PSYCHOLOGY 6: Somatic Symptom Disorders & Dissociative Disorders

Advanced Psychology ESL – Clinical Features, Mind–Body Interaction & Diagnostic Principles

1. Introduction

Somatic symptom and dissociative disorders involve disruptions in:

  • bodily perception

  • identity

  • memory

  • consciousness

These conditions do not mean symptoms are imaginary. Instead, they arise from:

  • altered nervous system processing

  • trauma-related mechanisms

  • stress dysregulation

  • abnormal communication between brain and body

They often coexist with anxiety, trauma histories, or autonomic nervous system instability.

SECTION A — SOMATIC SYMPTOM & RELATED DISORDERS

2. Somatic Symptom Disorder (SSD)

SSD features real physical symptoms accompanied by excessive worry, fear, or preoccupation.

Core Features

  • one or more distressing physical symptoms

  • disproportionate anxiety about the meaning of symptoms

  • extensive time spent researching, checking, or seeking reassurance

  • symptoms are genuine and often chronic

Etiology

  • heightened interoceptive sensitivity

  • hyperactive threat-detection networks

  • trauma, chronic stress, or early adversity

  • catastrophic interpretation of bodily sensations

Treatment

  • CBT for health anxiety

  • mindfulness + interoception retraining

  • stress reduction

  • collaborative medical care

3. Illness Anxiety Disorder (Hypochondriasis)

High fear of having or developing a serious illness despite minimal symptoms.

Core Features

  • excessive health-related worry

  • reassurance-seeking or avoidance of medical care

  • misinterpretation of normal bodily sensations

  • symptoms persist ≥ 6 months

Treatment

  • CBT

  • exposure to illness-related fears

  • limit reassurance cycles

  • SSRIs for severe anxiety

**4. Conversion Disorder

(Functional Neurological Symptom Disorder)**

Neurological symptoms without identifiable neurological damage.

Possible Symptoms

  • paralysis

  • tremors

  • gait abnormalities

  • non-epileptic seizures

  • sensory loss

  • speech or vision disturbances

Symptoms are involuntary. Not faked. Not imagined.

Etiology

  • trauma

  • dysregulated emotion–motor network connectivity

  • malfunctioning brain body-mapping systems

  • stress-induced neural shutdown

Treatment

  • physiotherapy (most effective for motor symptoms)

  • trauma therapy

  • CBT

  • neurological + psychological joint care

5. Psychological Factors Affecting Medical Conditions

A medical diagnosis is worsened or complicated by psychological variables such as:

  • anxiety

  • avoidance

  • stress responses

  • poor adherence to treatment

This diagnosis applies when psychological factors increase risk or impair recovery.

SECTION B — DISSOCIATIVE DISORDERS

6. Dissociative Amnesia

Inability to recall important personal information, usually following trauma.

Types

  • localized – memory gap for a specific event/period

  • selective – partial amnesia for traumatic elements

  • generalized – entire life history lost (rare)

Treatment

  • trauma-informed psychotherapy

  • grounding techniques

  • never forcing memory retrieval

7. Depersonalization/Derealization Disorder (DPDR)

Depersonalization

Feeling detached from oneself — observing your mind/body from outside.

Derealization

Feeling that the world is unreal, foggy, dreamlike, distorted.

Insight remains intact — distinguishing this from psychosis.

Etiology

  • severe anxiety

  • prolonged hypervigilance

  • trauma

  • altered temporal-parietal neural activity

Treatment

  • grounding + sensory awareness

  • CBT for misinterpretation of symptoms

  • trauma therapy where appropriate

8. Dissociative Identity Disorder (DID)

(Brief summary — full detail appears in earlier Psychology units.)

A trauma-origin disorder involving:

  • two or more identity states

  • memory gaps

  • significant shifts in perception, emotion, and behaviour

Treatment

  • long-term trauma-focused therapy

  • stabilization → trauma processing → integration

  • grounding and safety planning

  • medication only for comorbid symptoms

SECTION C — OTHER SOMATIC & SIMULATION-RELATED CONDITIONS

9. Factitious Disorder (Munchausen Syndrome)

Factitious Disorder involves intentional production or exaggeration of symptoms, motivated by:

  • desire to assume the “sick role”

  • need for attention, care, or sympathy

There is no external reward (e.g., money, legal outcome), distinguishing it from malingering.

