Somatoform Disorders  Definition?  Common Features  Lots of Physical Complaints  Appear to be Medical Conditions  But No Identifiable Medical Cause  Pathological Concern about  Functioning of body or  Physical appearance

 Five Somatoform Disorders  Hypochondriasis  Somatization Disorder  Conversion Disorder  Pain Disorder  Body Dysmorphic Disorder

 Physical Complaints  No Known Medical Cause  Preoccupied with Bodily Symptoms  Misinterpretation of Symptoms  Strong Disease Conviction  Differentiated from Illness Phobia  Severe Anxiety About Possibly Having a Serious Disease  Many Medical Visits and Tests  Reassurance Doesn’t Help  Impaired Functioning/Distress

 Causes?  Disorder of Cognition / Perception  More Disease in Family  More Illness Concern in Family  More Attention for Sick Behavior

 Psychological Treatment  Challenge illness-related misinterpretations  Provide more substantial and sensitive reassurance  Stress management and coping strategies  Medical Treatment?

 Previously Called Briquet’s Syndrome Previously Called Briquet’s Syndrome  Many Physical Complaints Many Physical Complaints  Starting before age 30 Starting before age 30  No Known Medical Cause No Known Medical Cause  Concern about Symptoms Concern about Symptoms  but Not What They Mean but Not What They Mean  Life/Identity Revolves Around Symptoms Life/Identity Revolves Around Symptoms  Impaired Functioning Impaired Functioning  Previously Called Briquet’s Syndrome Previously Called Briquet’s Syndrome  Many Physical Complaints Many Physical Complaints  Starting before age 30 Starting before age 30  No Known Medical Cause No Known Medical Cause  Concern about Symptoms Concern about Symptoms  but Not What They Mean but Not What They Mean  Life/Identity Revolves Around Symptoms Life/Identity Revolves Around Symptoms  Impaired Functioning Impaired Functioning

 Causes? Causes?  Family Link Family Link  Link to Antisocial Personality Link to Antisocial Personality  Weak Behavioral Inhibition Weak Behavioral Inhibition  Causes? Causes?  Family Link Family Link  Link to Antisocial Personality Link to Antisocial Personality  Weak Behavioral Inhibition Weak Behavioral Inhibition

 Treatment Treatment  Difficult to Treat Difficult to Treat  No Proven Treatments No Proven Treatments  Treatment Focuses on Treatment Focuses on  Reduction of Medical Visits Reduction of Medical Visits  Assign a “Gatekeeper” Physician Assign a “Gatekeeper” Physician  Reducing Secondary Gain Reducing Secondary Gain  Treatment Treatment  Difficult to Treat Difficult to Treat  No Proven Treatments No Proven Treatments  Treatment Focuses on Treatment Focuses on  Reduction of Medical Visits Reduction of Medical Visits  Assign a “Gatekeeper” Physician Assign a “Gatekeeper” Physician  Reducing Secondary Gain Reducing Secondary Gain

 Popularized by Freud Popularized by Freud  Physical Malfunctioning Physical Malfunctioning  Often involves sensory-motor areas Often involves sensory-motor areas  Paralysis, Blindness, Mutism, Anesthesia Paralysis, Blindness, Mutism, Anesthesia  No Organic Pathology No Organic Pathology  La Belle Indifference La Belle Indifference  Impaired Functioning Impaired Functioning  Popularized by Freud Popularized by Freud  Physical Malfunctioning Physical Malfunctioning  Often involves sensory-motor areas Often involves sensory-motor areas  Paralysis, Blindness, Mutism, Anesthesia Paralysis, Blindness, Mutism, Anesthesia  No Organic Pathology No Organic Pathology  La Belle Indifference La Belle Indifference  Impaired Functioning Impaired Functioning

