Chapter 6: Somatic Symptom & Related Disorders & Dissociative Disorders

Members: Bergado, Franchezzca Mae C.

David, Jose Gaudencio
Opinaldo, Jade Adrian
Tapales, Alyza Marie C.

Somatic Symptom Disorder came from the word soma which means body, and the problems
preoccupying these people seem, initially, to be physical disorders. What the somatic symptom
disorders have in common is that there is an excessive or maladaptive response to physical
symptoms or to associated health concerns. These disorders are sometimes grouped under the
shorthand label of “medically unexplained physical symptoms”

The DSM-V listed five basic Somatic Symptom Disorders namely; Somatic Symptom Disorder,
Illness Anxiety Disorder, Psychological Factors Affecting Medical Condition, Conversion
Disorder, and Factitious Disorder

These are the Diagnostic Criteria for Somatic Symptom Disorder

1. One or more somatic symptoms that are distressing and/or result in significant
disruption of daily life
2. Excessive thoughts, feelings, and behaviors related to the somatic symptoms or
associated health concerns as manifested by at least one of the following:
a. Disproportionate and persistent thoughts about the seriousness of one’s
symptoms
b. High level of health-related anxiety
c. Excessive time and energy devoted to these symptoms or health concerns
3. Although any one symptom may not be continuously present, the state of being
symptomatic is persistent (typically more than 6 months)Conversion Disorder
(Functional Neurological Symptom Disorder)

Illness Anxiety Disorder was formerly known as hypochondriasis. In illness anxiety disorder the
concern is primarily with the idea of being sick instead of the physical symptom itself.

These are some of the Major Characteristics of Illness Anxiety Disorder:

1. Illness Anxiety Disorder is highly preoccupied with bodily functions, minor physical
abnormalities, and ambiguous physical sensations
2. They have intrusive thoughts where they attribute physical symptoms to a suspected
disease
3. And they are not malingering or consciously faking symptoms to achieve specific goals

These are some of the Causal Factors in Illness Anxiety Disorder

There are three factors that contributes to the Illness Anxiety Disorder
1. These disorders seem to develop in the context of a life event
2. People who develop these disorders tend to have had a disproportionate incidence of
disease in their family when they were children
 3. An important social and interpersonal influence may be involved

These are the Treatments for Illness Anxiety Disorder

 Cognitive-Behavioral Therapy
 SSRIs
 Behavioral Techniques
 Group Therapy

The term conversion has been used off and on since the Middles Ages but was popularized by
Freud, who believed the anxiety resulting from unconscious conflicts somehow was converted
into physical symptoms to find expression. This allowed the individual to discharge some
anxiety without actually experiencing it. As in phobic disorders, the anxiety resulting from
unconscious conflicts might be displaced onto another object.

Clinical Description
Conversion disorder generally have to do with physical malfunctioning, such as paralysis,
blindness, or aphonia, without any physical or organic pathology to account for the
malfunction. Most conversion symptoms suggest that some kind of neurological disease is
affecting sensory-motor systems, although conversion symptoms can mimic the full range of
malfunctioning.

Clinical Description
And in addition to blindness, paralysis and aphonia, conversion symptoms may include total
mutism and the loss of the sense of touch. Some people have seizures, which may be
psychological in origin, because no significant electroencephalogram changes can be
documented.

Another relatively common symptom in which the sensation of a lump in the throat that makes
it difficult to swallow, eat or sometimes talk is the Globus hystericus.

Clinical Description (closely related disorders)

Distinguishing among conversion reactions, real physical disorders and outright malingering is
sometimes difficult. Several factors can help but one symptom, widely regarded as a diagnostic
sign, has proved not to be useful.

It was long thought that the patients with conversion reaction had the same quality of
indifference to the symptoms thought to be present in somatization disorder. This attitude is
referred to as belle indifference. This was considered as a hallmark of conversion reactions but
unfortunately, this turns out not to be the case.

It was found out that a blasé attitude towards illness is sometimes displayed by people with
actual physical disorders, and some people with conversion symptoms do become quite
distressed.
A more puzzling is a set of conditions called factitious disorders, which falls somewhere
between malingering and conversion disorder. The symptoms are under voluntary control, as
with malingering, but there is no obvious reason for voluntarily producing the symptoms
except, possibly to assume the sick role and receive increased attention. This disorder may
extend to other members of the family.

