1. Dissociative and somatoform disorders (p. 171) The dissociative disorders show altered or disrupted identity, memory, or consciousness; the somatoform disorders involve physical symptoms that have no physiological basis. Both disorders occur because of some psychological need and both rely on self-reports, and so are subject to faking. There are four dissociative disorders: dissociative amnesia, dissociative fugue, dissociative identity disorder (formerly called multiple-personality disorder), and depersonalization disorder. Except for depersonalization, dissociative disorders are rare, although there has been a dramatic increase in reports of dissociative identity disorder.
2. Dissociative amnesia (p. 172) Dissociative amnesia is the partial or total loss of important personal information, often occurring in response to a stressful event. There are five types. Localized amnesia is characterized by total memory loss for a particular, short time period, and is the most common form. In selective amnesia, the memory loss is for details about an incident. Total loss of memory for ones past life is the criterion for generalized amnesia, systematized amnesia involves the loss of memory for only selected types of information, and total loss of memory from one point in time to another occurs in continuous amnesia. Repression of a traumatic event seems to be the main reason for psychogenic amnesia; a similar process occurs in posthypnotic amnesia. There is great controversy about the validity of uncovered, repressed memories for child abuse.
3. Dissociative fugue and depersonalization disorder (p. 174) In dissociative fugue, memory loss is accompanied by flight to another area and establishment of a new identity. Recovery from this and from psychogenic amnesia is usually abrupt and complete.
   Depersonalization disorder is characterized by feelings of unreality or distorted perceptions of the body or environment. It is more common than the other dissociative disorders, tends to be chronic, is often accompanied by mood or anxiety disorders, and can be precipitated by stress.
4. Dissociative identity disorder (multiple-personality disorder) (p. 177) In dissociative identity disorder, two or more (often many more) distinct personalities exist in one individual. Not all personalities are aware of one another. However, even objective testing with physiological measurements produces conflicting findings about the existence of distinct personalities. Although this condition was once thought to be rare, there has been a dramatic increase in reported cases, perhaps because of the influence of therapists while clients are under hypnosis. People with dissociative identity disorder often report a history of childhood abuse. Diagnosis in childhood is possible, but misdiagnosis is common, both by seeing the disorder in people who have other problems and by failing to see multiple personality in people diagnosed with other disorders. Diagnosis is much more common in the United States and Canada than in other parts of the world.
5. Etiology and treatment of dissociative disorders (p. 181) The causes of dissociative disorders are subject to a good deal of conjecture because faking is always a possibility. The psychodynamic perspective sees repression of, unpleasant emotions as the cause of dissociative disorders. Splits in consciousness protect the individual from anxiety and pain. Behavioral theorists suggest that avoidance of stress is the main causative factor. One of the current approaches, the sociocognitive model, conceptualizes DID as a syndrome with rule-governed and goal-directed experiences, and displays of multiple role enactments created, legitimized, and maintained by social reinforcement. The disorder may also be the unintended effect of treatment, an iatrogenic condition. The expectations of therapists 'and their use of hypnosis, which increases suggestibility, may create memories of abuse and personalities.
   Recovery from dissociative amnesia, dissociative fugue, and depersonalization disorder often occurs spontaneously; therefore, treatment often aims at reducing the depression or anxiety these conditions produce. Dissociative identity disorder is usually treated with psychotherapy and hypnosis, but not with notable success. Behavior therapists use contingent reinforcement for the healthy personality and extinction for the others.
6. Somatoform disorders (p. 186) The principal symptoms of somatoform disorders are complaints of physical symptoms that have no apparent physiological cause. Faking is possible, but when symptoms such as fever are consciously induced, they are considered factitious disorders rather than malingering, which involves voluntary faking for monetary or other rewards. Somatic complaints are far more common in non-Western cultures where a somatopsychic view (physical problems produce emotional symptoms) is more prevalent than the Western psychosomatic view (internal conflicts are expressed as physical symptoms).
7. Somatization disorder and conversion disorder (p. 188) In somatization disorder, individuals have physical complaints in four or more different sites in the body, symptoms for which there are no physiological explanations. Complaints include gastrointestinal, sexual, and pseudoneurological symptoms. If the individual does not fully meet the criteria but has at least one physical complaint for six months, the diagnosis would be undifferentiated somatoform disorder. Patients shop around for doctors and often have unneeded surgery. Somatization disorder, formerly called hysteria, is rarely diagnosed in men although over one third of males referred for unexplained somatic complaints meet the criteria for the disorder. A cross-cultural study found it to be relatively rare. Interestingly, somatoform disorders are not included in China's most recently revised counterpart to the DSM; the Chinese have commented that somatization is a Western construct.
   In conversion disorder, there is a significant physical impairment, such as paralysis in a limb or sensory problems, without physical basis. When neurological or other processes prove the symptoms impossible (such as in glove anesthesia), diagnosis is readily made; otherwise, it is quite hard to differentiate conversion disorder from actual illnesses or faking.
8. Pain disorder, hypochondriasis, and body dysmorphic disorder (p. 192) Pain that is excessive, lingers too long, or is unrelated to a physiological cause is characteristic of Pain disorder. As with ordinary pain, there is a complex interaction among perception, thinking, and behavior
   In hypochondriasis, there is a consistent preoccupation with illness in the face of doctors repeated assurances of health. Those with hypochondriasis often have a history of illness and parents who focused on illness. Fear, anxiety, and depression are common complaints.
   Body dysmorphic disorder involves an excessive concern with an imagined or slight physical defect such as facial features, excessive hair, or the shape of genitals. Individuals with this disorder frequently check their appearance in the mirror and fear that others are looking at the defect. They make frequent requests for plastic surgery regardless of the treatment's outcome. Because the disorder involves obsessive thinking and delusions, its placement in the diagnostic category of somatoform disorders has been questioned. It is also not clear where normal concerns about appearance end and the disorder begins.
9. Etiology and treatment of somatoform disorders (p. 195) A diathesis-stress view of somatoform disorders suggests that individuals are hypersensitive to bodily sensations and are predisposed to react strongly to somatic sensations. In the event of a stressor, they develop intense bodily complaints and symptoms. Psychoanalysts believe that repression accounts for the process of converting unconscious conflicts into physical symptoms. There is primary gain in the reduction of anxiety and secondary gain in the sympathy the individual receives. Behavioral theorists contend that a sick role is reinforced by others and helps the person escape from responsibilities. The sociocultural perspective stresses that, historically, social norms did not provide women with appropriate channels for the expression of aggressive or sexual needs. As a result, women developed hysterical symptoms. The biological perspective notes that individuals with somatoform disorders are unusually sensitive to bodily sensations and have higher arousal levels than others.
   Psychoanalytic treatment emphasizes the need to relive unpleasant experiences so that they can be mastered rather than converted into symptoms. Behavioral therapists advise extinction for complaints and reinforcement for healthy behavior. Cognitive-behavioral treatments focus on changing the conscious thoughts and expectations of clients. Family therapists teach family members to support one another without resorting to physical symptoms and to anticipate such problems. Biological treatment consists of antidepressant medication for the somatization disorder; increased physical activity for conversion disorder; and SSRIs for body dysmorphic disorder.