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Summary: Somatic, Dissociative, and Personality Disorders

Somatic disorders are psychological problems with physical or bodily mani­festations. Somatic symptom disorder is characterized by many complaints with no known physical cause.

Conversion disorders are characterized by a symbolic relationship between the trauma and the symptom. For example, a person who stabs somebody and feels guilty about it might experience a loss of sensation in the hand that held the knife.

The term "hypochondriasis" has been replaced by illness anxiety disorder in DSM-5. This is an excessive concern with illness, despite few if any visible symptoms.

So-called closet hypochondriacs are extremely health-conscious people who may perform daily rituals of checking their bodies for signs of disease. They often become involved in health fads.

Dissociative disorders involve a split (dissociation) between normal consciousness and some other brain process that temporarily controls behavior. Some dissociative states, such as "driving on autopilot," are normal.

Less normal, and less common, is the dissociative fugue state, in which a person suffers a temporary lapse of consciousness while wandering or acting out a complex behavior. Fugue states are most common in people who have suffered from seizure disorders and may be due to seizure-like activity in the brain.

The most dramatic dissociative state is multiple personality disorder, which was renamed dissociative identity disorder (DID) in previous versions of the DSM. The best-authenticated cases of multiple personality involve trauma during early childhood.

Other dissociative disorders include dissociative amnesia, in which autobio­graphical memory is temporarily lost, and depersonalization disorders, in which a person feels cut off or alienated from his or her own body or from the environment.

Personality disorders come in ten varieties in DSM-5. Each is an inflexible and maladaptive pattern that causes difficulties for a person.

Of the personality disorders, perhaps the most important is the antisocial person­ality. People with that syndrome are also known as psychopaths or sociopaths.

The person with this disorder is guiltless and lacks empathy. He or she feels no remorse about hurting other people or violating social norms. If caught doing something illegal, such a person will typically apologize to get out of trouble but might do the same thing later.

Sociopaths are often intelligent and charming, which makes them even more dangerous to others. The disorder is not genetically determined; sometimes one identical twin pair is an sociopath and the other is not.

Some psychologists speculate that certain fearless hero types are the same, physiologically, as psychopaths. Their lack of reactivity to stress is shown by mild responses to electric shock stimulation.

According to Lykken, the same person who might have been a sociopath could turn into a fearless hero type, if raised to pursue approval rather than avoid punish­ment. A tolerance of risky and stressful situations can make a person very successful in some professions.

Write to Dr. Dewey at

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