Unit 4 – Somatoform and dissociative disorders
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Explain the clinical descriptions, statistics, causes, risk factors and treatments of
hypochondriasis; somatization disorder; conversion disorder and body dysmorphic disorder
(C2)
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Easy Way to Remember: “H-S-C-B”
• H – Hypochondriasis (Health anxiety).
• S – Somatization Disorder (Multiple physical symptoms).
• C – Conversion Disorder (Neurological symptoms).
• B – Body Dysmorphic Disorder (Appearance obsession).
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Overview of Hypochondriasis, Somatization Disorder, Conversion Disorder, and Body
Dysmorphic Disorder
This section outlines the clinical descriptions, prevalence statistics, causes, risk factors,
and treatments of key somatic symptom and related disorders. The ICD-11 and DSM-5
codes are also included.
1. Hypochondriasis (Illness Anxiety Disorder)
ICD-11 Code: 6B23
DSM-5 Code: F45.21
Clinical Description
Hypochondriasis (now referred to as Illness Anxiety Disorder in DSM-5) is characterized
by:
• Excessive fear of having a serious illness, despite minimal or no medical evidence.
• Repeated checking for symptoms or avoiding medical appointments out of fear.
• Preoccupation with bodily sensations leading to distress and impairment
Example: A person repeatedly visits doctors for minor headaches, convinced they have a
brain tumor.
Prevalence Statistics
• Affects 1-5% of the general population.
• More common in early adulthood
Causes
• Biological: Increased activity in anterior insula and amygdala (related to threat
perception).
• Psychological: Cognitive distortions (e.g., “If I feel pain, it must be cancer”).
• Environmental: Childhood trauma, overprotective parenting
Risk Factors
• History of serious illness in family members.
• Comorbid anxiety and depressive disorders.
Treatments
• Cognitive-Behavioral Therapy (CBT): Addresses catastrophic thinking.
• Exposure Therapy: Gradual exposure to feared illnesses.
• Medication: SSRIs for severe cases
2. Somatization Disorder (Somatic Symptom Disorder)
ICD-11 Code: 6C20
DSM-5 Code: F45.1
Clinical Description
Somatization disorder (now called Somatic Symptom Disorder) involves:
• Multiple, recurrent physical symptoms (e.g., pain, digestive issues) without medical
explanation.
• Excessive distress, thoughts, or behaviors related to symptoms.
• Symptoms last for at least six months
Example: A person experiences chronic stomach pain and fatigue but medical tests show
no physical cause.
Prevalence Statistics
• Affects 5-7% of the general population.
• More common in women
Causes
• Genetic: Runs in families.
• Neurobiological: Overactive pain perception system.
• Psychological: Heightened attention to bodily sensations
Risk Factors
• History of abuse or trauma.
• Low socioeconomic status.
• Comorbid depression or anxiety.
Treatments
• CBT: Helps reduce excessive symptom focus.
• Mindfulness-Based Therapy: Improves emotional regulation.
• Antidepressants: Used if co-occurring depression is present
3. Conversion Disorder (Functional Neurological Symptom Disorder)
ICD-11 Code: 6B40
DSM-5 Code: F44.4
Clinical Description
Conversion disorder involves:
• Neurological symptoms (e.g., paralysis, blindness, seizures) that cannot be medically
explained.
• Symptoms appear suddenly and may follow psychological stress.
• Often show “la belle indifférence” (lack of concern about symptoms)
Example: A person suddenly loses the ability to walk after witnessing a traumatic
accident, but doctors find no physical cause.
Prevalence Statistics
• Found in 5% of neurology clinic patients.
• More common in women
Causes
• Freudian Theory: Repressed conflicts are converted into physical symptoms.
• Neurobiological: Disruptions in brain areas related to motor function.
• Environmental: Past trauma, high stress
Risk Factors
• History of childhood abuse or neglect.
• Comorbid neurological diseases (e.g., epilepsy).
Treatments
• CBT: Helps patients understand emotional triggers.
• Physical Therapy: Helps regain motor function.
• Hypnosis or Suggestion Therapy: In some cases
4. Body Dysmorphic Disorder (BDD)
ICD-11 Code: 6B21
DSM-5 Code: F45.22
Clinical Description
BDD is characterized by:
• Preoccupation with perceived flaws in physical appearance (often minor or nonexistent).
• Compulsive behaviors (e.g., mirror checking, excessive grooming).
• Severe distress and impaired social functioning
Example: A person refuses to leave the house because they believe their nose is
“deformed,” even though others see nothing wrong.
Prevalence Statistics
• 2.4% of U.S. adults (higher in dermatology and cosmetic surgery patients)
• Onset typically in adolescence (12-17 years).
Causes
• Neurobiological: Dysfunction in visual processing and executive control regions.
• Psychological: Perfectionism, negative self-image.
• Environmental: Childhood trauma, bullying
Risk Factors
• Family history of OCD or BDD.
• Early exposure to social rejection or teasing.
Treatments
• CBT: Challenges distorted body image beliefs.
• Medications: SSRIs reduce obsessive thoughts.
• Exposure and Response Prevention (ERP): Prevents compulsive behaviors
Conclusion
These disorders involve intense physical or appearance-related distress without medical
explanation.
They often result from biological vulnerabilities, psychological factors, and
environmental stressors.
