when everyone (host and alters) is aware of each other

What is a one-way relationship in DID?

when some alters are aware of all the other alters, but none of the other alters are aware of them

When does the host in DID become co-conscious?

when they realize that they have other things in their head that they can’t control

How is there a mutually beneficial relationship between the host and alters?

the host doesn’t have proper coping skills, and the alters take care of that problem and get gratification for doing so

How are alters different than the host?

they have their own unique brain wave patterns, memories, likes and dislikes, ages, ethnicities, genders, etc., and as the host ages, they don’t

Why does the host usually not have a reason to want to change?

the alters help them not have to deal with stressors

How do alters deal with stressors?

they have unique abilities that come out for certain stressors

What is a depersonalization disorder?

when you feel disconnected from your own body and mental processes; your mind in a sense levitates out of your body and is watching events happen o you, but processing them as if it’s someone else

Why is depersonalization disorder NOT a dissociative disorder?

because it never affects memory

What is the behavioral explanation for dissociative disorders?

conditioning/reinforcement – if something comes up and you can avoid dealing with it by doing this activity, it reinforces you to keep doing it

What is the psychodynamic explanation for dissociative disorders?

repression – subconsciously, you’re trying to act as if the event(s) never happened

What must happen first in order to treat someone with a dissociative disorder?

you have to get the person in touch with the problem and realize what they’re avoiding

How can hypnosis be used in treating dissociative disorders?

it can help in calming down the conscious mind to get in touch with some of the alters

How can drug therapy be used in treating dissociative disorders?

Amytal and Pentothal block the conscious mind and force the patient to be honest, making access to the alters easier

What is the most common treatment for dissociative disorders?

cognitive therapy, in which you integrate the personalities by getting the host to realize they don’t need them anymore and can ‘kill’ them off

Why does the host go through a grieving process every time an alter is lost?

because they lose a part of themselves