abpsych 4: somatization

what is somatization?

the presentation or experience of mental phenomena as physical (somatic) symptoms

illness anxiety disorder

• preoccupation with having or acquiring a serious illness

• somatic symptoms are not present or mild in intensity

• high level of anxiety about health

• performs excessive health-related behaviors or exhibits maladaptive avoidance

• illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time

somatic symptom disorder

• one or more somatic symptoms

• excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns

• the state or being symptomatic is persistent, typically for more than 6 months

conversion disorder

• one or more symptoms of altered voluntary motor or sensory function

• evidence of incompatibility between the symptom and recognized neurological or medical conditions

factitious disorder

• falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception

• motivated by internal incentives (ex: desire for attention, avoiding anxiety…)

• presents him/herself to others as ill, impaired, or injured

• deceptive behavior is evident even in the absence of obvious external rewards

• vs malingering: intentionally producing symptoms motivated by external incentives (ex: avoiding military duty, obtaining financial compensation…)

etiology: psychodynamic theory

• defense mechanism

• our relational experiences growing up play a central role in our ability to regulate our emotions and respond to stressors

etiology: behavioral theory

reinforcement and modeling (observational learning) for the amplification of physical symptoms

etiology: sociocultural theory

• a variety of behaviors and events can come to elicit the physiological response that the person misconstrues (cognitive misattribution) as dangerous

• persons with somatic symptom disorders have likely developed complex repertoires of verbal and other symbolic responses that elicit negative affect and serve as a basis for escape or avoidance behavior

treatment

• little research on treatment, but CBT and STDP have promise

• focus on comorbid conditions:

  • DBT to enhance emotion regulation

  • EMDR, PE, CPT to address trauma-related symptoms

  • medications if anxiety or depression is present