1. Somatoform Disorders, Psychological Factors Affecting Medical Conditions, and Dissociative Disorders
Chapter 6
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2. Somatoform Disorders
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3. SOMATOFORM DISORDERS soma = “body” in Greek
Conditions in which psychological conflicts are translated into physical problems or complaints
Psychological in nature
Caused by “the mind,” their symptoms are reflected in “the body” in ways that differ from other psychological disorders because there is no apparent physiological basis for them.
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4. Conversion Disorder
Involves the translation of unacceptable drives or troubling conflicts into physical symptoms
Individual experiences a change in a bodily function not due to an underlying medical condition.
Clients with conversion disorder show a wide range of physical ailments:
Pseudoseizures
Disorders of movement
Paralysis
Weakness
Disturbances of speech
Blindness and other sensory disorders
Cognitive impairment
Conversion disorders can be classified as a form of dissociative disorder.
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5. Somatization Disorder
Multiple and recurrent bodily symptoms
Lack a physiological basis
Expression of psychological issues
Difference between somatization disorder and conversion disorder
Somatization disorder involves multiple and recurrent bodily symptoms, rather than a single physical complaint.
Somatization disorder is relatively rare.
Present with higher than expected frequency among patients seeking treatment for chronic pain.
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6. Pain Disorder The only symptom is pain that has no physiological basis
In pain disorder, clients experience pain to such a degree that their lives become consumed by the pursuit of relief.
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7. Hypochondriasis
Misinterpretation of normal bodily functions as signs of serious illness
Hypochondriacs believe or fear that normal bodily reactions represent the symptoms of a serious illness.
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8. Conditions Related to Somatoform Disorders
Malingering
Factitious Disorder
Munchausen’s Syndrome
Factitious (or Munchausen’s) by proxy
Malingering: Fabrication of physical or psychological symptoms for some ulterior motive.
Factitious disorder: People fake symptoms or disorders, not for the purpose of any particular external gain but because of an inner need to maintain a sick role.
Munchausen's syndrome: An extreme form of factitious disorder in which the individual goes to great lengths to maintain a sick role.
The person’s whole life becomes consumed with the pursuit of medical care.
Factitious disorder by proxy (or Munchausen’s syndrome by proxy): A person induces symptoms in another person who is under that individual’s care.
Primary gain: The relief from anxiety or responsibility due to the development of physical or psychological symptoms.
Secondary gain: The sympathy and attention that a sick person receives from other people.
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9. Body Dysmorphic Disorder
Individuals are preoccupied with the idea:
That a part of their body is ugly or defective
People with BDD may check themselves constantly, groom themselves to an excessive degree, or constantly seek reassurance from others about how they look.
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10. Body Dysmorphic Disorder
Gender based concerns
Common areas of concern
Skin
Hair
Nose
Men - Body build and with thinning hair
Women - Weight and hips
Men may experience more distress over their symptoms than women.
BDD is frequently accompanied by major depressive disorder, social phobia, obsessive-compulsive disorder, and eating disorders.
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11. Theories and Treatment of Somatoform Disorders
Cognitive behavioral therapy
Hypnotherapy
Medication
Interpersonal therapy
In applying cognitive behavioral therapy to clients with somatoform disorders, clinicians help their clients gain a more realistic appraisal of their body’s reactions.
In hypnotherapy, the therapist instructs the hypnotized client to, for example, move the paralyzed limb.
The therapist then makes the post-hypnotic suggestion to enable the client to sustain the movement after the therapist brings him or her out of hypnosis.
SSRIs are the medication that clinicians most likely use in treating conversion disorder.
Health anxiety: Worry about physical symptoms and illness.
Interpersonal therapy - Useful to help people with BDD develop improved strategies for dealing the distress they feel in their relationships with others.
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12. Psychological Factors Affecting Medical Conditions
The DSM-IV diagnostic category psychological factors affecting medical conditions includes situations in which psychological or behavioral factors have an adverse effect on a medical condition.
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13. Psychological Factors Affecting Medical Conditions
Conditions in which a client’s physical illness is adversely affected by one or more psychological states
Depression, stress, denial of a diagnosis, or engaging in poor or even dangerous health related behaviors
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14. Table 6.2 - Psychological Factors Affecting General Medical Condition
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15. Theories of Mind-body Interaction
Stress
Coping strategies for stress
Problem-focused
Emotion-focused
Emotional expression
Personality style
Type A behavior pattern
Type D personality
Stress: Unpleasant emotional reaction a person has when he or she perceives an event to be threatening.
Stressor: Event that disrupts the individual’s life.
Coping: Process through which people reduce stress.
Types of events that qualify as stressors:
Social Readjustment Rating Scale (SRRS)
Life events scales
Cognitive stress models
Hassle: A relatively minor event that can cause stress.
Uplifts: Events that boost your feelings of well-being.
Problem-focused coping: The individual reduces stress by acting to change whatever makes the situation stressful.
Emotion-focused coping: Person does not change the situation itself but tries to improve his or her feelings about the situation.
Emotional expression: Expressing your emotions can improve your physical and mental well-being.
Personality style
Type A behavior pattern: Pattern of behaviors that include being hard-driving, competitive, impatient, cynical, suspicious of and hostile toward others, and easily irritated.
Type D personality: People who experience emotions that include anxiety, irritation, and depressed mood.
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16. Applications to Behavioral Medicine
Behavioral medicine: An interdisciplinary approach to medical conditions affected by psychological factors that is rooted in learning theory
Psychoeducation
The field of behavioral medicine applies the growing body of scientific evidence regarding mind-body relationships to helping improve people’s physical health by addressing its relationships to:
Psychological factors of stress
Emotions
Behavior patterns
Personality
Psychoeducation is an important component of behavioral medicine.
Behavioral medicine is moving increasingly toward interventions that the profession once considered “alternative”, including mindfulness training, relaxation, and meditation.
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17. Dissociative Disorders
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18. Forms of Dissociative Disorders
Dissociative identity disorder:
Formerly called multiple personality disorder
An individual develops more than one self or personality
People with DID have at least two distinct identities and when inhabiting the identity of one, are not aware that they also inhabit the other identity.
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19. Dissociative Amnesia
An inability to remember important personal details and experiences
Dissociative amnesia is usually associated with traumatic or very stressful events.
Amnesia is not due to ordinary forgetfulness.
What they forget is a traumatic or stressful experience.
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20. Dissociative Fugue
A person, confused about personal identity, suddenly and unexpectedly travels to another place and is unable to recall past history or identity
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21. Depersonalization Disorder
A dissociative disorder in which the individual experiences recurrent and persistent episodes of depersonalization
People feel that they are controlled by forces outside of themselves, or that they are observing themselves from outside their own bodies.
Derealization: Condition in which people feel as though they are living in a dream and that their surroundings are not real.
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22. Theories and Treatment of Dissociative Identity Disorder
Goal
Integrate alters
Methods
Hypnotherapy
Cognitive behavioral techniques
Treatment goal - Integrate the disparate parts within the person’s consciousness of self, memory, and time.
Through hypnotherapy, clients recall traumatic experiences that seem to have caused the dissociation.
Cognitive Behavioral techniques - Clients develop a coherent sense of themselves and their experiences.
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23. The Biopsychosocial Perspective
Distinctions between real and fake psychological symptoms
Cognitive-behavioral explanations
How stress affects physical functioning
Cognitive-behavioral explanations provide useful approaches for treatment.
Learning more about how stress affects physical functioning, including the impact of social discrimination on chronic conditions.
Heart disease and diabetes.
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