Dissociative disorders and somatic symptom disorders are influenced by a variety of factors, including biological, cognitive, sociocultural, and psychodynamic influences, with the strongest explanation for the disorder being the psychodynamic perspective, which emphasizes dissociation as a type of defense mechanism used to cope with trauma or abuse.

The Biological Perspective

Figure 1. The science behind a psychological disorder is complex.

Though researchers have not found a specific genetic link for these disorders, there are genetic links to dissociation as it relates to childhood adversity. Biological factors may include trauma-induced responses.^[1]

Some studies have found that heritability rates for dissociation rage from 50 to 60% but it is often believed that the mix of genetic and environment plays a larger role in developing dissociative disorders than solely a biological explanation.^[2]

The Psychodynamic Perspective

Freud’s model suggested the emotional charge deriving from painful experiences would be consciously repressed as a way of managing the pain, but that the emotional charge would be somehow converted into neurological symptoms. Freud later argued that the repressed experiences were of a sexual nature. Pierre Janet, the other great theoretician of hysteria, argued that symptoms arose through the power of suggestion, acting on a personality vulnerable to dissociation. In this hypothetical process, the subject’s experience of their leg, for example, is split off from the rest of their consciousness, resulting in paralysis or numbness in that leg.

Some support for the Freudian model comes from findings of high rates of childhood sexual abuse in conversion patients. Support for the dissociation model comes from studies showing heightened suggestibility in conversion patients.

Essentially, the idea behind the psychodynamic perspective is that someone experiencing dissociation, either of identity or in Functional Neurological Symptom Disorder (Conversion Disorder), is using a type of defense mechanism to guard against negative feelings because of inadequate coping skills; this type of emotional conflict becomes overwhelming and results in the symptoms one might experience.

The Cognitive Perspective

Cognitive psychologists have identified all manners of different kinds of memory—iconic, haptic, echoic, short-term, working, long-term, declarative, non-declarative, procedural, semantic, episodic, implicit, explicit, and more. These kinds of memory, or memory systems, can be thought of as (collections of) different kinds of specific memories, and they are distinguished in terms of their content, durability, and the way in which they are acquired and accessed. The concepts of retrieval and forgetting are, of course, central to any discussion of memory and memory-related disorders. Dissociative amnesia, flashbacks and other dissociative phenomena have frequently been observed not only as a result of traumatic stress, but also as a result of the use of dissociative drugs such as PCP, ketamine, or LSD.^[3]

Additionally, imaging of the prefrontal cortex in those with Functional Neurological Symptom Disorder (Conversion Disorder) shows that a person with paralysis due to the disorder does attempt to move the paralyzed area of the body but is unable to—thus proving that the patient is not faking their issues; rather they are prohibited from completing the action they wish due to a disconnect in the brain regions responsible for making a connection between conscious will and the ability to act it out.^[4]

The Sociocultural Perspective

It has been found that those with lower socioeconomic status (SES), education, and history of abuse are more likely to develop DID and other somatic disorders. Many authors have found the occurrence of conversion to be more frequent in rural, lower socio-economic groups, where technological investigation of patients is limited and individuals may be less knowledgeable about medical and psychological concepts.

Figure 2. Familial, societal, and cultural factors may contribute to trauma and people’s response to it, which can lead to disorders such as DID.

DID can be found in all cultural settings. Even though it is common thought that childhood abuse or trauma is a prerequisite to experiencing this disorder, there still needs to be suitable environmental factors in which this disorder can evolve, usually one defined by a home context in which there is denial, boundary violations, reality distortions, paranoia, and narcissism; in many cases, these negative traits are what makes up the family dynamics, including tyrannical and/or unfair traditions that further the issues. However, it is important to note that familial systems are only a small part of a greater context with society and culture. For example, in South Africa, some communities may find that dissociation is necessary for survival when these areas are plagued with mixed messages and there is major cultural and societal conflict (versus inner psychological conflict).^[5]