Somatoform and dissociative disorders

C. Robert Cloninger, Mehmet Dokucu

    Research output: Chapter in Book/Report/Conference proceedingChapter

    6 Scopus citations

    Abstract

    Most patients consulting physicians have a mixture of physical and mental complaints that require careful differential diagnosis. A somatoform disorder is diagnosed when the primary disorder is a mental disorder with prominent physical complaints. The assessment and treatment of somatoform disorders requires patience and compassion to maintain a therapeutic alliance, but randomized controlled trials show that treatment with antidepressants or cognitive-behavioral therapy reduce health care use and subjective distress. Somatization disorder is the prototype of somatoform disorders. It has been shown to be a chronic and heritable deficit in emotional intelligence that is clinically manifest with complaints of multiple bodily pains, and gastrointestinal, pseudoneurological, sexual, and reproductive symptoms. Conversion disorders involve acute or chronic loss of voluntary sensorimotor functions, such as psychogenic blindness, paralysis, or tremors, in response to psychosocial stress, such as marital quarrels, personal rejection, or events associated with a high risk of injury or death. In contrast, some somatoform disorders more closely resemble physical phobias (e.g., hypochondriasis) or social phobias (e.g., body dysmorphic disorder). Dissociative disorders involve the disruption or loss of the integrative mechanisms of consciousness, memory, identity, or perception. Dissociative disorders include amnesia (a disruption of memory), fugue (a disruption of identity), depersonalization (a disruption of perception), and dissociative identity disorder (a disruption of consciousness and identity, formerly called multiple personality disorder). In dissociative disorders, transitions between personalities or the onset of amnesic or fugue states are usually precipitated by psychosocial stress such as those observed in conversion disorders. Thus, both conversion and dissociative disorders are typically precipitated by severe psychosocial stress, but it is often difficult to elicit the relevant history before treatment until the clinician can contact collateral informants. Recent brain imaging results suggests that hyperactivity of the anterior cingulate cortex can actively inhibit motor activity (e.g., psychogenic paralysis), sensory perception (e.g., psychogenic anesthesia), memory (e.g., amnesia), or identity (e.g., fugue) as a defensive response to stressors.

    Original languageEnglish
    Title of host publicationThe Medical Basis of Psychiatry
    Subtitle of host publicationThird Edition
    PublisherHumana Press
    Pages181-194
    Number of pages14
    ISBN (Print)9781588299178
    DOIs
    StatePublished - Jan 1 2008

    Keywords

    • Alexithymia
    • Brain-imaging
    • Conversion disorder
    • Dissociative disorders
    • Emotional intelligence
    • Meditation
    • Pharmacotherapy
    • Psychotherapy
    • Self-awareness
    • Somatization disorder
    • Somatoform disorders
    • Well being

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  • Cite this

    Cloninger, C. R., & Dokucu, M. (2008). Somatoform and dissociative disorders. In The Medical Basis of Psychiatry: Third Edition (pp. 181-194). Humana Press. https://doi.org/10.1007/978-1-59745-252-6_11