Dissociative and Somatoform Disorders 365
Psychological Factors: Self-Hypnosis?
There is no generally accepted explanation for how psychological factors might
produce the selective bodily symptoms in conversion disorder (Halligan, Bass, &
Wade, 2000). But self-hypnosis offers one possible explanation—that the disorder is
the result of unintended self-hypnotic suggestion. According to this theory, patients
have, consciously or unconsciously, “suggested” to themselves that they have symp-
toms. Thus, those who have a sensory conversion disorder may unknowingly hyp-
notize themselves so that they are not consciously aware of the sensations in some
part of their body (Kozlowska, 2005); that is, such sensations have become dissoci-
ated. This theory receives support from the fact that people with conversion disor-
der are unusually hypnotizable (Roelofs, Hoogduin, et al., 2002).
The theory that conversion disorder results from self-hypnosis is sup-ported by the finding that areas of the brain activated by hypnotically induced
paralysis are similar to those activated by paralysis in patients with conversion
disorder (Halligan et al., 2000; Oakley, 1999). The self-hypnosis explanation
also is consistent with neodissociation theory, discussed in the section on disso-
ciative amnesia: The sensory system is somehow disconnected from the execu-
tive monitoring system, creating the conscious experience of a lack of sensory
input (Hilgard, 1994). Thus, conversion symptoms can be con-
sidered to be errors in the cognitive processing of sensation and
movement (Kozlowska, 2005; Oakley, 1999).
Social Factors: Stress Response
Life stressors, such as combat, can trigger conversion disorder.
Moreover, the greater the severity or number of stressors, the more
severe the conversion symptoms (Roelofs et al., 2005). As we saw
with SD, somatic symptoms can be a culturally accepted way to
express feelings of helplessness (Celani, 1976), which may explain
why some soldiers develop conversion disorder in combat. Conver-
sion disorder can also be a way to obtain the attention associated
with being sick. This was certainly true for Anna O., and for many
other women of the Victorian era.
Hypochondriasis
People who are diagnosed with hypochondriasisare preoccupied with a fear or
belief that they have a serious disease, but this preoccupation arises because they
have misinterpreted their bodily sensations or symptoms (American Psychiatric
Association, 2000). Despite the fact that physicians cannot identify a medical
problem, patients with hypochondriasis persist in clinging strongly to their con-
viction that they have a serious disease. Although people with SD and those with
hypochondriasis share a focus on bodily symptoms, only those with hypochon-
driasis believe that they have a serious illness despite reassurance from doctors.
Moreover, people with hypochondriasis do not see that there are other possible
explanations for their sensations (Smeets, de Jong, & Mayer, 2000).
What Is Hypochondriasis?
Patients with hypochondriasis may or may not realize that their worries are
excessive for the situation; when they do not, they are said to have poor insight
into their condition. Consider a man who sees floating “spots” and does not
believe his eye doctor when told that such fl oaters are normal and nothing to worry
about. The man probably doesn’t think that the doctor is lying about the spots, but
he may believe that the doctor didn’t do a thorough enough eye examination; he may
think that the fl oaters indicate that he is going blind or that he has a tumor. His wor-
ries about this problem are distressing and preoccupying to the point that he’s func-
tioning less well at work—not because of the fl oaters, but because of his frequent
thoughts about the fl oaters. To be diagnosed with this disorder in DSM-IV-TR, this
P SNSymptoms of conversion disorder may be more
common after signifi cant psychological stressors,
such as military combat. This soldier is displaying
muscular spasms as part of his conversion
disorder. Such symptoms among soldiers are
thought to resolve a confl ict between their loyalty
to comrades and their fear of battle: Soldiers with
such symptoms are unable to fi ght (Spiegel, 1974).Image Courtesy MPI Home VideoHypochondriasis
A somatoform disorder marked by a
preoccupation with a fear or belief of having a
serious disease, but this preoccupation arises
because the individual has misinterpreted his
or her bodily sensations or symptoms.