Clinical Description (Unconscious Mental Processes)

Unconscious cognitive processes seem to play a role in much of psychopathology, but now here
is this phenomenon more readily and dramatically apparent then when we attempt to
distinguish between conversion and related conditions.

Statistics
Like somatization disorder, conversion disorders are found primarily in women and typically
develop during adolescence or slightly thereafter. However, they occur relatively often in males
at times of extreme stress. Conversion reactions are not uncommon in soldiers exposed to
combat. The conversion symptoms often disappear after a time, only to return later in the
same or similar form when a new stressor occurs.

Causes
While the specific cause of conversion disorder is still being studied, researchers think it develops as
a way for your brain to deal with emotional strife. It’s almost always triggered by stressful situations
and other mental disorders. And the symptoms usually develop suddenly.
Women are more likely to have it than men. It also happens more often to people with a history of
emotional trauma, and in those who have a hard time talking about their feelings.
Sometimes, physical symptoms might help resolve some sort of internal conflict. For example, if
you’re struggling with the desire to hurt someone, conversion disorder may cause you to develop
paralysis, making it impossible to act on that desire.
Freud describe four basic processes in the development of conversion disorder. The first one is
the individual experiences as traumatic event. An unacceptable, unconscious conflict. Second,
because the conflict and the resulting anxiety are unacceptable, the person represses the
conflict, making it unconscious. Third, the anxiety continues to increase and threatens to
emerge into consciousness, and the person “converts into physical symptoms thereby relieving
the pressure of having deal directly with the conflict
Slide 8
Treatment
Although few systematic controlled studies have evaluated the effectiveness of treatment for
conversion disorders, we often treat this condition in our clinics, as do others and closely follow
our thinking on etiology. This is because conversion disorder has much in common with
somatization disorder, many of the treatment principles are similar.
There is no specific medication to treat conversion disorder. Psychotherapy treatments are most
often used, including: occupational or physical therapy, counseling, hypnosis and antidepressants or
antipsychotic drugs
How to prevent Conversion disorder?
The best way to prevent conversion disorder is to try to find effective ways to manage life’s
unavoidable stresses. Physical exercise and stress-relieving activities like yoga and meditation may
help.
Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions or
sense of who he or she is. This is a normal process that everyone has experienced. Examples of
mild, common dissociation include daydreaming, highway hypnosis or “getting lost” in a book
or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings.
It can be divided into two types: depersonalization and derealization. In depersonalization, your
perception alters so that you temporarily lose the sense of your own reality, as if you are in a
dream and you are watching yourself. On the other hand, derealization happens when one’s
sense of reality of the external world is lost. Things may seem to change shape or size; people
may seem dead or mechanical.

During a traumatic experience such as an accident, disaster or crime victimization, dissociation

can help a person tolerate what might otherwise be too difficult to bear. In situations like these,
a person may dissociate the memory of the place, circumstances or feelings about of the
overwhelming event, mentally escaping from the fear, pain and horror. This may make it
difficult to later remember the details of the experience, as reported by many disaster and
accident.

There are three main dissociative disorders.

The first one is depersonalization-derealization disorder. Depersonalization/ derealization
disorder involves significant ongoing or recurring experience of one or both conditions of
depersonalization or derealization: both were explained beforehand. People may feel as if
things and people in the world around them are not real. During these altered experiences, the
person is aware of reality and that their experience is unusual. The experience is very
distressful, even though the person may appear to be unreactive or lacking emotion. Symptoms
may begin in early childhood; the average age a person experiences the disorder is 16. Less
than 20 percent of people with depersonalization/derealization disorder first experience
symptoms after age 20.

