Somatic Symptom and Related Disorders and Dissociative
Disorders
SOMATIC SYMPTOM AND RELATED DISORDERS
- Illness anxiety disorder was formerly known as “hypochondriasis,”
which is still the term widely used among the public.
- If one or more physical symptoms are relatively severe and are
associated with anxiety and distress the diagnosis would be somatic
symptom disorder.
- Concern is primarily with the idea of being sick instead of the
physical symptom itself.
- Illness anxiety disorder and somatic symptom disorder share many
features with the anxiety and mood disorders, particularly panic
disorder
- Anxiety and mood disorders are often comorbid with somatic
symptom disorders; that is, if individuals with somatic symptom
disorders have additional diagnoses, these most likely are anxiety or
mood disorders
- Somatic symptom disorder and illness anxiety disorder are
characterized by anxiety or fear that one has a serious disease.
- In these two disorders, the individual is preoccupied with bodily
symptoms, misinterpreting them as indicative of illness or disease.
- Key feature of this disorder is preoccupation with physical
symptoms.
- Individuals with somatic symptom disorders, on the other hand,
focus on a longterm process of illness and disease (for example,
cancer or AIDS).
- This condition may dominate the individual’s life and interpersonal
relationships.
- Physical malfunctioning, such as paralysis, without any apparent
physical problems.
- Distinguishing among conversion reactions, real physical disorders,
and outright malingering, or faking, is sometimes difficult. Even
more puzzling can be factitious disorder, in which the person’s
symptoms are feigned and under voluntary control, as with
malingering, but for no apparent reason.
- The causes of somatic symptom disorders are not well understood
but seem closely related to anxiety disorders.
- Treatment of somatic symptom disorders ranges from basic
techniques of reassurance and social support to interventions
meant to reduce stress and remove any secondary gain for the
behavior.
- Specifically tailored cognitive-behavioral therapy has proved
successful with these conditions.
Diagnostic Criteria for Somatic Symptom Disorder
A. One or more somatic symptoms that are distressing and/or result
in significant disruption of daily life.
B. Excessive thoughts, feelings, and behaviors related to the somatic
symptoms or associated health concerns as manifested by at least
one of the following:
1. Disproportionate and persistent thoughts about the seriousness
of one’s symptoms.
2. High level of health-related anxiety.
3. Excessive time and energy devoted to these symptoms or health
concerns.
C. Although any one symptom may not be continuously present, the
state of being symptomatic is persistent (typically more than 6
months)
Specify if:
With predominant pain (previously pain disorder): This specifier is
for individuals whose somatic complaints predominantly involve
pain.
Specify current severity:
Mild: Only one of the symptoms in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are
fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are
fulfilled, plus there are multiple somatic complaints (or one very
severe somatic symptom)
Diagnostic Criteria for Illness Anxiety Disorder
A. Preoccupation with fears of having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in
intensity. If another medical condition is present or there is a high
risk for developing a medical condition the preoccupation is clearly
excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is
easily alarmed about personal health status.
D. The individual performs excessive health-related behaviors or
exhibits maladaptive avoidance.
E. Illness preoccupation has been present for at least 6 months, but
the specific illness that is feared may change over that period of
time.
F. The illness-related preoccupation is not better explained by
another mental disorder, such as somatic symptom disorder,
generalized anxiety disorder, or obsessive-compulsive disorder.
Specify whether:
Care-seeking type: Medical care, including physician visits or
undergoing tests and procedures, is frequently used.
Care-avoidant type: Medical care is rarely used.
DISSOCIATIVE DISORDERS
- Dissociative disorders are characterized by alterations in
perceptions: a sense of detachment from one’s own self, from the
world, or from memories.
- Dissociative disorders include;
> depersonalization-derealization disorder, in which the individual’s
sense of personal reality is temporarily lost (depersonalization), as is
the reality of the external world (derealization).
- Dissociative amnesia, the individual may be unable to remember
important personal information.
- Generalized amnesia, the individual is unable to remember
anything; more commonly, the individual is unable to recall specific
events that occur during a specific period (localized or selective
amnesia).
- Dissociative fugue, a subtype of dissociative amnesia, memory loss
is combined with an unexpected trip (or trips).
- In the extreme, new identities, or alters, may be formed, as in
dissociative identity disorder (DID).
- The causes of dissociative disorders are not well understood but
often seem related to the tendency to escape psychologically from
stress or memories of traumatic events.
- Treatment of dissociative disorders involves helping the patient
reexperience the traumatic events in a controlled therapeutic
manner to develop better coping skills.
- In the case of DID, therapy is often long term. Particularly essential
with this disorder is a sense of trust between therapist and patient.
Diagnostic Criteria for Depersonalization-Derealization Disorder
A. The presence of persistent or recurrent experiences of
depersonalization, derealization, or both:
Depersonalization: Experiences of unreality, detachment, or being Diagnostic Criteria for Dissociative Identity Disorder
an outside observer with respect to one’s thoughts, feelings, A. Disruption of identity characterized by two or more distinct
sensations, body or actions. personality states, which may be described in some cultures as an
Derealization: Experiences of unreality or detachment with respect experience of possession. The disruption of marked discontinuity in
to surroundings. sense of self and sense of agency, accompanied by related
B. During the depersonalization or derealization experience, reality alterations in affect, behavior, consciousness, memory, perception,
testing remains intact. cognition, and/or sensory-motor functioning. These signs and
C. The symptoms cause clinically significant distress or impairment in symptoms may be observed by others or reported by the individual.
social, occupational, or other important areas of functioning. B. Recurrent gaps in the recall of everyday events, important
D. The disturbance is not attributable to the physiological effects of personal information, and/or traumatic events that are inconsistent
a substance (e.g., a drug of abuse, medication) or another medical with ordinary forgetting.
condition (e.g., seizures). C. The symptoms cause clinically significant distress or impairment in
E. The disturbance is not better explained by another mental social, occupational, or other important areas of functioning.
disorder, such as schizophrenia or panic disorder. D. The disturbance is not a normal part of a broadly accepted
cultural or religious practice. Note: In children, the symptoms are not
Diagnostic Criteria for Dissociative Amnesia attributable to imaginary playmates or other fantasy play.
A. An inability to recall important autobiographical information, E. The symptoms are not attributable to the physiological effects of
usually of a traumatic or stressful nature, that is inconsistent with a substance or another medical condition.
ordinary forgetting. Note: Dissociative amnesia most often consists
of localized or selective amnesia for a specific event or events; or
generalized amnesia for identity and life history.
B. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a
substance or a neurological or other medical condition.
D. The disturbance is not better explained by dissociative identity
disorder, posttraumatic stress disorder, acute stress disorder,
somatic symptom disorder, or major or mild neurocognitive disorder.
Specify if:
With dissociative fugue: Apparently purposeful travel or bewildered
wandering that is associated with amnesia for identity or for other
important autobiographical information.