Chapter 5: Somatic Symptom and Related Disorders and Dissociative Disorders

Somatic symptom disorders involve excessive preoccupation with physical symptoms and health concerns that persist despite medical evaluation revealing no organic disease process. Somatic Symptom Disorder represents a condition where individuals experience genuine distress centered on bodily sensations, often leading to repeated medical visits and extensive healthcare-seeking behavior. Illness Anxiety Disorder, formerly called hypochondriasis, centers on the conviction of having a serious illness rather than on actual physical symptoms, with anxiety about disease dominating the clinical presentation. Conversion Disorder involves unexplained neurological symptoms such as paralysis or sensory loss that do not follow known anatomical pathways and lack physiological explanation, typically emerging after psychological stress or trauma. Factitious Disorder involves intentional production or exaggeration of symptoms for psychological reasons including attention-seeking, without external rewards, whereas Factitious Disorder Imposed on Another represents a form of abuse where one person deliberately induces illness in another. Dissociative disorders involve disruptions in the normal integration of consciousness, memory, and identity, typically developing in response to severe or prolonged trauma. Depersonalization-Derealization Disorder creates persistent feelings of detachment from one's own body or surroundings despite intact reality testing. Dissociative Amnesia involves inability to recall significant personal information beyond normal forgetting, often triggered by traumatic events. Dissociative Fugue involves sudden, unexpected travel with identity confusion or assumption of a new identity. Dissociative Identity Disorder involves the presence of two or more distinct personality states with different behavioral patterns, memories, and characteristics, typically stemming from severe childhood trauma, particularly repeated abuse. Treatment approaches across these disorders emphasize cognitive-behavioral therapy, trauma-focused interventions, emotion regulation strategies, and in some cases pharmacological support for comorbid anxiety or depression.