Introduction to Psychological Disorders
Senior 6 · Psychology
Introduction to Psychological Disorders
Lesson 3 of 5
25 min
Two weeks after a frightening road accident in which she was not physically hurt, Ange, 17, wakes up unable to move her right leg. At the district hospital, the doctors find no fracture, no stroke and no nerve damage, and a careful neurological examination shows a pattern that does not fit any nerve injury. Ange is not pretending: she is frightened and cannot walk. (An illustrative case.)
Ange's condition is one of a group once called "hysteria", a word now abandoned because it was used to dismiss patients, especially women. This lesson looks at two groups of disorders in which the mind's distress is expressed through the body or through disruptions of memory and identity.
Definition
Somatoform disorders (DSM-5-TR: somatic symptom and related disorders; ICD-11: bodily distress disorder): disorders in which physical symptoms, or worry about them, cause great distress and disruption, and are accompanied by excessive thoughts, feelings or behaviours about health.
Functional (conversion) symptoms: real neurological symptoms, such as weakness, seizures or loss of sight, that are not caused by recognised nerve or brain disease and are not produced deliberately.
Dissociation: a disruption in the normal integration of consciousness, memory, identity, emotion and perception. Example: feeling as if you are watching yourself from outside your body.
Malingering: deliberately faking symptoms for an external reward, such as avoiding work. It is not a mental disorder.
| Disorder | Key features | Example |
|---|---|---|
| Somatic symptom disorder | One or more distressing bodily symptoms with excessive, persistent thoughts, anxiety or behaviour about them (usually for six months or more). The symptoms may or may not have a medical explanation; the problem is the excessive response | A man with back pain who visits many clinics, stops working and thinks about his pain all day |
| Illness anxiety disorder (formerly hypochondriasis) | Preoccupation with having or getting a serious illness, with few or no symptoms, and repeated checking or avoidance of doctors | A student certain that every headache is a brain tumour, despite normal tests |
| Functional neurological symptom disorder (conversion disorder) | Weakness, paralysis, abnormal movements, seizures, loss of speech or sight that are incompatible with recognised neurological disease | Ange's leg; seizures with a normal EEG recorded during the attack |
| Factitious disorder | Deliberately producing or faking symptoms, without an obvious external reward, apparently to take on the role of a patient | A person who secretly contaminates his own wound so that it does not heal |
Notice the key difference: in somatic symptom and functional disorders the person is not producing the symptoms on purpose. In factitious disorder the symptoms are deliberate but the motive is psychological; in malingering they are deliberate for an outside reward.
Treatment starts with a clear, respectful explanation that the symptoms are real and common and can improve, followed by CBT, physiotherapy for functional weakness, and avoiding unnecessary tests and treatments, which can reinforce worry.
Some dissociation is ordinary (Figure 1). It becomes a disorder only when it is severe, persistent and disabling.
Figure 1. Dissociation lies on a continuum. Most of it is ordinary; it becomes a disorder only when it is severe, persistent and causes distress or disability.
| Disorder | Key features |
|---|---|
| Dissociative amnesia | Inability to recall important personal information, usually about a traumatic or stressful event, that is too extensive to be ordinary forgetting and not caused by injury or drugs. Rarely, it includes dissociative fugue: travelling away and being confused about one's identity |
| Depersonalisation–derealisation disorder | Persistent or repeated experiences of being detached from one's own body or thoughts (depersonalisation) or of the world seeming unreal or dreamlike (derealisation), while knowing that these are only feelings |
| Dissociative identity disorder (DID) | Two or more distinct personality states, with recurrent gaps in memory for everyday events or personal information |
Experiences of trance or possession are part of accepted religious and cultural practice in many communities around the world. Both the DSM-5-TR and the ICD-11 count them as a disorder only when they are involuntary, cause distress or impairment, and are not part of a broadly accepted cultural or religious practice.
Most researchers now accept that both trauma and suggestion play a part. Treatment focuses on safety and stabilisation, then carefully processing trauma, then integrating the person's sense of self.
CrashCourse: "Schizophrenia and Dissociative Disorders: Crash Course Psychology #32" (about 10 minutes). Watch the second part, on dissociative disorders, and note how the video describes the debate about DID. The first part prepares you for the next lesson.
Warning
"It's all in your head" is wrong and harmful. Functional and somatic symptoms are genuinely experienced and can be as disabling as other illnesses. Telling a person they are faking delays effective treatment and destroys trust. Equally, a physical cause must always be properly checked first by a health worker.
Important
Where to get help in Rwanda. If you, or someone you know, is struggling, talk to a trusted adult (a parent, teacher or school counsellor) and visit your local health centre. The Rwanda Biomedical Centre asks people to call its toll-free number 114 with questions about its services or in an emergency. Asking for help is a sign of strength, not weakness.
Tip
Who intends what? Somatic and functional symptoms: not intended. Factitious disorder: intended, to be a patient. Malingering: intended, for a reward (not a disorder). This three-way comparison is a favourite exam question.
Practice
Sources and credits
Written by Ganzaa: the text, the diagram (Figure 1), the tables and the exercises.