 Causes? Causes?  Psychodynamic view is still popular Psychodynamic view is still popular  Emphasis on the role of trauma, conversion, and secondary gain Emphasis on the role of trauma, conversion, and secondary gain  Detachment from the trauma and negative reinforcement seem critical Detachment from the trauma and negative reinforcement seem critical  Getting physically sick is culturally acceptable Getting physically sick is culturally acceptable  Causes? Causes?  Psychodynamic view is still popular Psychodynamic view is still popular  Emphasis on the role of trauma, conversion, and secondary gain Emphasis on the role of trauma, conversion, and secondary gain  Detachment from the trauma and negative reinforcement seem critical Detachment from the trauma and negative reinforcement seem critical  Getting physically sick is culturally acceptable Getting physically sick is culturally acceptable

 Treatment Treatment  Similar to Somatization Disorder Similar to Somatization Disorder  No Well Established Treatments No Well Established Treatments  Address the Trauma Address the Trauma  Remove Sources of Secondary Gain Remove Sources of Secondary Gain  Reduce supportive consequences of talk about physical symptoms Reduce supportive consequences of talk about physical symptoms  Treatment Treatment  Similar to Somatization Disorder Similar to Somatization Disorder  No Well Established Treatments No Well Established Treatments  Address the Trauma Address the Trauma  Remove Sources of Secondary Gain Remove Sources of Secondary Gain  Reduce supportive consequences of talk about physical symptoms Reduce supportive consequences of talk about physical symptoms

 Pain is Real Pain is Real  Pain May Initially Have Organic Cause Pain May Initially Have Organic Cause  Psychological Factors Maintain Pain Psychological Factors Maintain Pain  Can Be Debilitating Can Be Debilitating  Pain is Real Pain is Real  Pain May Initially Have Organic Cause Pain May Initially Have Organic Cause  Psychological Factors Maintain Pain Psychological Factors Maintain Pain  Can Be Debilitating Can Be Debilitating

 Previously known as dysmorphophobia Previously known as dysmorphophobia  Preoccupation with Defect in Appearance Preoccupation with Defect in Appearance  “Imagined” Ugliness “Imagined” Ugliness  Often seek multiple plastic surgeries Often seek multiple plastic surgeries  Fixation or Avoidance of Mirrors Fixation or Avoidance of Mirrors  Ideas of Reference Ideas of Reference  Suicidal Ideation and Tendencies Suicidal Ideation and Tendencies  Previously known as dysmorphophobia Previously known as dysmorphophobia  Preoccupation with Defect in Appearance Preoccupation with Defect in Appearance  “Imagined” Ugliness “Imagined” Ugliness  Often seek multiple plastic surgeries Often seek multiple plastic surgeries  Fixation or Avoidance of Mirrors Fixation or Avoidance of Mirrors  Ideas of Reference Ideas of Reference  Suicidal Ideation and Tendencies Suicidal Ideation and Tendencies

 Causes? Causes?  Little is Known Little is Known  Runs in Families Runs in Families  Similarities to OCD Similarities to OCD  Intrusive Thoughts and Checking Compulsions About Appearance Intrusive Thoughts and Checking Compulsions About Appearance  Treatment Treatment  Parallels OCD treatment Parallels OCD treatment  Medications (i.e., SSRIs) that work for OCD provide some relief Medications (i.e., SSRIs) that work for OCD provide some relief  Exposure and Response Prevention Exposure and Response Prevention  Plastic surgery is typically unhelpful Plastic surgery is typically unhelpful  Causes? Causes?  Little is Known Little is Known  Runs in Families Runs in Families  Similarities to OCD Similarities to OCD  Intrusive Thoughts and Checking Compulsions About Appearance Intrusive Thoughts and Checking Compulsions About Appearance  Treatment Treatment  Parallels OCD treatment Parallels OCD treatment  Medications (i.e., SSRIs) that work for OCD provide some relief Medications (i.e., SSRIs) that work for OCD provide some relief  Exposure and Response Prevention Exposure and Response Prevention  Plastic surgery is typically unhelpful Plastic surgery is typically unhelpful

 Malingering Malingering  Factitious Disorders Factitious Disorders  Munchausen’s Syndrome by Proxy Munchausen’s Syndrome by Proxy  Malingering Malingering  Factitious Disorders Factitious Disorders  Munchausen’s Syndrome by Proxy Munchausen’s Syndrome by Proxy