Somatoform and Dissociative Disorders the Chapter Opens

Somatoform and Dissociative Disorders

The chapter opens with the story of a man who mysteriously becomes paralyzed after he cannot save his wife from drowning. Psychologists call this kind of problem a somatoform disorder -- physical problems not explainable in medical terms but caused by some kind of psychological dysfunction.

Hysterical Somataform Disorders: In hysterical somatoform disorders, the person shows a change in physical functioning. It can be difficult to diagnose because it isn't always possible to rule out all physical causes.

In conversion disorders, a conflict the person has gets converted into physical symptoms. The example of the man who was paralyzed after his wife drowned is an example of conversion disorder. The problem could be blindness or some other neurological symptom. They're more common in women and appear during great stress.

Sometimes the conversion disorder gets the person attention, such as claiming a wide range of symptoms that baffle the doctors and send the person on a medical quest to find someone who can treat them. Sometimes the conversion of a psychological conflict to physical symptoms includes a sensation of pain. Because these problems can resemble real physical ailments, it can present diagnostic problems, but often an examination reveals that the symptoms are inconsistent with how the nervous system works.

In Munchausen syndrome the person deliberately makes him or herself sic, and in Munchausen by proxy, the person makes child ill on purpose so the person can be seen as an outstanding parent trying to find good medical care for her child (it is usually a female).

In a preoccupation somatoform disorder, the person has excessive interest in his or her bodily function, imagining symptoms where there are none. In hypochondriasis, the person is convinced that small, even imagined symptoms mean a very serious illness.

In Body Dysmorphic Disorder, the person is greatly dissatisfied with his or her appearance out of proportion to any justifiable complaint, and with an exaggerated response. The example was of a woman who overheard someone complain about someone's body odor, decided they meant her, and became nearly a social isolate for fear that someone would "smell her body odor," even though she bathed four times a day.

Dissociative Disorders cause our identity to be fragmented in some way, causing memories to be separated from the person. In dissociative amnesia, the person forgets who he or she is. They may travel to a new location and take on a new identity. It serves a protective service; the person forgets things that are threatening or stressful to them. It can take several forms including selective amnesia, where someone remembers part of events but not all of them. Dissociative disorders can be localized, selective, generalized or continuous, and all serve a protective service. Like PTSD, combat soldiers are vulnerable to dissociative disorders.

One controversial area related to this is that of "repressed memories." Some believe that these recovered memories are accurate, but in some cases the children have been given signals of what the listener wants to hear, or asked leading questions. While the problem of sexual abuse in childhood is a very real one, the issue of retrieving repressed memories is a controversial one.

Dissociative identity disorder is another name for multiple personality disorder. This is a disorder lots of people have some familiarity with because of the movies Sybil and Three Faces of Eve. Like the other dissociative disorders, this one serves a protective function, and new personalities typically form after an instance of child abuse. Often the abuse is sexual in nature. Sometimes there's one personality who is aware of all of the others, and sometimes some personalities know each others while others are unaware that other personalities exist. The subpersonalities can vary by age and even sex. One will have on skill, while another will have another skill. They can even have different autonomic nervous system reactions and even differing EEG's.

The psychoanalytic view says that dissociative disorders are caused by repression, an ego defense to protect the personality from the realities of childhood abuse.

Behaviorists believe that dissociation starts with normal brain function, such as thoughts drifting, or forgetting, and that this eases pain, and so happens more often. They suggest that the ability to remember may be rigid in people prone to dissociation, so that they have to be in the same state of mind as when they learned something to recall it. This could explain why different personalities know different pieces of information that the others don't have. Others feel dissociation may be a form of self-hypnosis.