Abnormal Psychology

Dissociative and Somatoform Disorders 353

Somatoform Disorders: An Overview

The hallmark of somatoform disorders is complaints about physical well-being

that cannot be entirely explained by a medical condition, substance use, or another

psychological disorder. For example, one somatoform disorder is hypochondriasis,

which is characterized by an individual’s preoccupying belief that he or she has a

serious illness, despite negative medical tests. By their very nature, however, soma-

toform disorders are “rule out” diagnoses, meaning that the clinician must make

sure that there aren’t medical conditions or other psychological disorders that can

better explain the patients’ physical symptoms. For instance, if a person repeatedly

has panic attacks and complains of a racing heart, chest pain, and shortness of

breath, he or she will not be considered to have a somatoform disorder, because the

symptoms are explained by another psychological disorder—panic disorder.

In the absence of a medical condition or another psychological disorder, clini-

cians must judge the extent to which patients’ physical symptoms (see Table 8.9)

impair functioning, lead to signifi cant distress, and are not under voluntary con-

trol, and decide whether the symptoms qualify as a somatoform disorder

according to DSM-IV-TR criteria. Somatoform disorders are relatively rare

in the general population but are the most common type of psychological

disorder in medical settings (Bass, Peveler, & House, 2001): A third of

patients visiting their primary care physician have symptoms that are not

adequately explained by a medical condition (Kroenke, 2003). The medi-

cal costs of caring for patients with somatoform disorders are substantial;

according to one estimate, patients with these disorders account for over

$250 billion in medical costs each year (Barsky, Orav, & Bates, 2005).

Somatoform disorders are not a new phenomenon; they have a long

history, although different labels have been given to them over time.

They were described by the ancient Greek philosopher Hippocrates, who

thought that somatoform symptoms—generally reported by women—were

caused by a wandering uterus, from which the term hysteria is derived

(hystera is Greek for “uterus”; Phillips, 2001). Hysteria was often used to

refer to bodily symptoms that lack a medical explanation, as was true of Anna O.;

in addition, patients with hysteria typically describe their symptoms dramatically.

Somatoform disorders must be distinguished from factitious disorder, men-

tioned in Chapter 3, in which people intentionally induce symptoms or falsely report

symptoms that they do not in fact have to receive attention from others. Those with

a somatoform disorder neither pretend to have symptoms nor intentionally induce

physical symptoms for any type of gain.

Somatoform disorders share two common features (Looper & Kirmayer, 2002):

1.bodily preoccupation, which is similar to the heightened awareness of

panic-related bodily sensations experienced by people with panic disorder

(see Chapter 7), except that with somatoform disorders the patient can be

preoccupied with any aspect of bodily functioning; and

2.symptom amplifi cation, or directing attention to bodily symptoms such as those

in Table 8.9, which in turn intensifi es the symptoms (Kirmayer & Looper, 2006;

Looper & Kirmayer, 2002). A common example of symptom amplification

occurs when someone with a headache pays attention to the headache–and,

invariably, the pain worsens.

Body dysmorphic disorder—a preoccupation with a perceived bodily defect—is the

only somatoform disorder that does not include an actual somatic symptom.

The somatoform disorders involve dissociation; in these disorders, the processes

of sensation and perception of bodily functioning are not integrated, but rather

have become separated or altered. Somatoform disorders and dissociative disorders

are classifi ed separately only because of the bodily aspect of somatoform symp-

toms, but some researchers suggest that they should be combined into one category

(Kihlstrom, 2001).

Symptoms of somatoform disorders have existed

for millennia and were written about in the

Papyrus Ebers, an ancient Egyptian medical

document dating to 1600 B.C.E. However, the

Egyptians believed that these symptoms had an

underlying medical cause.

University Library, Leipzig, Germany/Archives Charmet/The Bridgeman Art Library

• Muscle and joint pain • Palpitations


• Lower back pain • Irritable bowel


• Tension headache • Dizziness


• Atypical facial pain • Insomnia


• Chronic fatigue • Non-ulcer dyspepsia
  (indigestion)


• Non-cardiac chest pain

Source: Mayou & Farmer, 2002. For more information see the Permissions

section.

Table 8.9 • Common Bodily Complaints of

Patients with Somatoform Disorders

Somatoform Disorders

A category of psychological disorders

characterized by complaints about physical

well-being that cannot be entirely explained

by a medical condition, substance use, or

another psychological disorder.