Psychiatry: disorder groups
Dissociative & bodily distress (somatic symptom) disorders
Dissociative disorders disrupt memory, identity or awareness; bodily distress (somatic symptom) disorders involve distressing physical symptoms with excessive worry. Psychiatrists help patients and medical colleagues manage both without needless tests or blame.
Depth by stage, Pre-U → Consultant (details)
What is it?
Dissociation means a disconnection between thoughts, memories, surroundings, actions and identity. Mild forms such as 'zoning out' are normal. Dissociative disorders are more severe: memory loss for important events (dissociative amnesia), feeling unreal or detached (depersonalisation-derealisation), episodes of altered identity, or trance and possession states that occur outside accepted cultural or religious practice.
Functional neurological symptom disorder — called dissociative neurological symptom disorder in ICD-11 — includes non-epileptic seizures, weakness or loss of function that is real and distressing but not explained by structural nerve disease.
Bodily distress disorder (ICD-11), or somatic symptom disorder (DSM-5-TR), describes physical symptoms such as pain or fatigue with excessive attention, worry or repeated medical contact. These patients are common in general hospitals and need a respectful, coordinated approach.
Why does a psychiatrist need it?
These conditions are frequent in emergency departments, neurology and medical wards. Psychiatrists help make positive diagnoses, explain them without suggesting the symptoms are 'fake', reduce harmful over-investigation, and treat underlying trauma, anxiety or depression. In Malaysia they must also understand culturally shaped presentations such as trance or possession states.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareAware of the mind-body link and illness behaviour from behavioural science.
- ClinicalAwareKnows these conditions exist and should not be dismissed.
- HousemanshipUnderstandsMeets patients with unexplained symptoms or non-epileptic attacks in wards and emergency and responds respectfully.
- Medical officerUnderstandsAssesses and explains functional symptoms with supervision and liaises with medical teams.
- Psych traineeAppliesDiagnoses and manages the group, including cultural presentations, in liaison settings.
- Specialist / consultantMasters / TeachesLeads complex cases and multidisciplinary pathways with neurology and medicine.
What are the key topics?
Conditions
- Dissociative neurological symptom disorder / functional neurological symptom (conversion) disorder, including non-epileptic seizures
- Dissociative amnesia
- Depersonalisation-derealisation disorder
- Trance disorder and possession trance disorder (ICD-11)
- Dissociative identity disorder and partial DID
- Bodily distress disorder (ICD-11) / somatic symptom disorder (DSM-5-TR)
- Factitious disorder (and the distinction from malingering, which is not a mental disorder)
Causes and understanding
- Stress and trauma links; but not every case has identifiable trauma
- Predisposing, precipitating and perpetuating factors
- Attention and expectation models of functional symptoms
- Cultural idioms of distress, including spirit possession beliefs
- Illness behaviour, sick role and the impact of repeated investigations
Assessment
- Thorough medical assessment, with positive signs for functional disorders (e.g. Hoover's sign) usually made by neurology
- Avoiding premature labelling and missing physical disease
- Screening for depression, anxiety, trauma and substance use
- Understanding the person's and family's explanation of the illness
Management
- Clear, non-blaming explanation of the diagnosis
- Physiotherapy and graded rehabilitation for functional weakness
- CBT-based approaches; trauma-focused therapy where relevant
- Consistent care from one coordinating doctor; limiting unnecessary tests
- Working sensitively with traditional and religious healing beliefs alongside medical care
How is it learned and assessed?
- Behavioural science (illness behaviour, sick role)
- Emergency and medical ward exposure in housemanship
- Liaison psychiatry rotations in training
- MMed Part II; MRCPsych Paper A (psychopathology) and Paper B; CASC stations such as explaining functional seizures
Typical textbooks and resources
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- Lishman's Organic Psychiatry — Wiley-Blackwell; neuropsychiatry reference
- Handbook of Liaison Psychiatry — Cambridge University Press
- neurosymptoms.org — patient information on functional neurological disorder by Jon Stone (University of Edinburgh)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Are functional or somatic symptoms 'all in the mind'?
No. The symptoms are real and often disabling. They arise from how the brain and body are functioning rather than from structural damage, and they can improve with the right explanation and rehabilitation.
Is spirit possession a psychiatric disorder?
Not in itself. Trance and possession experiences that are part of accepted cultural or religious practice are not disorders. A diagnosis is considered only when episodes are involuntary, distressing, impair functioning and fall outside what the person's community regards as normal.