352 CHAPTER 8
Somatoform Disorders
During the course of her illness, Anna O. developed medical symptoms that her
doctors could not explain. For instance, she saw an eye doctor for problems with
her vision, but he was unable to identify the cause (Breuer & Freud, 1895/1955).
Similarly, doctors were unable to fi nd a medical explanation for her cough. How
might persistent medically unexplained physical symptoms such as these arise?
How should they best be treated? Such bodily symptoms may fall under the category
ofsomatoform disorders in DSM-IV-TR.- Dissociative fugue is characterized by sudden, unplanned travel
and diffi culty remembering the past, which in turn leads to iden-
tity confusion. Apparently, the frontal lobes of patients with
this disorder are not as effective at accessing stored memories,
particularly about the self; the reduced activation in the frontal
lobes might be caused by stress-related hormones. People who
have had this disorder are more hypnotizable and dissociate
more easily than do others. Moreover, dissociative fugue typi-
cally occurs in response to a traumatic event. - Depersonalization disorder is characterized by the persis-
tent feeling of being detached from oneself, which may be ac-
companied by derealization. This disorder appears to involve
an under-reaction to emotional stimuli, and is more common
among people who experienced severe chronic emotional
abuse during childhood than among people who did not have
this experience. - Dissociative identity disorder (DID) hinges on the presence of
two or more distinct alters, each of which takes turns control-
ling the person’s behavior. The DSM-IV-TR diagnostic criteria for
DID have been criticized for being vague, and the symptoms are
easy to fake. - Although neuroimaging studies of patients with DID fi nd that
their brains function differently when different alters are domi-
nant, such studies generally have not used appropriate control
groups (such as one in which participants are asked to fake
having this disorder). People with this disorder are more hyp-
notizable and dissociate more readily than do people who do
not have this disorder. After the airing of the television movie
Sybil, in 1976, the prevalence of DID increased dramatically. The
diagnosis of DID is controversial. - The posttraumatic model proposes that DID is caused by se-
vere, chronic physical abuse during childhood, which leads to
dissociation during the abuse; the dissociated states come to
constitute alters, with their own memories and personality traits.
The sociocognitive model proposes that DID arises as the result
of interactions between a therapist and a suggestible patient, in
which the therapist inadvertently encourages the patient to be-
have in ways consistent with the diagnosis. Both interpretations
are consistent with the fi nding that severe childhood trauma is
associated with the disorder.- The goal of treatment for dissociative disorders ultimately is
to reduce the symptoms themselves and lower the stress they
induce. For patients with DID, the specifi c methods employed
depend on what the clinician views as the cause of the disorder:
According to the posttraumatic model, therapists should help
patients, 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.
Making a Diagnosis
- Reread Case 8.1 about Mrs. Y, and determine whether or not
her symptoms meet the criteria for dissociative amnesia. 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? - Reread Case 8.2 about Joe, and determine whether or not his
symptoms meet the criteria for dissociative fugue. Specifi cally,
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 infor-
mation infl uence your decision? - Reread Case 8.3 about Mr. E, and determine whether or not his
symptoms meet the criteria for depersonalization disorder. Spe-
cifi cally, list which criteria apply and which do not. If you would
like more information to determine his diagnosis, what informa-
tion—specifically—would you want, and in what ways would
the information infl uence your decision? - Reread Case 8.4 about Robert Oxnam, and determine whether
or not his symptoms meet the criteria for dissociative identity
disorder. Specifi cally, 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?