Disorders Focusing on Somatic Symptoms  Disorders focusing on somatic symptoms are problems that appear to be medical but are actually caused by psychosocial factors  Unlike psychophysiological disorders, in which psychosocial factors interact with genuine physical ailments, somatoform disorders are psychological disorders masquerading as physical problems

Disorders Focusing on Somatic Symptoms These disorders include: Factitious disorder Conversion disorder Somatic symptom disorder Illness anxiety disorder Body dysmorphic disorder

What Are Disorders focusing on Somatic Symptoms?  People with these disorders suffer actual changes in their physical functioning  These disorders are often hard to distinguish from genuine medical problems  It is always possible that a diagnosis is a mistake and that the patient's problem has an undetected organic cause

Facticious Disorder  A disorder in which an individual feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person  Popularly known as Munchausen Syndrome

Facticious Disorder  The precise causes of factitious disorder are not understood, although clinical reports have pointed to factors such as depression, unsupportive parental relationships during childhood, and an extreme need for social support  Clinicians have been unable to develop dependably effective treatments for this disorder

Conversion Disorder  A psychosocial conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning  Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling  Most conversion disorders begin between late childhood and young adulthood  They are diagnosed in women twice as often as in men  They usually appear suddenly, at times of stress, and are thought to be rare

Conversion Disorder  Conversion disorders are often similar to “genuine” medical ailments, physicians sometimes rely on oddities in the patient’s medical picture to help distinguish the two  Symptoms may be at odds with the way the nervous system is known to work

Somatic Symptom Disorder  People with somatic symptom disorder become excessively distressed, concerned, and anxious about bodily symptoms that they are experiencing, and their lives are greatly disrupted by the symptoms  The symptoms are longer-lasting but less dramatic than those found in conversion disorder  In some cases, the symptoms have no known cause

Somatization Pattern  People with somatization disorder have many long-lasting physical ailments that have little or no organic basis  Also known as Briquet’s syndrome  To receive a diagnosis, a patient must have a range of ailments, including several pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological symptom  Patients usually go from doctor to doctor in search of relief

Predominant Pain Pattern  Pain disorder associated with psychological factors  Patients may receive this diagnosis when psychosocial factors play a central role in the onset, severity, or continuation of pain  Although the precise prevalence has not been determined, it appears to be fairly common The disorder often develops after an accident or illness that has caused genuine pain  The disorder may begin at any age, and more women than men seem to experience it

What Causes Conversion and Somatic Symptom Disorders?  Previously called hysterical disorders  Widely considered unique and in need of special explanation  No explanation has received much research support, and the disorders are still poorly understood

What Causes Conversion and Somatic Symptom Disorders? The psychodynamic view Freud believed that these disorders represented a conversion of underlying emotional conflicts into physical symptoms Because most of his patients were women, Freud centered his explanation on the psychosexual development of girls and focused on the phallic stage (ages 3 to 5) During this stage, girls develop a pattern of sexual desires for their fathers (the Electra complex) and recognize that they must compete with their mothers for his attention Because of the mother's more powerful position, girls repress these sexual feelings

What Causes Conversion and Somatic Symptom Disorders? The psychodynamic view Freud believed that if parents overreact to such feelings, the Electra complex would remain unresolved and the child might re-experience sexual anxiety throughout her life Freud concluded that some women unconsciously hide their sexual feelings in adulthood by converting them into physical symptoms Today's psychodynamic theorists take issues with Freud's explanation of the Electra conflict They continue to believe that sufferers of these disorders have unconscious conflicts carried from childhood

What Causes Conversion and Somatic Symptom Disorders? The psychodynamic view Psychodynamic theorists propose that two mechanisms are at work in these disorders: Primary gain: symptoms keep internal conflicts out of conscious awareness Secondary gain: symptoms further enable people to avoid unpleasant activities or receive sympathy from others

What Causes Conversion and Somatic Symptom Disorders? The behavioral view Behavioral theorists propose that the physical symptoms of these disorders bring rewards to sufferers May remove individual from an unpleasant situation May bring attention from other people In response to such rewards, people learn to display symptoms more and more This focus on rewards is similar to the psychodynamic idea of secondary gain, but behaviorists view the gains as the primary cause of the development of the disorder

What Causes Conversion and Somatic Symptom Disorders? The cognitive view Some cognitive theorists propose that these disorders are a form of communication, providing a means for people to express difficult emotions Like psychodynamic theorists, cognitive theorists hold that emotions are being converted into physical symptoms This conversion is not to defend against anxiety but to communicate extreme feelings

What Causes Conversion and Somatic Symptom Disorders? The multicultural view Some theorists believe that Western clinicians hold a bias that sees somatic symptoms as an inferior way of dealing with emotions The transformation of personal distress into somatic complaints is the norm is many non-Western cultures As we saw in Chapter 6, reactions to life's stressors are often influenced by one's culture

What Causes Conversion and Somatic Symptom Disorders? A possible role for biology The impact of biological processes on these disorders can be understood through research on placebos and the placebo effect Placebos: substances with no known medicinal value Treatment with placebos has been shown to bring improvement to many – possibly through the power of suggestion but likely because expectation triggers the release of endogenous chemicals Perhaps traumatic events and related concerns or needs can also trigger our “inner pharmacies” and set in motion the bodily symptoms of conversion and somatic symptom disorders

How Are Conversion and Somatic Symptom Disorders Treated?  People with conversion and somatic symptom disorders usually seek psychotherapy only as a last resort  Individuals with preoccupation disorders typically receive the kinds of treatments applied to anxiety disorders, particularly OCD:  Antidepressant medication  Exposure and response prevention (ERP)  Cognitive-behavioral therapies

How Are Conversion and Somatic Symptom Disorders Treated?  Treatments for these disorders often focus on the cause of the disorder and apply the same kind of techniques used in cases of PTSD, particularly:  Insight – often psychodynamically oriented  Exposure – client thinks about traumatic event(s) that triggered the physical symptoms  Drug therapy – especially antidepressant medication

How Are Conversion and Somatic Symptom Disorders Treated?  Other therapists try to address the physical symptoms of these disorders, applying techniques such as:  Suggestion – usually an offering of emotional support that may include hypnosis  Reinforcement – a behavioral attempt to change reward structures  Confrontation – an overt attempt to force patients out of the sick role  Researchers have not fully evaluated the effects of these particular approaches on these disorders

Illness Anxiety Disorder  People with this disorder unrealistically interpret bodily symptoms as signs of a serious illness  Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating  Although some patients recognize that their concerns are excessive, many do not

Body Dysmorphic Disorder  Body dysmorphic disorder  People with this disorder, also known as dysmorphophobia, become deeply concerned about some imagined or minor defect in their appearance Most often they focus on wrinkles, spots, facial hair, swelling, or misshapen facial features (nose, jaw, or eyebrows)  Most cases of the disorder begin in adolescence but are often not revealed until adulthood