The second disorder is dissociative amnesia, which involves not being able to recall information
about oneself (not normal forgetting). This amnesia is usually related to a traumatic or stressful
event and may be:
◦ localized – unable to remember an event or period of time (most common type)
◦ selective – unable to remember a specific aspect of an event or some events within a period
of time
◦ generalized – complete loss of identity and life history (rare)
Dissociative amnesia is associated with having experiences of childhood trauma, and
particularly with experiences of emotional abuse and emotional neglect. People may not be
aware of their memory loss or may have only limited awareness. And people may minimize the
importance of memory loss about a particular event or time.
A subtype of dissociative amnesia is referred to as dissociative fugue. This disorder revolves
around a specific incident—an unexpected trip. Mostly, individuals just take off and later find
themselves in a new place, unable to remember why or how they got there. During these trips,
a person sometimes assumes a new identity or at least becomes confused about the old
identity. Fugue states usually end abruptly, and the individual returns home, recalling most, if
not all, of what happened. In this disorder, the disintegrated experience is more than memory
loss, involving at least some disintegration of identity, if not the complete adoption of a new
one.

An apparently distinct dissociative state not found in Western cultures is called amok. Running
amok is only one of many “running” syndromes in which an individual enters a trance-like state
and suddenly, imbued with a mysterious source of energy, runs or flees for a long time. Among
native peoples of the Arctic, running disorder is termed pivloktoq. Among the Navajo tribe, it is
knows as frenzy witchcraft.
Trance and possession are a common part of some religious and cultural practices and are not
considered abnormal. These dissociative trances commonly occur in India,
Nigeria (locally referred to as vinvusa), Thailand (phii pob) and other Asian and African
countries.

Suggestibility is a personality trait distributed normally across the population, much like weight
and height. Some people are more suggestible than others; some are relatively immune to
suggestibility; and the majority fall in the midrange.
According to auto hypnotic model people who are suggestible may be able to use dissociation
as a defense against extreme trauma. (Putnam,1991). According to this view, when the trauma
becomes unbearable, the person’s very identity splits into multiple dissociated identities.
Children’s ability to distinguish clearly between reality and fantasy as they grow older may be
what closes the developmental window for developing DID at as young as 9.
People who are less suggestible may develop a severe post-traumatic stress reaction but not a
dissociative reaction

BIOLOGICAL CONTRIBUTIONS
On the other hand, much as in PTSD, there is some evidence of smaller hippocampal and
amygdala volume in patients with did compared to “normals”
Individuals with certain neurological disorders, experience may dissociative symptoms.
Patients with dissociative experiences who have seizure disorders are clearly different from
those who do not (Ross, 1997). The seizure patients develop dissociative symptoms in
adulthood that are not associated with trauma, in clear contrast to DID patients without seizure
disorders.
Traumas or anything that can result to brain damage may induce other types of dissociative
experience. Also, sleep deprivation is a strong evidence that produces dissociative symptom.
REAL MEMORIES ARE FALSE
Regarding the memories or repressed memories of trauma, it is said that severe trauma can be
one of the causes of dissociative symptoms, while on the other hand it is also said that this
assumption is only made by careless therapists who assume that people with this condition
may have been severely abused sexually.
On the other hand, if falsely diagnosed by the therapists, false accusations and the such could
lead to further problems within the family and with the patient itself
FALSE MEMORY SYNDROME FOUNDATION
The goal of the organization is to educate the public about false memories that may have been
suggested during psychotherapy, so that in the absence of other objective evidence such
memories cannot be used to convict innocent people.

TREATMENT – For dissociative amnesia. When necessary, therapy focuses on recalling what
happened during the amnesic or fugue states, often with the help of friends or family who
know what happened, so that patients can confront the information and integrate it into their
conscious experience. For more diff cult cases, hypnosis or benzodiazepines (minor
tranquilizers) have been used, with suggestions from the therapist that it is okay to remember
the events (Maldonado et al., 1998)
For DID patients it is accounted that only 5 out of 20 patients achieved full integration of their
identities. Strategies used today are based on accumulated clinical wisdom, as well as on
procedures that have been successful with PTSD.
Goal is to identify the cues or triggers that provoke memories of trauma, dissociation, or both
and to neutralize them. . To instill this sense of control, the therapist must skillfully, and slowly,
help the patient visualize and relive aspects of the trauma until it is simply a terrible memory
instead of a current event. However, it is possible that reemerging memories of trauma may
trigger further dissociation and the therapist must always be on guard and prevent this from
happening.