The DSM-V-TR and many psychopathology texts group Somatic and Dissociative disorders together.  In the DSM-V-TR somatic disorders are listed after dissociative disorders which are tied to stress and PTSD.  They both share created realities that are not true but they also differ in direction.  Somatic disorders attach to physical symptoms without no correlating reality or pathology from a physical sense but find their origin in the mind.  Likewise, many are tied to anxiety, or fear of possessing the actual disease associated with the symptoms.   Dissociate disorders are tied to breaks from reality that do not exist as well but more so in the mind and one’s surroundings.  They are tied to trauma and stress.  This leads to derealization and depersonalization, various amnesias and dissociative identity stemming from trauma.  In this short blog, we will review the basis and criteria of diagnosis for different somatic disorders as well as dissociative disorders.

Please also review AIHCP’s Healthcare Certification Programs, as well as its many Behavioral Health Certifications.

Somatic Disorders

Somatic disorders contain symptoms of a disease created by the mind with no real existence of the disease within the person.  Somatic means coming from the mind and manifesting physiological manifestations of a particular physical disorder (Barlow, et, al., 2023).   Similar to Somatic Symptom Disorder is Conversion Disorder.  Freud believed that the energy associated with mental illness could manifest as physical disease in other parts of the body causing motor control issues that were only a product of the mind (Barlow, et al., 2023).

The biggest difference between Somatic Disorder and Conversion Disorder was the the type of physical manifestation and mental state.  In Somatic Disorder there are a broad range of persistent physical disorders including pain and fatigue.  These irks and pains cause discomfort throughout the day and lead to intense anxiety within the individual as the person attempts to understand the nature of their illness.  Conversion differs in the manifestation and reaction.  The manifestation effects motor control and cause paralysis, blindness, or other body movement.  It usually follows an immediate stressor and can resolve itself quicker.  Hence individuals do not deal with it longer over a chronological period (DSM-V-TR, 2022).

The DSM-V-TR lists these criteria Somatic Symptom Disorder for diagnosis .

A. One or more somatic symptoms that cause significant disruption in life

B. Excessive thoughts or behaviors tied to the somatic symptoms with at least one of the following:

1. disproportionate and persistent thoughts about the seriousness of the issue

2.  high levels of anxiety about the symptom or overall health

3. excessive time and energy directed to these symptoms and concerns

C.  These symptoms persist for 6 months.

Somatic Symptom Disorder can be specified with predominant pain, persistent symptoms, and as mild, moderate or severe.

(DSM-V-TR, 2022).

 

The DMS-V-TR lists this criteria for Conversion diagnosis

A. One or more of the symptoms have altered motor or sensory function

B. Clinical findings discover no correlation between the symptoms and recognized neurological disorder

C. There is no rational explanation for the disorder

D. The symptom causes clinically significant distress or functioning

It can be specified as acute, chronic, with psychological or without psychological stressor, with various symptom types such as weakness or paralysis, abnormal movement, swallowing symptoms, speech symptoms, seizures, sensory loss, special sensory loss or mixed symptoms.

(DSM-V-TR, 2022).

Another Somatic related disorder is Illness Anxiety Disorder which deviates from Somatic Symptom Disorder in regards to mild to no symptoms with the fear of disease existing in the mind.  In the past it was referred to as Hypochondria (Barlow, et al., 2023).   The DSM-V-TR lists the following diagnostic criteria for IAD.

A. Preoccupation with having a serious illness

B. Somatic Symptoms or not present or very mild.  Other symptoms related to a different disorder are ignored.

C. High level of anxiety about health

D. The individual performs excessive health related behaviors for checkups

E. Illness preoccupation exceeds 6 months

F. The illness preoccupation has no other mental health disorder explanation

The DSM-V-TR specifies them as either care seeking or care avoidant

Ultimately within all of these disorders, individuals refuse to believe experts and fall more so upon their own anxiety ridden logics.  They tend to seek their own information and insist they know more than medical professionals.

Tied closely to this are other disorders resulting in faking symptoms or purposely re-creating the symptoms for medical help or attention.  Some do this for mental reasons, while others seek financial reward via malingering.  Obviously those who seek medical attention and cause symptoms for no logical or financial reason suffer a deeper issue.   Factitious Disorder results in this deception to gain attention or aid.  Some may also look to keep attention on a person under one’s care by causing or lying about symptoms.   In the past this was referred to as Munchausen Syndrome (Barlow, et al., 2023).