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Explain the clinical descriptions, statistics, causes, risk factors and treatments of
depersonalization and derealisation disorder; dissociative amnesia; dissociative fugue;
dissociative trance disorder and dissociative identity disorder (C2)
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Easy Way to Remember: “D-D-F-T-I”
• D – Depersonalization/Derealization Disorder (Feeling detached).
• D – Dissociative Amnesia (Forgetting traumatic events).
• F – Dissociative Fugue (Sudden travel with amnesia).
• T – Dissociative Trance Disorder (Possession experiences).
• I – Dissociative Identity Disorder (Multiple personalities).
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Overview of Depersonalization/Derealization Disorder, Dissociative Amnesia,
Dissociative Fugue, Dissociative Trance Disorder, and Dissociative Identity Disorder
1. Depersonalization/Derealization Disorder (DPDR)
ICD-11 Code: 6B62
DSM-5 Code: F48.1
Clinical Description
• Depersonalization: Feeling detached from one’s own body, thoughts, or emotions (e.g.,
feeling like an outside observer of oneself).
• Derealization: Experiencing the external world as unreal, dreamlike, foggy, or distorted.
• Reality testing remains intact, meaning individuals know their experiences are not real
Example: A person suddenly feels like they are watching themselves from outside their
body during a stressful argument.
Prevalence Statistics
• 1-2% lifetime prevalence.
• Equal prevalence in men and women.
• Onset is typically around age 16, but symptoms can persist for years
Causes & Risk Factors
• Neurobiological: Reduced activation in the prefrontal cortex and limbic system.
• Psychological: Early emotional abuse, neglect, or severe stress.
• Environmental: Chronic anxiety, panic attacks, or substance abuse (e.g., marijuana,
hallucinogens)
Treatments
• Cognitive-Behavioral Therapy (CBT): Helps individuals reconnect with reality.
• Mindfulness-Based Therapy: Reduces distress related to depersonalization.
• Medications: SSRIs and anticonvulsants may help in severe cases
2. Dissociative Amnesia
ICD-11 Code: 6B61
DSM-5 Code: F44.0
Clinical Description
• Inability to recall important autobiographical information (usually traumatic events).
• Localized amnesia: Forgetting specific events.
• Generalized amnesia: Forgetting entire life history.
• Can include dissociative fugue (sudden travel away from home)
Example: A soldier forgets all memories of a battlefield after returning home from war.
Prevalence Statistics
• 1.8% 12-month prevalence (higher in females)
Causes & Risk Factors
• Psychological: Response to severe trauma, abuse, or war.
• Biological: Reduced activity in the right frontal and temporal brain areas affecting
autobiographical memory
Treatments
• Hypnosis & Psychotherapy: Helps recover lost memories.
• Cognitive Therapy: Assists in coping with distress.
• Removing the person from the traumatic environment may lead to spontaneous
recovery
3. Dissociative Fugue
ICD-11 Code: 6B61.0
DSM-5 Code: F44.1 (as a subtype of dissociative amnesia)
Clinical Description
• Sudden unexpected travel away from home with an inability to recall one’s past.
• May involve establishing a new identity.
• Recovery is sudden, but individuals may not remember the fugue state
Example: A man disappears from his home in New York and is later found living in
Texas with no memory of his past.
Prevalence Statistics
• Rare disorder with no precise prevalence rates.
Causes & Risk Factors
• Severe psychological stress, trauma, or war.
• Often occurs after natural disasters, abuse, or extreme stress
Treatments
• Psychotherapy & Hypnosis: Helps recover identity.
• Supportive Therapy: Prevents confusion and distress after memory returns.
4. Dissociative Trance Disorder (Possession Trance Disorder)
ICD-11 Code: 6B63
DSM-5 Code: Not separately classified (part of Other Specified Dissociative Disorders)
Clinical Description
• Trance-like state with narrowed awareness and altered identity.
• The person may feel possessed by a spirit, deity, or external force.
• The episode lasts for days or longer, causing significant distress
Example: A person enters a trance and believes they are possessed by a historical figure,
speaking in a different voice and not recognizing their own identity.
Prevalence Statistics
• More common in cultural and religious contexts where trance states are normal.
Causes & Risk Factors
• Cultural factors: Found in societies where spirit possession beliefs are common.
• Psychological distress & trauma.
Treatments
• CBT: Helps differentiate between cultural beliefs and distressing symptoms.
• Grounding Techniques: Helps maintain connection with reality.
5. Dissociative Identity Disorder (DID)
ICD-11 Code: 6B64
DSM-5 Code: F44.81
Clinical Description
• Presence of two or more distinct identities that take control of behavior.
• Recurrent amnesia for personal information.
• Each identity has unique memories, behaviors, and emotions
Example: A woman alternates between different personalities—one being a shy student
and another an aggressive adult with no memory of each other’s actions.
Prevalence Statistics
• 1.5% 12-month prevalence (1.6% in males, 1.4% in females)
• 90% of cases involve childhood trauma or abuse
Causes & Risk Factors
• Extreme childhood trauma and abuse.
• Neurobiological: Impairment in orbitofrontal cortex, amygdala, and hippocampus
(affecting memory and self-perception).
• Cultural influences: Some identities may be shaped by religion or mythology
Treatments
• Long-term Psychotherapy: Helps integrate different identities.
• Hypnosis: May aid in retrieving repressed memories.
• Trauma-Focused CBT: Addresses childhood abuse.
Conclusion
Dissociative disorders are severe disruptions in identity, memory, or perception, usually
triggered by trauma or extreme stress.
