Module 9 – Somatic Symptom & Dissociative Disorders

Somatic Symptom Disorder (SSD)

Psychological disorder where a person experiences one or more distressing physical symptoms with excessive thoughts, feelings, or behaviors related to those symptoms.

Key Feature of SSD

Symptoms are real and distressing, but there is no sufficient medical explanation.

Illness Anxiety Disorder (IAD)

Preoccupation with having or acquiring a serious illness despite minimal or no physical symptoms.

Difference Between SSD and IAD

SSD involves actual physical symptoms; IAD involves fear of illness without symptoms.

Conversion Disorder

Loss or change in voluntary motor or sensory function (e.g., blindness, paralysis) without neurological cause.

Example of Conversion Disorder

Sudden paralysis after witnessing a traumatic event, with no medical explanation.

Factitious Disorder

Intentionally producing or feigning physical or psychological symptoms to assume the “sick role,” without external rewards.

Malingering

Deliberately faking illness for external gain (e.g., money, drugs, avoiding work or military service).

Primary Gain

Internal psychological benefit from symptoms (e.g., relief from anxiety or conflict).

Secondary Gain

External benefits from symptoms (e.g., attention, financial gain, avoiding responsibilities).

Common Cognitive Feature in SSD

Catastrophic interpretation of normal bodily sensations (“My headache means I have a tumor”).

Behavioral Maintenance of SSD

Checking, reassurance seeking, and doctor visits reinforce illness behavior through attention.

Biological Explanation for SSD

Heightened sensitivity to bodily sensations due to overactivation of the anterior cingulate and insula.

Cognitive Explanation for SSD

Misinterpretation of normal sensations as dangerous or life-threatening.

Sociocultural Factors in SSD

Higher prevalence in cultures where emotional distress is expressed physically.

Treatment for SSD

Cognitive-behavioral therapy (CBT) targeting maladaptive thoughts and reducing reassurance-seeking behaviors.

Treatment for IAD

Education, stress management, and gradual exposure to illness-related fears.

Treatment for Conversion Disorder

Physical rehabilitation, stress reduction, and addressing underlying trauma.

Dissociative Disorders

Disorders involving disruptions in consciousness, memory, identity, or perception of the environment.

Dissociation

Temporary detachment from reality, such as feeling numb, unreal, or outside one’s body.

Depersonalization

Feeling detached from oneself (“I feel like I’m watching myself from outside my body”).

Derealization

Feeling that the external world is unreal or distorted (“Everything looks foggy or dreamlike”).

Dissociative Amnesia

Inability to recall important personal information, usually after trauma or stress, not due to physical injury.

Dissociative Fugue

Subtype of dissociative amnesia where a person suddenly travels or wanders away and cannot recall their past.

Dissociative Identity Disorder (DID)

Presence of two or more distinct personality states that take control of behavior, with gaps in memory.

Common Cause of DID

Severe and chronic childhood trauma, especially repeated physical or sexual abuse.

Controversy Around DID

Some argue it is iatrogenic (created by therapy) due to suggestive techniques or cultural influence.

Biological Factors in Dissociation

Irregular activity in hippocampus and amygdala related to memory and emotion processing.

Treatment for Dissociative Disorders

Long-term psychotherapy focusing on trauma integration and identity unification.

Treatment Goal for DID

Integrate different personality states into one coherent self.

Somatic Symptom Disorder.

Example Scenario – A person constantly visits doctors for stomach pain despite repeated normal test results and excessive worry.

Illness Anxiety Disorder (IAD)

Example Scenario – A person becomes convinced they have cancer after reading about it online, despite no symptoms.

Conversion Disorder

Example Scenario –A student loses vision after witnessing a violent crime, but eye exams show no problem.

Factitious Disorder

Example Scenario – A caregiver induces illness in their child to gain attention from medical staff. (Munchausen by proxy).

Dissociative Identity Disorder (DID)

Example Scenario – A woman alternates between two identities with different names and memories, unaware of each switch.

Depersonalization

Example Scenario –A man describes feeling like he’s floating above his body during stressful moments.