It is interesting to see the power of the mind to cause physiological symptoms.  Yet if one simply realizes the power of worry to cause a stomach ache, then one can see on a large scale how somatic symptoms can manifest in individuals with greater anxiety and distorted beliefs about health.

Dissociative Disorders

While the mind can create physiological symptoms, it can also create separations from reality due to traumatic events or high levels of stress.  Many of the dissociative disorders are closely tied to PTSD and trauma induced orders and directly follow the DSM-V-TR’s chapter on Trauma and Stress Related Disorders.  The DSM-V-TR points out that many dissociative disorders are frequently in the aftermath of severe trauma.  Their symptoms include “unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experiences (2022).  This leads to depersonalization, derealization, amnesia and dissociative identity.  They can all play roles in the more general umbrella of PTSD but also be a diagnosis within itself.

Depersonalization/Derealization Disorder

According to the DSM-V-TR, depersonalization is the experience of unreality, detachment or being outside or external from one’s own thoughts, or feelings or even sensations of the body.  One senses a distorted senses of time and feels absent from self as if almost outside of one’s own body (2022).  Similar and also shared frequently between the two is the subjective experience of derealization.  Within derealization one experiences unreality and detachment from one’s surroundings as if reality is dreamlike or foggy or distorted (2022).

Dissociative Amnesia

Loss of memory due to trauma leaves the person with an inability to recall or remember.  The loss of memory can be localized or selective only to the event, or in more severe cases generalized and effecting one’s identity (DSM-V-TR, 2022).   In some cases, it can be specified with dissociative fugue where the individual travels or wanders and cannot relate where they came from (2022).

Dissociative Identity

One of the most wild and bizarre forms of dissociation is multiple personalities.  The DSM-V-TR now labels it as Dissociative Identity in which the person creates different identities when faced with intense trauma.  These identities are formed at a younger age and usually add new ones as the person needs to adjust to the unresolved trauma.  The DSM-V-TR lists the following criteria for diagnosis

A. Disruption of identity by two or more distinct personality states.  The disruption marks a distinct discontinuity in sense of self which displays changes in behavior, memory, perception, consciousness, cognition and sensory-motor functioning.

B. Recurrent gaps to recall events and personal information are inconsistent with normal forgetfulness

C. The symptoms cause significant distress to all elements of social functioning

D. The disturbance is not part of a cultural or religious practice

E. The disturbance is not associated with other substances or medical conditions

(DSM-V-TR, 2022).

Barlow states that most experience an average of 15 different personalities or alters.  These alters merge from the host identity (2023).   It is believed that under severe cases of trauma, younger children who may possess a genetic and biological vulnerability can develop DID.  Diagnosing DID should be done with great care as not to lead an individual to bias or place falsememories regarding a person’s past.  Ultimately, it is very difficult to fake DID although criminals in the past have attempted to use a DID defense (Barlow, et, al. 2023).

Some identities are classified as possessive identities which can be mistaken for demonic manifestation.  If existing within the religious traditions, one must be careful of cultural and religious beliefs regarding this.  In fact, the Catholic Church goes to great lengths and diagnosis within itself to determine a difference between a possessing identity with what it considers to be an external source in its manual of exorcism.   Obviously before the era of modern science, many DID were considered possessions and did not meet the current diagnosis within the Catholic Church.  Those who are not religious still doubt any form of possession within itself but that is a debate for another day.

Conclusion

Physiological symptoms can be very real.  The brain can shut itself off for its own defense and create different realities.  These are all things that modern psychology has discovered.  Many of these issues stem from trauma, anxiety and stress.  When a person has the biological vulnerability, the recipe for the manifestation for these disorders become a reality for the person.  Therapy and medication can play large roles in facing past issues and traumas.  With the exception of DID, many of these mental issues can resolve quickly with proper care.  Obviously DID deals with a far deeper trauma and requires deeper psychotherapy to unify the person.  That involves identifying triggers, reliving trauma, and carefully realigning the past without causing more damage (Barlow, et al., 2023).

Please also review AIHCP’s Behavioral Health Certifications.  AIHCP offers Trauma Informed Care as well for professionals seeking additional training and credentials in this field.

Additional Blogs

Disruptive and Impulse Control Disorders.  Access here

Personality Disorders.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

Additional Resources

Goodman, B. 2024. “Somatic Symptom and Related Disorders”. WEBMED.  Access here

“What is Somatic Symptom Disorder?” APA.  Access here

“Dissociative Identity Disorder (Multiple Personality Disorder)” (2024). Cleveland Clinic.  Access here

“Dissociative Identity Disorder (Multiple Personality Disorder)”. PsychologyToday.  Access here