8.4 SUMMING UP

Dissociative Disorders

• Dissociation involves a separation of mental processes that are normally integrated—such as consciousness, memory, emotion, or identity. To qualify as a dissociative disorder, this separation must cause significant distress or impair functioning. Specific symptoms of dissociative disorders include amnesia, identity problems, derealization, and depersonalization.
• Dissociative amnesia is characterized by significantly impaired memory for important experiences or for personal information that cannot be explained as ordinary forgetfulness or accounted for by another psychological disorder, substance use, or a medical condition.
• A subtype of dissociation amnesia, dissociative fugue, is characterized by sudden, unplanned travel and difficulty remembering the past, which in turn leads to identity confusion.
• Depersonalization-derealization disorder is characterized by the persistent feeling of being detached from oneself or one’s surroundings.
• Dissociative identity disorder (DID) hinges on the presence of two or more distinct personality states, which gives rise to a discontinuity in the person’s sense of self and agency.
• Although neuroimaging studies of patients with DID find that their brains function differently when different alters are dominant, such studies generally have not used appropriate control groups. People with this disorder are more hypnotizable and dissociate more readily than do people who do not have this disorder.
• Two models have been formulated to explain DID. The posttraumatic model proposes that DID is caused by severe, chronic physical abuse during childhood, which leads to dissociation during the abuse; the dissociated states come to constitute alters, with their own memories and personality traits. The sociocognitive model proposes that DID arises as the result of interactions between a therapist and a suggestible patient, during which the therapist inadvertently encourages the patient to behave in ways consistent with the diagnosis. Both interpretations are consistent with the finding that severe childhood trauma is associated with the disorder.
• The goal of treatment for dissociative disorders is to reduce the symptoms themselves and lower the stress they induce.

Somatic Symptom Disorders

• Somatic symptom disorders center on complaints about physical well-being along with cognitive distortions about those bodily symptoms and their meaning; the focus on these symptoms causes significant distress or impairs functioning. All somatic symptom disorders involve bodily preoccupation and symptom amplification.
• Somatic symptom disorder (SSD) is characterized by at least one somatic symptom about which the person has excessive thoughts, feelings, or behaviors, and that is distressing or disrupts daily life.
• Factors that contribute to SSD include genes, catastrophic thinking about illness, symptom amplification, bodily preoccupation, other people’s responses to illness, and the way symptoms function as a means of expressing helplessness.
• Conversion disorder centers on sensory systems, motor symptoms, and seizures that may initially appear to have neurological causes but in fact are inconsistent with a neurological or medical condition.
• Illness anxiety disorder is characterized by misinterpretation of or worry about bodily sensations and symptoms, which leads to a belief that the person has a serious illness—despite the absence of evidence of a medical problem and reassurance from health care personnel.
• CBT is generally the treatment of choice for somatic symptom disorders; medications, when used, target anxiety-related symptoms. Group and family therapy are generally used as supplementary treatments.