Disorders with Somatic Symptoms

• Two kinds of disorders commonly associated with stress and anxiety

  • Somatoform
  • Dissociative
• What are somatoform disorders?

  Disorders that appear to be medical but are due to psychosocial factors
• What are dissociative disorders?


  Patterns of memory loss and identity change that are caused almost entirely by psychosocial factors than physical ones
• Commonalities between somatoform and dissociative disorders:

  • May occur in response to severe stres
  • Forms of escape from stress
  • Many suffer from both
  • Treated similarly
• Two main types of somatoform disorders:

  • Hysterical
  • Preoccupation
• What happens in hysterical somatoform disorders?

  Actual changes in their physical functioning
• Three hysterical somatoform disorders:

  • Conversion disorder
  • Somatization disorder
  • Pain disorder
• Conversion Disorder


  Psychosocial conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning

  • Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling
• When do conversion disorders often appear?

  Late childhood and young adulthood
• Are conversion disorders more common in men or women?

  2x as many women as men
• Difference in length of somatization disorder vs conversion disorder

  Somatization disorder is typically much longer than a conversion disorder, typically for many years
• Hysterical vs factitious symptoms

  Hysterical somatoform disorders are different from patterns in which individuals are purposely producing or faking medical symptoms
• What is malingering


  Intentionally faking illness to achieve external gain
• Causes of preoccupation somatoform disorders

  Behaviorists model: classical conditioning or modeling

  Cognitive theorists: Oversensitivity to bodily cues

  Psychodynamic: Conversion of emotional conflicts to physical symptoms
• Causes of hysterical somatoform disorders


  Widely considered unique and in need of a special explanation
• Treatments for preoccupation disorders

  Antidepressants, exposure and response prevention (ERP)
• Treatments for hysterical disorders

  Typically focuses on the cause of the disorder and apply to the same kind of techniques used in PTSD

  • Exposure
  • Insight
  • Drug therapy: antidepressants
• Do therapists address the physical symptoms of hysterical disorders?

  Yes by using techniques like

  • Suggestion: offering emotional support that may include hypnosis
  • Reinforcement: Behavioral attempt to change reward structures
  • Confrontation: an overt attempt to force patients out of the sick role
• Dissociative disorders


  When changes in memory lack a clear physical cause
• Kinds of dissociative disorders

  • Dissociative amnesia
  • Dissociative fugue
  • Dissociative Identity Disorder
• In what situation are dissociative symptoms most often found

  Cases of acute and posttraumatic stress disorder
• Dissociative amnesia


  People are unable to recall important information, usually of an upsetting nature, about their lives
• What is localized(circumscribed) dissociative amnesia?

  Most common type of amnesia; loss of all memory of events occuring within a limited time period
• What is selective dissociative amnesia?


  Loss of memory for some, but not all, events occuring within a period
• What is generalized dissociative amnesia?


  Loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends
• What is continuous amnesia?


  Forgetting both old and new information and events; quite rare
• What is dissociative fugue?


  Forgets their personal identities and details of their past, but also flee to an entirely different location
• How long does dissociative fugue last?

  For some it is brief- a matter of hours or days

  For others the fugue is severe- people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics
• When does dissociative fugue happen?

  Rare, but typically after severely stressful events
• How do fugues end?

  Typically abruptly. When people are still in their fugue, therapists find it necessary to continually remind them of their own identity. Majority regain most or all of their memories and never have a reoccurence.
• Mutually amnesic relationships in DID

  Subpersonalities have no awareness of one another
• Mutually cognizant patterns in DID

  each subpersonality aware of the rest
• One-way amnesic relationships in DID

  most common pattern; some personalities are aware of others, but the awareness is not mutual

  • Those who are aware are "quiet observers"
• What may be a reason that the cases of DID are increasing?

  • Growing number of clinicians believe that the disorder is real and willing to diagnose
  • Diagnostic procedures have become more accurate
• Which dissociative disorders typically do and do not require treatment?

  Dissociative amnesia and dissociative fugue typically recover on their own, but DID usually requires treatment
• Treatment for dissociative amnesia + fugue

  • Psychodynamic Therapy
  • Hypnotic Therapy
  • Drug therapy such as barbiturates or "truth serums"
• How is DID treated?

  Very difficult and complex.

  • Bonding with the primary personality and with each subpersonality
  • As bonds are formed, therapist tries to educate the patients and help them recognize the nature of the disorder
  • Some use hypnosis or video to present to other subpersonalities
  • group therapy
  • Recovering memories
• Maintenance therapy is important in DID