Ch. 8: Disorders Featuring Somatic Symptoms

Psychological factors may contribute to...

somatic, or bodily, illnesses in a variety of ways.

Bodily illness can be caused by psychological factors such as:

stress, worry, and unconscious needs.

Factitious Disorder

a condition in which a person acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms; producing or faking symptoms simply out of a wish to be a patient.

People with the factitious disorder may malinger, which means...

they intentionally fake illness to achieve external gain (eg. financial compensation, military deferment)

people with a factitious disorder often go to extremes to create...

the appearance of illness.

Examples of the extremes that factitious disorder individuals will do?

Many secretly give themselves medications to produce symptoms; Patients often research their supposed ailments and are impressively knowledgeable about medicine.

Clinical researchers have a hard time determining the prevalence of this disorder because..

patients hide the true nature of their problem.

Factitious Disorder is more common in..

women than men and the disorder usually begins during early adulthood.

Factitious disorder seems to be particularly common among people who:

(a) received extensive medical treatment as children, (2) carry a grudge against the medical profession, or (3) have worked as a nurse, lab technician, or medical aide.

The precise causes of factitious disorder are not understood, although clinical reports have pointed to factors such as...

depression unsupportive parental relationships, and an extreme need for social support.

T/F: Psychotherapists and medical practitioners often become angry at people with a factitious disorder, feeling that they are wasting their time.

True

People with a factitious disorder, however, feel they...

have no control over their problems and often experience great distress.

Munchausen Syndrome by Proxy

A factitious disorder imposed on another, where parents make up or produce physical illnesses in their children.

T/F: An individual with a factitious disorder is smart and knows all the symptoms of the illness they want to copy.

True.

When a bodily ailment has an excessive and disproportionate impact on the individual, no apparent medical cause, or is inconsistent with known medical diseases, a physician may suspect..

Conversion Disorder or Somatic Symptom Disorder

Conversion Disorder

People with this disorder display physical symptoms that affect voluntary motor or sensory functioning, but the symptoms are sensory with known medical diseases; the individuals experience neurological-like symptoms - blindness, paralysis, or loss of feeling - that have no neurological basis.

Conversion disorder often is hard to distinguish from...

genuine medical problems.

It is always possible that a diagnosis of conversion disorder is a...

mistake and the patient's problem has an undetected medical cause.

For conversion disorders, physicians sometimes rely on...

oddities in the patient's medical picture to help distinguish the two. (Ex: Conversion symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesia.

Unlike people with factitious disorder, those with conversion disorder don't...

consciously want or produce their symptoms.

How does the conversion disorder get its name?

Clinical theorists used to believe that individuals with the disorders are converting psychological needs into neurological symptoms.

At what age does a conversion disorder usually begin?

Between late childhood and young adulthood; appears suddenly, at times of stress.

How much more is a conversion disorder diagnosed in women than men?

Twice as often.

How often is the occurrence of the conversion disorder?

It is thought to be rare, occurring in at most 5 of every 1,000 persons.

Somatic Symptom Disorder

People with somatic symptom disorder become excessive distressed, concerned, and anxious about bodily symptoms that they are experiencing.

What are the two patterns of somatic symptom disorder?

Somatization pattern and predominant pain pattern.

People with a somatization pattern experience:

many long-lasting physical ailment that have little or no original basis.

A person with somatic symptom disorder ailments often include:

pain symptoms, gastrointestinal symptoms, sexual symptoms, and neurological symptoms.

Somatic Symptom Disorder: Somatization Pattern

Patients with this pattern often describe their symptoms in dramatic and exaggerated terms (mostly feel anxious and depressed); lasts for many years (their problem doesn't switch from one to the other); Symptoms may fluctuate over time but rarely disappear completely without therapy.

Somatization Pattern rates in women?

Between 0.2% and 2% of all women in the U.S. experience a somatization pattern in any given year (compared with less than 0.2% of men).

T/F:The pattern often runs in families and begins between adolescence and young adulthood.

True.

Somatic Symptom Disorder: Predominant Pain Pattern

If the primary feature of somatic symptom disorder is pain, the individual is said to have a predominant pain pattern. Although the precise prevalence has not been determined, it appears to be fairly common; The pattern often develops after an accident or illness that has caused genuine pain.

At what age can a Predominant Pain Pattern develop and what gender experiences it more?

The disorder may begin at any age, and more women than men seem to experience it.

For many years, conversion and somatic symptom disorders were referred to as...

hysterical disorders; This label was to convey the prevailing belief that excessive and uncontrolled emotions underlie the bodily symptoms.

Causes of Conversion and Somatic Symptom Disorder: Psychodynamic View

Freud believed that hysterical 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 what stage of development?

Phallic stage of development (ages 3-5); During this stage, Freud believed that 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, however, because of the mother's more powerful position, however, girls repress these sexual feelings.

Freud believed that if parents overreact to such feelings (phallic stage of development)...

the Electra complex would remain unresolved and the child might re-experience sexual anxiety throughout her life; some women unconsciously hide their sexual feelings in adulthood by converting them into physical symptoms.

How do today's psychodynamic theorists take issue with Freud's explanation of the Electra conflict?

They continue to believe that sufferers of these disorders have unconscious conflicts carried from childhood.

Which two mechanisms do psychodynamic theorists propose are at work in hysterical disorders?

Primary and Secondary gain.

Primary Gain

bodily symptoms keep internal conflicts out of conscious awareness.

