Ch5 Concepts: Somatic Symptoms & Dissociative Disorders

What are the 5 main types of somatic symptom disorder?

1. Somatic Symptom Disorder/Hypochondriasis

2. Illness Anxiety Disorder (IAD)

3. Conversion Disorder

4. Factitious Disorder/imposed on another

5. Psychological factors affecting medical conditions

What are the main symptoms/characteristics for somatic symptom disorder (SSD) with or without pain? 

• Clear pain, no medical cause (dull/achy, sharp/intense)

• Past DSM: Pain Disorder 

What are the prevalence and statistics for somatic symptom disorder (SSD) with or without pain? 

5-8% report SSD with some type of pain

What are the known causes for somatic symptom disorder (SSD) with or without pain? 

• Family history of illness/disease

• Stressful life events

• Sensitivity to physical sensations

• Past experiences: benefits of “illness role” (ex: increased attention, sympathy)

What are the effective treatments for somatic symptom disorder (SSD) with or without pain? 

• Best treatment: CBT

• Treatment goals

  • Decreased doctor shopping (seeks too many 2nd options, medical specialists)

  • Assign only 1 “gatekeeper” physician to make medical decisions

  • Decreased supportive consequences: decreased benefits of talking about symptoms

What are the main symptoms/characteristics for illness anxiety disorder (IAD) / hypochondriasis?

• Physical complaint but no clear cause 

• Strong disease conviction: misdiagnosis of “serious” disease  

• Medical reassurance: no amount of reassurance helps. They overwhelm the medical system.  

What are the prevalence and statistics for illness anxiety disorder (IAD) / hypochondriasis?

• 1.5%

• Equal for men and women

• Onset at any age (can happen at anytime)

• Chronic course

What are the known causes for illness anxiety disorder (IAD) / hypochondriasis?

• Cognitive and perceptual distortions 

• Family history of illness or disease  

What are the effective treatments for illness anxiety disorder (IAD) / hypochondriasis?

• CBT is usually effective

  • Challenge illness-related misinterpretations

  • Substantial and sensitive education, reassurance

  • Stress management and coping strategies

  • Antidepressants offer some help

What are the major symptoms/characteristics for conversion disorder (CD)? 

• psychogenic: caused by one’s mind

• Functional neurological symptom disorder 

• Physical malfunction: sensory or motor abilities

  • Glove anesthesia: “I can’t feel anything from my wrist out to my fingers.” If you have nerve damage, you can’t feel this, it starts from your arm. Their mind is so into believing this that they can stick a needle in their hand, and their hand won’t react.  

  • Ex: Blindness (Claims they can’t see) 

3. No physical or organic cause

   1. Ex: “Psychogenic” non-epileptic seizures  

4. “La belle indifference”: Indifferent or laissez faire attitude about condition  

5. Most have normal function, but lacks awareness: Pupils shrink to light, but still reports blindness  

What are the statistics for conversion disorder (CD)? 

• Prevalence: rare condition

• Onset in adolescence

• Chronic course but intermittent

• Mostly women report with conversion disorder

• Cultural or religious groups are more common

  • Ex: fundamentalist religions (seizures, paralysis, trances: part of faith healers/rituals)

What are the proposed causes (e.g., psychic conflict, secondary gain) for conversion disorder (CD)? 

• In general, not well known

• Comes from Freud’s psychodynamic view, limited research: You have a conflict going in your head where you’re fearful of it, but you can’t admit it yourself that you’re afraid. So your brain (ego) creates a false medical condition that gives an excuse to not have to return to that stressful event.

  • Past trauma & unconscious conflict: physical symptoms

• Behavioral theory: what types of behavior are being reinforced by having a conversion disorder?

  • Primary gain: escapes conflict or feared situation

  • Secondary gains: increased attention, sympathy, support as reward

What are the treatments for conversion disorder (CD), which are similar to SSD? 

• After traumatic event, need to process the trauma and treat symptoms. 

• Remove secondary gains: decrease supportive benefits of talking about symptoms  

What are the main differences among malingering, factitious disorder, and factitious disorder imposed on another?

• FD: actually has physical symptoms but caused intentionally by themself

• Malingering: purposely fakes symptoms, don’t actually hurt themself

• FD imposed on another: causes symptoms in another person to gain sympathy from hospital worker or friends

What are the major types of dissociative disorders?

1. Depersonalization-Derealization Disorder

2. Dissociative amnesia / fugue

3. Dissociative trance disorder

4. Dissociative identity disorder (DID)

What are depersonalization and derealization?  How are these important to dissociative disorders? 

1. Depersonalization: perceptual distortions of one’s body or experience

   1. Ex: feels strange in one’s body (“Why do my shoes feel weird?”)

   2. How you feel about yourself/body

2. Derealization: losing a sense of external world

   1. Ex: world seems like a dream, hazy; sounds and sights aren’t clear as they used to be.

   2. How you feel about the world around you

What are the major symptoms/characteristics associated with depersonalization-derealization disorder? 

