Abnormal Psychology

332 CHAPTER 8

individual mental process is not disturbed, but their normal integrated function-

ing is disturbed. (With schizophrenia, in contrast, it is the mental processes them-

selves, such as the form or pattern of thoughts, that are disturbed; see Chapter 12.)

Somatoform disorders are marked by persistent bodily symptoms for which there is

no medically identifi able cause. In this chapter we explore dissociative and somato-

form disorders—their diagnostic criteria, criticisms of those criteria, the causes of

the disorders, and treatments for them.

Dissociative Disorders

Breuer reported that Anna O. was an extremely bright young woman prone to

“systematic day-dreaming, which she described as her ‘private theatre.’” Anna

lived “through fairy tales in her imagination; but she was always on the spot when

spoken to, so that no one was aware of it. She pursued this activity almost continu-

ously while she was engaged in her household duties” (Breuer & Freud, 1895/1955,

p. 22). These dissociative states, or “absences,” began in earnest when Anna became

too weak to care for her father, and they became more prominent after his death in

April 1881. Let’s examine dissociative disorders in more detail, and then consider

whether Anna’s symptoms would meet the criteria for any of these disorders.

Dissociative Disorders: An Overview

Dissociation may arise suddenly or gradually, and it can be brief or chronic (Steinberg,

1994, 2001). Four types of dissociative symptoms are noted in DSM-IV-TR (Ameri-

can Psychiatric Association, 2000; Steinberg, 1994, 2001):

• amnesia, or memory loss, which is usually temporary but, in rare cases, may be
  permanent;


• identity problems, in which an individual isn’t sure who he or she is or may assume
  a new identity;


• derealization, in which the external world is perceived or experienced as strange or
  unreal, and the individual feels “detached from the environment” or as if viewing the
  world through “invisible fi lters” or “a big pane of glass” (Simeon et al., 2000); and


• depersonalization, in which the perception or experience of self—either one’s
  body or one’s mental processes—is altered to the point of feeling like an observer,
  as though seeing oneself from the “outside,” Individuals experiencing deperson-
  alization may describe it as feeling is if “under water” or “fl oating,” “like a dead
  person,” “as if I’m here but not here,” “detached from my body,” “going through
  the motions,” “like a robot,” “emotionless,” in a “brain fog,” or “like my mind is
  a blank” (Simeon et al., 2000).

Anna O. appeared to experience derealization. After her father died, she

recounted “that the walls of the room seemed to be falling over” (Breuer & Freud,

1895/1955, p. 23). She also reported having trouble recognizing faces and needing

to make a deliberate effort to do so: “‘this person’s nose is such-and-such, his hair

is such-and-such, so he must be so-and-so.’ All the people she saw seemed like wax

fi gures without any connection with her” (Breuer & Freud, 1895/1955, p. 26).

Normal Versus Abnormal Dissociation

Before you start worrying about whether you might have a dissociative disorder,

you may be relieved to learn that experiencing symptoms of dissociation is not nec-

essarily abnormal; occasional dissociating is a part of everyday life (Seedat, Stein, &

Forde, 2003). For instance, you may fi nd yourself in a class, but not remember

walking to the classroom. Or, on hearing bad news, you may feel detached from

yourself, as if you’re watching yourself from the outside.

In some cases, periods of dissociation are part of religious or cultural rituals

(Boddy, 1992). Consider the phenomenon of possession trance observed in some

societies: During a hypnotic trance, a kind of spirit is believed to assume control of

Anna O. was diagnosed with hysteria, which is

a vague condition that is not in the DSM-IV-TR

classifi cation system. Symptoms that were seen

as part of hysteria are now generally considered

to be symptoms of either dissociative disorders or

somatoform disorders.

Mary Evans Picture Library/Alamy

Amnesia

Memory loss, which is usually temporary but,

in rare cases, may be permanent.

Identity problem

A dissociative symptom in which an individual

is not sure who he or she is or may assume a

new identity.

Derealization

A dissociative symptom in which the external

world is perceived or experienced as strange

or unreal.

Depersonalization

A dissociative symptom in which the

perception or experience of self—either one’s

body or one’s mental processes—is altered

to the point of feeling like an observer, as

though seeing oneself from the “outside.”