Secondary Gain

bodily symptoms further enable people to avoid unpleasant activities or receive sympathy from others.

Causes of Conversion and Somatic Symptom Disorder: The Behavioral View

Behavioral theorists propose that the physical symptoms of hysterical disorders bring rewards to sufferers (which leads people learn to display symptoms more); May remove individual from unpleasant situation and/or bring attention from other people.

Causes of Conversion and Somatic Symptom Disorder: The Cognitive View

Some cognitive theorists propose that conversion and somatic symptom disorders are forms of communication, providing a means for people to express difficult emotions; cognitive theorists hold that emotions are being converted into physical symptoms to communicate extreme feelings.

Causes of Conversion and Somatic Symptom Disorder: 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 lesson to be learned from multicultural findings is that both bodily and psychological reactions to life events are often influenced by one's culture.

How Are Conversion and Somatic Symptom Disorders Treated?

People with conversion and somatic symptom disorders usually seek psychotherapy only as a last resort because they believe their problems are completely medical.

Many therapists focus on the causes of Conversion and Somatic Symptom Disorders and apply techniques including:

Insight, exposure, and drug therapy.

How Are Conversion and Somatic Symptom Disorders Treated: Insight

often psychodynamically oriented.

How Are Conversion and Somatic Symptom Disorders Treated: Exposure

client thinks about traumatic event(s) that triggered the physical symptoms.

How Are Conversion and Somatic Symptom Disorders Treated: Drug Therapy

especially antianxiety and antidepressant medication.

Other therapists try to address the physical symptoms of Conversion and Somatic Symptom Disorders, applying techniques such as:

Suggestion, reinforcement, and confrontation.

How Are Conversion and Somatic Symptom Disorders Treated: Suggestion

usually an offering of emotional support that may include hypnosis.

How Are Conversion and Somatic Symptom Disorders Treated: Reinforcement

a behavioral attempt to change reward structures.

How Are Conversion and Somatic Symptom Disorders Treated: Confrontation

an overt attempt to force patients out of the sick role.

Illness Anxiety Disorder

People with illness anxiety disorder, previously known as hypochondriasis, experience chronic anxiety about their health and are concerned that they are developing a serious medical illness, despite the absence of somatic symptoms.

What do individuals with Illness Anxiety Disorder do?

They repeatedly check their bodies for signs of illness and misinterpret bodily symptoms as signs of a serious illness;

Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating.

At what age is Illness Anxiety Disorder developed?

Can begin at any age, it starts most often in early adulthood among men and women in equal numbers.

What is the percentage of individuals with Illness Anxiety Disorder?

Between 1% and 5%

Illness Anxiety Disorder: Behaviorists View

Developed from classical conditioning or modeling.

Illness Anxiety Disorder: Cognitive View

Developed due to oversensitivity to bodily cues.

What kinds of treatments are given to individuals with Illness Anxiety Disorder?

Antidepressant medication, Exposure and response prevention (ERP), and Cognitive-behavioral therapies.

Where do Psychophysiological Disorders result from?

result from an interaction of biological (our environment), psychological (our thoughts), and sociocultural factors (who we're around).

It is important to recognize that these psychophysiological disorders bring about..

actual physical damage; These can be observed by medical professional .

Traditional Psychophysiological Disorders

Before the 1970s, the best known and most common of the psychophysiological disorders were ulcers, asthma, insomnia, chronic headaches, high blood pressure, and coronary heart disease.

Ulcers

Lesions in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding.

How many people experience ulcers?

Over 25 million people at some point in their lives.

Ulcers: Psychosocial Factors

Environmental pressures, intense feelings of anger or anxiety.

Ulcers: Physiological Factors

Bacterial infection.

Asthma

A narrowing of the body's airways that makes breathing difficult.

How many people are affected by asthma and at what age?

Up to 25 million people in the U.S. each year; Most victims are children or young teens at the time of first attack (Its unusual for people to develop asthma in adulthood unless its job induced).

Asthma: Psychosocial Factors

Environmental pressures or anxiety.

Asthma: Physiological Factors

Allergies, a slow-acting sympathetic nervous system, weakened respiratory system.

Insomnia

Difficulty falling asleep or maintaining sleep for 30 consecutive days.

How many individuals are affected by insomnia?

Affects 10% of people in the U.S. each year.

Insomnia: Psychosocial Factors

High levels of anxiety or depression.

Insomnia: Physiological Factors

Overactive arousal system, certain medical ailments.

Chronic Headaches

Frequent intense aches of the head or neck that are not caused by another physical disorder.

Chronic Headaches: Psychosocial Factors

Environmental pressures; general feelings of helplessness, anger, anxiety, depression.

Chronic Headaches: Psysiological Factors

Abnormal serotonin activity, vascular problems, muscle weakness.

How many individuals are affected by chronic headaches?

Tension headaches affect 45 million Americans each year; Migraine headaches affect 23 million Americans each year.

Hypertension

Chronic high blood pressure, usually producing few outward symptoms.

Hypertension: Psysiological Factors

Obesity, smoking, poor kidney function, high proportion of collagen (rather than elastic) tissue in an individual's blood vessels.

Hypertension: Psychosocial Factors

Constant stress, environmental danger, general feelings of anger or depression.

How many individuals are affected by hypertension?

Affects 75 million Americans each year.

What is the percentage of hypertension caused by physiological factors alone?

10%