• Recurrent sensation of unreality of one’s body or surroundings, but reality testing is intact.

• Strange perceptual feelings. Dominate and interfere with functioning.

• Only diagnosed if primary problem that’s been happening for multiple days, that’s affecting your studies, work, relationships.

• Rule out other conditions first! Could be Panic disorder, PTSD, sleep deprivation, substance use, tumor, hormonal imbalance: medical check-up with doctor

What are the prevalence and statistics associated with depersonalization-derealization disorder? 

• 1-2%

• High co-morbidity

• Onset in adolescence, teen years

• Life-long and chronic course

What are the known causes associated with depersonalization-derealization disorder? 

• History of trauma increases risk

• Cognitive deficits in attention, short-term memory, spatial reasoning

• Easily distracted & cognitive deficits: Tunnel vision, mind emptiness

What are the treatments associated with depersonalization-derealization disorder? 

Limited research… :(

What is dissociative amnesia?

• Psychogenic memory loss typically after traumatic event. 

• Types

  • Generalized: very rare. Can’t recall all aspects of a single memory experience because it was so horrific!  

  • Localized/selective: More common. Can’t recall certain aspects of a single memory experience. 

What is dissociative fugue?

• complete loss of personal memory & identity

• assumes new identity

• don’t know who they are, where they came from

• wanders off to a different place, can’t recall how and why they ended up in a new place.  

What are the major causes associated with dissociative amnesia and fugue?

little is known. Traumatic stress events as “triggers” 

What are the major statistics associated with dissociative amnesia and fugue?

• Onset is usually in adulthood, occurs rapidly and suddenly 

• Dissipation: sudden, rapid return of memory 

What are the treatments associated with dissociative amnesia and fugue?

Most improve without treatment and regain all memories! 

What is the main difference between “generalized” and “localized/selective” amnesia? 

• Generalized: very rare. Can’t recall all aspects of a single memory experience because it was so horrific!  

• Localized/selective: More common. Can’t recall certain aspects of a single memory experience. 

What are the major characteristics for dissociative trance disorder?

• Dissociative symptoms and sudden personality change, zombie-like. Don’t respond to calls of their name, mumbling to themselves. Don’t respond to stimuli. 

• Often attributed to “spirit possession“, which varies across cultures 

  • Nigeria: vinvusa 

  • Thailand: phii pob

• NOT dissociative fugue where they forget who they are. 

• Only diagnosed if significant distress or impairment. Gaps in memory while under trance state.  

What are the causes and treatments for dissociative trance disorder?

• Causes: often attributed to life stressors or trauma. May need to address stressor/trauma.

• Little is known for treatment.

How do the concepts of “host”, “alters”, and “switching” relate to DID? 

1. Host: main identity, keeps other identities together  

2. Alters: separate identities or personalities 

3. Switch: quick transition from 1 identity to another (head drop, walk difference) 

How do “repressed memories” play a controversial role for DID as described by Elizabeth Loftus? 

• Therapist may accidentally distort memories by creating “false” memories of abuse 

• 1980s-90s: increased interest in repressed memories 

Cultural-specific disorder, Koro (East Asia) - how does it relate to IAD?

fears penis (men) or nipples (women) retracting into body.

Cultural-specific disorder, Dhat (India) - how does it relate to IAD?

loss of semen in young men: dizziness, weakness, fatigue 

Cultural-specific disorder, Kyol Goeu (Khmer/Cambodia) - how does it relate to IAD?

• “Wind overload” – believes circulation is blocked and fears possible death

• Hard time breathing (dizziness, weakness, trembling)

What are the major characteristics of dissociative identity disorder (DID)?

• Key feature: dissociation of personality (Past DSM: Multiple Personality Disorder)

1. Adopts several new identities (Mean = 15, as high as 100). Unique behaviors, voices, postures 

2. Recurrent memory gaps when another identity  

What are the causes of dissociative identity disorder (DID)?

1. Linked to severe, chronic trauma, often in childhood 

2. Closely related to PTSD, possibly more extreme type 

3. Escape mechanism from impact of trauma  

4. Possible biological vulnerability  

Treatments for dissociative identity disorder (DID)?

1. Re-integration of identities: Create a single “whole” identity.. Consolidation of different “strengths”  

2. Identify and neutralize cues/triggers

   1. Triggers: provoke memories of trauma & dissociation  

3. May need to relive and confront early traumas. Hypnosis may be required.  

4. Caution: therapist may accidentally distort memories! Can create “false” memories of abuse (Elizabeth Loftus) 

Prevalence/statistics for DID?

• Gender: women 9x more likely than men ♀

• High comorbidity rates 

• Onset mostly in childhood or adolescence 🧒

• Chronic and lifelong course