Types

  • self-imposed (individual creates symptoms)

  • by proxy (caregiver induces or fabricates symptoms in another — dangerous and abusive)

Common Behaviours

  • tampering with medical tests

  • inventing dramatic medical histories

  • frequent hospital visits

  • unusually deep medical knowledge

Etiology

  • early trauma or medical abuse

  • severe attachment instability

  • unmet emotional needs

  • personality vulnerabilities

Treatment

  • long-term psychotherapy

  • building secure therapeutic attachment

  • careful medical–psychiatric coordination

10. Malingering (NOT a mental disorder)

Malingering = intentional symptom production for external gain, such as:

  • financial compensation

  • avoiding work

  • avoiding military duty

  • obtaining medication

Because motives are external, malingering is not diagnosed as a mental disorder, but clinicians must differentiate it from:

  • conversion disorder

  • factitious disorder

  • genuine neurological conditions

Key Differentiator

Malingering stops when the reward is removed.
Factitious Disorder continues even when there is no benefit.

SECTION D — NEUROBIOLOGICAL & PSYCHOPHYSIOLOGICAL MECHANISMS

11. Shared Mechanisms Across Somatic & Dissociative Disorders

Altered Stress Response (HPA Axis)

Chronic stress sensitizes the system → physical symptoms + dissociation.

Overactive Amygdala

Persistent threat detection → bodily symptoms or identity detachment.

Reduced Prefrontal Cortex Regulation

Difficulty modulating fear, interpretation, and bodily sensations.

Functional Neurological Disruption

Abnormal network functioning without structural brain damage.

Trauma-Driven Dissociation

Self-protection through memory fragmentation or emotional blunting.

12. Treatment Across Somatic & Dissociative Disorders

  • CBT for catastrophic interpretation

  • EMDR or trauma-focused therapies

  • physiotherapy (for FND/motor symptoms)

  • grounding and stabilization

  • mindfulness

  • psychoeducation

  • coordinated medical + psychological care

13. Academic Vocabulary

interoception
somatic preoccupation
functional neurological symptoms
conversion symptoms
identity fragmentation
dissociation
depersonalization
derealization
psychophysiology
stress hyperreactivity
catastrophic thinking
grounding techniques
secondary gain
primary gain

14. Discussion Questions

  1. How does Somatic Symptom Disorder differ from Illness Anxiety Disorder?

  2. Why are conversion symptoms real, even without medical findings?

  3. What neurological systems contribute to dissociation?

  4. How does trauma lead to identity fragmentation?

  5. Why is grounding essential in DPDR?

  6. How do Factitious Disorder and Malingering differ?

  7. Why is forcing memory retrieval dangerous in dissociative amnesia?

  8. What makes conversion disorder responsive to physiotherapy?

15. Case Studies (Short, Clinical, Non-Worksheet)

Case Study A — Conversion Disorder (Functional Motor Symptoms)

A 28-year-old woman develops sudden leg paralysis after a traumatic breakup. MRI and neurological tests are normal. Symptoms fluctuate depending on emotional triggers.

Teaching Focus:

  • FND neurobiology

  • role of stress

  • physiotherapy + trauma integration

Case Study B — Somatic Symptom Disorder

A 35-year-old man with chronic pain spends hours researching rare illnesses. Multiple tests show no dangerous pathology. Anxiety worsens the symptoms.

Teaching Focus:

  • catastrophic interpretation

  • CBT principles

  • interoceptive sensitivity

Case Study C — Depersonalization/Derealization

A 20-year-old student reports feeling “like he is observing himself from outside his body” during panic attacks, but retains insight.

Teaching Focus:

  • DPDR vs psychosis

  • grounding

  • anxiety-driven dissociation

Case Study D — Factitious Disorder

A 31-year-old frequently presents to emergency units with dramatic symptoms that disappear under observation. Medical tests are inconsistent. Motivation appears to be emotional rather than financial.

Teaching Focus:

  • primary vs secondary gain

  • differential with malingering

  • attachment + trauma patterns