1. Ch. 18 Section 4: Somatoform Disorders
Obj: Explain how the two somatoform disorders differ.

2. Somatization, which comes from the Greek word for “body,” refers to the expression of psychological distress through physical symptoms. People with somatoform disorders have psychological problems (such as depression) but experience inexplicable physical symptoms (such as paralysis).

3. It is important to distinguish between somatoform disorders and malingering, or the conscious attempt to “fake” an illness in order to avoid work, school, or other responsibilities. People with somatoform disorders do not intentionally fake their illnesses. They honestly feel pain or believe they cannot move their limbs.

4. Reliable statistics on the incidence of somatoform disorders are not available. Many diagnoses of somatoform illness later prove to be incorrect when patients are found to have medical illnesses that account for their symptoms. On the other hand, cases of somatoform disorders may go undiagnosed because of the focus on physical, as opposed to psychological, symptoms.

5. Types of Somatoform Disorders
The DSM-IV identifies six types of somatoform disorders. The two most common are conversion disorders and hypochondriasis.

6. Conversion Disorder – People with conversion disorder experience a change in or loss of physical functioning in a major part of the body for which there is no known medical explanation. For example, they may suddenly develop the inability to see at night or to move their legs, even though no medical explanation can be found for their sudden physical disability. These behaviors are not, however, intentionally produced. That is, the person is not faking it.

7. Conversion disorder is further complicated because many people who experience conversion disorder show little concern about their symptoms, no matter how serious or unusual those symptoms may be. This lack of concern about the symptoms may help in the diagnosis of conversion disorder.

8. Hypochondriasis – Also called hyponchondria, hypochondriasis is defined as a person’s unrealistic preoccupation with thoughts that he or she has a serious disease. People with hyponchondriasis become absorbed by minor physical symptoms and sensations, convinced that the symptoms indicate a serious medical illness. These people maintain their erroneous beliefs despite reassurances from doctors that there is nothing physically wrong with them. Some people with hypochondriasis visit doctor after doctor, seeking the one physician who will find the cause of their symptoms.

9. Explaining Somatoform Disorders
Explanations for somatoform disorders in general, and specifically conversion disorder or hypochondriasis, are primarily psychological. According to psychoanalytic theory, somatoform disorders occur when individuals repress emotions associated with forbidden urges and instead express them symbolically in physical symptoms. The physical symptoms thus represent a compromise between the unconscious need to express feelings and the fear of actually expressing them.

10. More recently, other psychologists have argued that people with conversion disorder “convert” psychological stress into actual medical problems. For example, a fighter pilot may lose the ability to see at night as a response to the great anxiety he feels about flying nighttime bombing missions. Another individual may suffer paralysis of the legs after nearly being in a car accident. Some behavioral theorists have suggested that somatoform symptoms can serve as a reinforcer if they successfully allow a person to escape from anxiety. There are also some indications that biological or genetic factors may play a role in the development of somatoform disorders.