Mood Disorders

CHAPTER

8

Chapter Outline

A

nna O., a well-to-do 21-year-old woman living in Austria

in the late 19th century, had been caring for her ill father

for weeks. Anna and her mother alternated shifts, Anna

taking the night shift, staying awake by his bedside. Her

father was dying of tuberculosis, and Anna also began to feel

sick. Her symptoms included severe vision problems, head-

aches, a persistent cough, paralysis (in her neck, right arm,

and both legs), lack of sensation in her elbows, and daily

periods of a state of consciousness similar to sleep-walking.

After her cough developed, Anna was forbidden to take care

of her father. Anna was diagnosed with hysteria, an emo-

tional condition marked by extreme excitability and bodily

symptoms for which there is no medical explanation.

For 2 years, Anna was treated by Dr. Joseph Breuer, a Viennese

neurologist. Breuer became a colleague of Sigmund Freud and told

Freud about Anna and her treatment, later described in Studies in

Hysteria (Breuer & Freud, 1895/1955). Prior to Breuer’s treatment of

Anna, hypnosis was often used to treat hysteria. The physician hyp-

notized the patient (usually a woman) and then gave her a suggestion

that the symptoms would go away. However, for some unknown

reason, Breuer did not give Anna any suggestions, although he did

hypnotize her. Instead, he asked her about her symptoms, and over

time she told him about them. Anna and Breuer often met daily for

treatment, sometimes twice a day. Anna’s treatment usually involved

Breuer’s hypnotizing her and then asking her to tell him what she

remembered about the origins of her symptoms. At other times, after

being hypnotized, she simply told him what was on her mind. Anna

referred to this process as the “talking cure.” Freud was fascinated by

Breuer’s account of Anna’s illness and her treatment; Breuer’s “talk-

ing cure” was a precursor to psychoanalysis, and Freud’s thoughts

about Breuer and Anna led to the beginnings of his psychoanalytic

theory (Freeman, 1980; see also Chapters 1 and 4).

Anna was diagnosed with hysteria—a common diagnosis at the

time—but this term is a vague label for a condition that includes a

wide range of symptoms. Hysteria is not a diagnosis in DSM-IV-TR;

instead, DSM-IV-TR classifi es symptoms that were once considered

manifestations of hysteria as part of the diagnostic criteria for two

CHAPTER 8 Dissociative and Somatoform Disorders

orders. The central feature of dissociative disorders is dissociation,

the separation of mental processes—such as perception, memory

and self-awareness—that are normally integrated. Generally, each

Chapter Outline

Dissociative Amnesia

Dissociative Disorders: An Overview

Dissociative Fugue

Dissociative Fugue

Depersonalization Disorder

Dissociative Identity Disorder

Treating Somatoform Disorders

Somatoform Disorders

Somatoform Disorders: An Overview

Somatization Disorder

Conversion Disorder

Hypochondriasis

Body Dysmorphic Disorder

Is Somatoform Disorder a Useful Concept?

Treating Eating Disorders

Follow-up on Anna O.

331

Dissociative and

Somatoform Disorders

Hysteria

An emotional condition marked by extreme

excitability and bodily symptoms for which

there is no medical explanation; hysteria is

not a DSM-IV-TR disorder.

Dissociation

The separation of mental processes—

such as perception, memory, and self-

awareness—that are normally integrated.

Noma Bliss