Chapter 7 Summary

In somatoform disorder, there are physical symptoms for which there are no biological explanations. Anxiety is assumed to play a role in these disorders, but it is not expressed overtly but rather transformed into physical symptoms.

Conversion disorder and somatoform disorder are the two principle types of somatoform disorders. Pain disorder, body dysmorphic disorder, and hypochondrias are other types of somatoform disorders about which less is known.

The sensory and motor dysfunctions of conversion disorder suggest neurological impairments, but these impairments do not always make anatomical sense. The symptoms do, however, seem to serve some psychological purpose. For example, they may arise suddenly in stressful situations allowing the individual to avoid some activity or responsibility.

In somatization disorder, multiple physical complaints that are not adequately explained by physical disorder or injury eventuate in frequent visits to physicians, hospitalization, and even unnecessary surgery.

Theory concerning the etiology of these disorders is speculative and focuses primarily on conversion disorder. According to psychoanalytic theory, conversion disorder is the result of repressed impulses that are converted into physical symptoms. In contrast, behavioral theories focus on the conscious and deliberate adoption of the symptoms as a means for obtaining a desired goal. Social and cultural factors may play a role in the disorder as well.

In therapies for somatoform disorders, psychoanalysts encourage the client face up to the repressed impulses while behavioral treatments attempt to reduce anxiety and reinforce behavior that will allow the patient to relinquish the symptoms.

Dissociative disorders are disruptions of consciousness, memory, and identity. An inability to recall important personal information, usually after some traumatic experience, is diagnosed as dissociative amnesia. In dissociative fugue, the person moves away, assumes a new identity, and is amnesic of his or her previous life. In depersonalization disorder, the person's perception of the self is altered. He or she may experience an out-of-body sensation or perceived changes in the size of body parts. The person with dissociative identity disorder has two or more distinct and fully developed personalities, each with unique memories, behavior patterns, and relationships.

Psychoanalytic theory regards dissociative disorders as instances of massive repression of some undesirable event or aspect of the self. In the treatment of dissociative identity disorder, the role of abuse in childhood and a high level of hypnotizability are emerging as important. Behavioral theories consider dissociative reactions as escape responses that are motivated by high levels of anxiety.

Psychoanalytic treatment is perhaps the most widespread choice for dissociative disorders. Both analytic and behavioral clinicians focus their treatment efforts on understanding the anxiety associated with the forgotten memories that underlie the disorders.