Dissociative and Somatoform Disorders 377
Key Concepts and Facts About Somatoform Disorders
- Somatoform disorders involve complaints about physical
well-being that cannot be entirely explained by a medical condi-
tion, substance use, or another psychological disorder and that
cause signifi cant distress or impair functioning. Diagnosing one
of these disorders may require many medical tests or visits to
physicians to ensure that the physical symptoms are not a result
of a medical condition. Somatoform disorders are rare and are
most likely to be observed in medical settings. All somatoform
disorders involve bodily preoccupation, symptom amplifi cation,
and dissociation. - Somatization disorder (SD) is characterized by multiple specifi c
physical symptoms that are medically unexplained and impair
an individual’s ability to function. People with SD may avoid
activities associated with their symptoms, which can create a
vicious cycle as they become out of shape physically. - The DSM-IV-TR criteria for diagnosing SD have been criticized on
several grounds: (1) all symptoms are counted equally; (2) the
minimum number of symptoms required is not based on research
results; (3) patients’ beliefs about their symptoms are not part of
the criteria; and (4) the bodily symptoms may be better explained
by other psychological disorders. - Factors that contribute to SD include genes, catastrophic think-
ing about illness (along with symptom amplifi cation and bodily
preoccupation), other people’s responses to illness, and the
way symptoms function as a means of expressing helplessness. - Conversion disorder involves sensory and motor symptoms that
may initially appear to have neurological causes but in fact are
not explained by a medical condition and are not consciously
produced. There are three types of symptoms: motor symptoms,
sensory symptoms, and seizures. - Criticisms of DSM-IV-TR diagnostic criteria for conversion disor-
der include: (1) the prominent role of dissociation suggests that
the disorder may be better grouped with dissociative disorders;
and (2) many cases of conversion disorder may be a type of fac-
titious disorder. - Factors thought to contribute to conversion disorder include
abnormal functioning of brain areas that interpret and manage
other brain areas that process sensation and pain, self-hypnosis
and dissociation, and intense social stressors. - Hypochondriasis is characterized by misinterpretation of bodily
sensations and symptoms, which leads to a belief that the
individual has a serious illness—this despite no evidence of a
medical problem and reassurance from health care personnel.
Hypochondriasis has numerous features that are similar to
those of anxiety disorders, including compulsions, obsessions,
anxiety, and avoidance. - The neural basis of hypochondriasis shares much with the neu-
ral basis of OCD and panic disorder (particularly the latter), but
hypochondriasis has at least some distinct neural events. Parts
of the brain involved in attention are more activated than nor-
mal, at least in certain circumstances.- Psychological factors that contribute to hypochondriasis include
attentional biases and catastrophic thinking (along with symp-
tom amplifi cation and bodily preoccupation). - Body dysmorphic disorder is characterized by an excessive
preoccupation with a perceived defect in appearance, which
is either imagined or slight. Body dysmorphic disorder shares
features with various anxiety disorders: a fear of being evalu-
ated, obsessions (about a perceived defect), time-consuming
compulsive behaviors (to hide or compensate for a perceived
defect in some way), and avoidance of anxiety-inducing stimuli
or situations. Some researchers advocate reclassifying body
dysmorphic disorder as an anxiety disorder. - Research on body dysmorphic disorder has focused on psycho-
logical factors, particularly cognitive biases and catastrophic
thinking (along with symptom amplifi cation and bodily preoc-
cupation). A patient’s perceived defect tends to be related to
bodily attributes that are highly valued in his or her culture or
subculture. - CBT is generally the treatment of choice for somatoform disor-
ders; medications, when used, target anxiety-related symptoms.
Group and family therapy are generally used as supplementary
treatments.
- Psychological factors that contribute to hypochondriasis include
Making a Diagnosis
- Reread Case 8.5 about Edward, and determine whether or
not his symptoms meet the criteria for somatization disorder.
Specifically, list which criteria apply and which do not. If you
would like more information to determine his diagnosis, what
information—specifi cally—would you want, and in what ways
would the information infl uence your decision? - Reread Case 8.6 about Mary, and determine whether or not her
symptoms meet the criteria for conversion disorder. Specifi cally,
list which criteria apply and which do not. If you would like more
information to determine her diagnosis, what information—
specifi cally—would you want, and in what ways would the infor-
mation infl uence your decision? - Reread Case 8.7 about the unnamed woman, and determine
whether or not her symptoms meet the criteria for hypochon-
driasis. Specifi cally, list which criteria apply and which do not.
If you would like more information to determine her diagnosis,
what information—specifi cally—would you want, and in what
ways would the information infl uence your decision? - Reread Case 8.8 about Ms. A, and determine whether or not her
symptoms meet the criteria for body dysmorphic disorder. Spe-
cifi cally, list which criteria apply and which do not. If you would
like more information to determine her diagnosis, what infor-
mation—specifi cally—would you want, and in what ways would
the information infl uence your decision?