Dissociative and Somatoform Disorders 379
perhaps through hypnosis, to characterize
each alter in detail. In contrast, according to the
sociocognitive model, therapists should try to
extinguish patients’ behaviors related to alters.Thinking like a clinician
How do mental health clinicians decide
whether an individual’s dissociative symp-
toms are normal or abnormal? Which of the
two theories of DID do you think is most
accurate and why?
The news reports that a 17-year-old boy
murdered his stepfather. The boy says that his
stepfather brutally abused him as a child, and
local medical and emergency room records
indicate numerous “accidents” that were con-
sistent with such abuse. The boy also says that
he has no memory of killing his stepfather; his
defense attorney and several psychiatrists
claim that the boy has DID and that an alter
killed the stepfather. Based on what you have
read in this chapter, how might this boy have
developed this disorder? (Mention neuro-
logical, psychological, and social factors and
possible feedback loops.) What would be
appropriate treatments for him and why? Do
think it is fair to punish a patient with DID for
what an alter did? Why or why not?Summary of
Somatoform Disorders
Somatoform disorders involve complaints
about physical well-being that cannot be
entirely explained by a medical condition, sub-
stance use, or another psychological disorder
and that cause signifi cant distress or impair
functioning. All somatoform disorders involve
bodily preoccupation, symptom amplifi cation,
and dissociation.
Somatization disorder (SD) is character-
ized by multiple specific 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. Fac-
tors that contribute to SD include genes,
catastrophic thinking about illness (along
with symptom amplifi cation and bodily preoc-
cupation), other people’s responses to illness,
and the way symptoms function as a means to
express helplessness.
Conversion disorder is characterized by
sensory and motor symptoms, and seizures,
which may initially appear to have neurologi-cal causes but in fact are not explained by a
medical condition and are not consciously
produced. Factors thought to contribute to
conversion disorder include abnormal func-
tioning of 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 reas-
surance from health care personnel. Hypo-
chondriasis has numerous features that are
similar to those of anxiety disorders, including
compulsions, obsessions, anxiety, and avoid-
ance; with hypochondriasis, the anxiety is
focused on health-related matters.
The neural basis of hypochondriasis
shares much with the neural basis of OCD and
panic disorder, but the three disorders arise
from at least some distinct neural events.
Psychological factors that contribute to hy-
pochondriasis include attentional biases and
catastrophic thinking, along with symptom
amplifi cation and bodily preoccupation.
Body dysmorphic disorder is character-
ized by an excessive preoccupation with a
perceived defect in appearance, which is either
imagined or slight. Body dysmorphic disorder
shares features with various anxiety disor-
ders: a fear of being evaluated, obsessions
(about a perceived defect), time-consuming
compulsive behaviors to hide or compensate
for a perceived defect in some way, and avoid-
ance of anxiety-inducing stimuli or situations.
Some researchers advocate reclassifying body
dysmorphic disorder as an anxiety disorder.
CBT is generally the treatment of choice
for somatoform disorders; medications, when
used, target anxiety-related symptoms. Group
and family therapy are generally used as sup-
plementary treatments.Thinking like a clinician
What do the four somatoform disorders have
in common? What do body dysmorphic disor-
der and hypochondriasis—and not the other
two somatoform disorders—have in common?
Why might conversion disorder more appropri-
ately be classifi ed as a dissociative disorder?
Do you think it should be—why or why not?
Now 57 years old, Mr. Andre left his native
Haiti 5 years ago and moved to the United
States. Unemployment rates in the U.S. were
high at the time of his arrival and Mr. Andrehad a hard time getting a job; he felt that he
was being discriminated against. His wife
supported the family for 2 years by cleaning
homes. After 2 years of looking, Mr. Andre did
get a job, delivering sandwiches to offi ces at
lunchtime. Within 4 months of starting this
job, though, he fell down a fl ight of stairs after
making a delivery, and he has had persistent
lower back pain since, leaving him bedridden
and unable to work. Doctors have not found
a medical explanation for this pain. What fac-
tors should (and shouldn’t) clinicians take
into account when evaluating Mr. Andre for
a somatoform disorder? If they do think he
has such a disorder, which one do you think
it might be and why, and what treatment(s)
should be recommended to Mr. Andre if you
are correct? On what basis could some of the
somatoform disorders be ruled out?Key Terms
Hysteria (p. 331)
Dissociation (p. 331)
Amnesia (p. 332)
Identity problem (p. 332)
Derealization (p. 332)
Depersonalization (p. 332)
Dissociative disorders (p. 333)
Dissociative amnesia (p. 334)
Dissociative fugue (p. 337)
Depersonalization disorder (p. 340)
Dissociative identity disorder (DID)
(p. 344)
Somatoform disorders (p. 353)
Somatization disorder (SD) (p. 354)
Pain disorder (p. 354)
Conversion disorder (p. 360)
Hypochondriasis (p. 365)
Body dysmorphic disorder (p. 369)More Study Aids
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chapter, go to:
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