Psychopathology:

Dissociative and Somatic

Symptom and Related
Disorders
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Department of Psychology
Western University
Eric Collins, Ph.D.

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 Learning Objectives

• Describe the symptoms and clinical features of the major dissociative disorders

• Compare and contrast two competing theories of the aetiology of dissociative identity disorder

• Describe the symptoms and clinical features of the major somatic symptom and related disorders

• Explain how biological, psychological, and social-environmental factors can work together to cause
somatic symptom and related disorders

• Discuss the goals and methods of contemporary psychological treatments for somatic symptom and
related disorders

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Historical Perspective “Anna O”
Hysteria: An outdated psychiatric term once used to describe
a symptom pattern characterized by emotional excitability and
physical symptoms without any organic cause
• Christianity
• Organic theories of hysteria were replaced by supernatural
explanations
• Demonic possession requiring exorcism

• Binet, Charcot, Jung, and Janet

• Breuer and Freud – Studies in Hysteria
• Primary gain
• Secondary gain

• DSM-III (1980)

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 Dissociative Disorders:
Characterized by severe
maladaptive disruptions or
alterations of identity, memory,
Dissociative Disorders and consciousness that are
experienced as being beyond
one’s control
Dissociation: The lack of
normal integration of one or
more aspects of psychological
functioning, such as identity,
memory, consciousness,
emotions, sensorimotor
functioning, and behaviour.

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 Dissociative Disorders
Dissociative Amnesia: The inhibition to recall significant personal information in the absence of
organic impairment
Depersonalization/Derealization Disorder: A dissociative disorder in which the individual has
persistent or recurrent experiences of depersonalization and/or derealization.
• Depersonalization: A condition in which individuals have a distinct sense of unreality and detachment
from their own thoughts, feelings, sensations, actions, or body.
• Derealization: Similar to depersonalization, but it involves feelings of unreality and detachment with
respect to one’s own surroundings rather than the self.

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 Dissociative Disorders
Dissociative Identity Disorder (DID): Characterized by the existence of two or more unique
personalities in a single individual. Each personality may have its own constellation of
behaviour, tone of voice, and physical gestures, and so on.
• Alters: Refers to each of the unique personalities in an individual who has DID. Alters may be very
different from each other, with opposite personality traits, and differences in the age, sex, race, and
family history they claim to have.

• Switching: The transition from one alter to another in an individual with DID. Occurs suddenly and is
often precipitated by stress or some other identifiable cue in the surrounding environment.

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 Dissociative Disorders: Treatment
Psychotherapy
• Helping patients resolve emotional distress associated
with past traumas and learn more effective ways of
coping with stress
• Stages of therapy
Hypnosis
• Popular treatment method for many clinicians working
with patients with DID to confirm the diagnosis, to
contact alters, and to uncover memories of childhood
abuse
• Approach is criticized because of the potential of
retrieving confabulated memories and personalities

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 Dissociative Disorders: Treatment

Medication
• Generally not useful in the direct treatment of dissociative disorders
• May be helpful in treating comorbid disorders, such as anxiety and depression

Neurosurgical Treatments
• Repetitive transcranial magnetic stimulation (rTMS) in the treatment of
dissociative disorders particularly in cases of depersonalization/derealization

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 Somatic Symptom and Related Disorders
Somatic Symptom and Related Disorders: A group of disorders in which individuals present with physical
symptoms suggestive of medical illnesses, along with significant psychological distress and functional
impairment

Conversion Disorder: Characterized by a loss of functioning in a part of their body that appears due to a
neurological or other medical cause, but without any underlying medical abnormality to explain it
• Glove Anesthesia: A sensory symptom of conversion disorder involving a loss of feeling in the whole hand or wrist. Since
this pattern is incompatible with the way nerves extend from the arm into the hand, it is clearly psychogenic in origin

• La Belle Indifference: A surprising nonchalance or lack of concern about the severity of one’s symptoms, which was
previously thought to be evidence of conversion disorder

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 Somatic Symptom and Related Disorders
Somatic Symptom Disorder: A disorder characterized by one or more bodily symptoms that are distressing to the
individual, result in significant disruption of daily life, and are accompanied by excessive worry and preoccupation,
extreme anxiety, or disproportionate time and energy
• Somatic Symptom Disorder with Predominant Pain: A subtype of somatic symptom disorder in which the presenting bodily
symptom involves pain

Illness Anxiety Disorder: Characterized by preoccupation with having or acquiring a serious illness, even though the
individual does not have any serious bodily symptoms. Individuals with this disorder are very preoccupied and anxious
about their health, become easily alarmed by even mild symptoms, and perform excessive health-related behaviours
such as repeatedly checking their body for signs of disease

Factitious Disorder: Characterized by faking or producing symptoms of illness or injury to gain a doctor’s attention and
thus to satisfy a need to play the role of patient
• Factitious Disorder Imposed on Another: Individual falsifies illness in another person, most commonly the person’s own child

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 Somatic Symptom and Related Disorders:
Treatment
Medication
• Existing research suggests that antidepressant medication is likely
helpful for addressing primary symptoms of these disorders

• However, the evidence supporting its efficacy is low in quality, and the
number of adverse effects reported in the available studies is concerning

Psychotherapy
• Shifted away from traditional psychodynamic therapy

• Cognitive, affective, and social processes

• Establishing co-operative therapeutic environment is crucial

• Cognitive behavioural therapy (CBT)

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 Lecture Takeaways
Dissociative Disorders Somatic Symptom and Related Disorders
Dissociative Amnesia Conversion Disorder
Depersonalization/Derealization Somatic Symptom Disorder
Dissociative Identity Disorder Illness Anxiety Disorder
Factitious Disorder

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