8 Somatic & Sexual Disorders

Disorders Featuring Somatic Symptoms

  • Physical symptoms primarily caused by psychological factors.
  • Types: Somatic symptom disorder, Conversion disorder, Illness anxiety disorder, Factitious disorder imposed on the self & another.
  • Somatic Symptom Disorder:
    • Lifetime prevalence ~7.6%, 12-month prevalence ~2.1%.
  • Illness Anxiety Disorder:
    • Lifetime prevalence ~3.4%, 12-month prevalence ~1.2%.
  • Factitious Disorder:
    • Prevalence estimated <1%.
  • More common in women; often comorbid with anxiety and depression.

Somatic Symptom Disorder Criteria

  • At least one upsetting or disruptive physical symptom
  • High proportion of thoughts, feelings, and behaviors related to the symptoms, including:
    • Excessive thoughts about symptom seriousness.
    • Continued anxiety about the symptoms.
    • Disproportionate time/energy focused on symptoms.
  • Symptoms persist for 6 months.
  • Somatization Pattern:
    • Multiple, varied symptoms like pain, gastrointestinal, sexual, and neurological complaints.

Somatic Symptom Disorder - Predominant Pain Pattern

  • Pain is the primary focus.
  • Severity is excessive relative to medical findings.
  • May be triggered or worsened by psychological factors.

Conversion Disorder

  • At least one symptom impacting voluntary or sensory function.
  • Symptoms inconsistent with neurological/medical evidence.
  • Causes distress or impairment.
  • Symptoms: Limb paralysis, walking difficulties, vision loss, speech difficulties, loss of sensation

Somatic Symptom & Conversion Disorders: Causes

  • Early psychodynamic view:
    • Emotional conflicts converted into physical symptoms.
    • Defense mechanisms: Primary gain, Secondary gain.
  • Contemporary psychodynamic theories:
    • Unresolved emotional pain manifests as physical symptoms when emotions are suppressed.
  • Cognitive-behavioral view:
    • Symptoms are learned, maintained, and reinforced over time.
    • Reinforced through attention, avoidance of stress, modeled illnesses, communication of distress, and secondary gains.

Somatic Symptom & Conversion Disorders: Treatment

  • Treatment approaches similar to anxiety disorders (OCD):
    • Antidepressants, Exposure and response prevention (ERP), CBT, Psychoeducation.
  • Focus may be on the cause (similar to PTSD treatment):
    • Insight (psychodynamic), Exposure (to traumatic events), Medication (antidepressants), multidisciplinary.

Illness Anxiety Disorder

  • Preoccupation with thoughts about having or getting a significant illness without prominent somatic symptoms.
  • High anxiety over health, easily triggered.
  • High number of health behaviors or dysfunctional health avoidant behaviors.
  • Concerns continue for at least 6 months.

Illness Anxiety Disorder: Causes & Treatment

  • Causes
    • Misinterpretation of normal bodily sensations, past experience with serious illness, overexposure to health information, cognitive distortions.
  • Treatment
    • CBT, SSRIs, Mindfulness & Stress Reduction, Psychoeducation

Factitious Disorder Imposed on the Self

  • False creation of physical/psychological symptoms, even without external rewards.
  • Presentation of oneself as ill, damaged, or hurt.
  • Symptoms may be faked, exaggerated, or intentionally caused.

Factitious Disorder & Other Somatic Disorders

  • Factitious Disorder:
    • Symptoms intentionally produced/exaggerated.
    • No external rewards; motivation is to assume the "sick role".
  • Other Somatic Disorders:
    • Symptoms not intentionally produced; caused by unconscious psychological conflict.
    • People have real symptoms or believe their symptoms are real.

Factitious Disorder Imposed on Another

  • False creation of symptoms in another person, even without external rewards.
  • Presentation of another person (victim) as ill, damaged, or hurt.
  • Most commonly affects children (perpetrator is often a caregiver).
  • Deception continues even when harm is evident.

Factitious Disorders: Causes & Treatment

  • Causes
    • Early trauma or neglect, History of frequent medical treatment, Lack of social support.
  • Treatment
    • Long-term psychotherapy (CBT or psychodynamic therapy).

Comparing Somatic Disorders

  • Somatic symptom disorder, conversion disorder, illness anxiety disorder, factitious disorder imposed on the self, factitious disorder imposed on another.

Sexual Disorders

  • Disorders relating to sexual response: desire, excitement/orgasm, sexual pain.
  • Sexual Dysfunction: Impairment related to phases of sexual functioning.
  • Linear Model: Desire → Arousal → Orgasm → Resolution

Disorders of Desire

  • Two dysfunctions affect this phase:
    • Male hypoactive sexual desire disorder
    • Female sexual interest/arousal disorder
  • Male Hypoactive Sexual Desire Disorder
    • Few/no sexual thoughts, fantasies, or desires; causes distress; lasts 6+ months.
  • Female Sexual Interest/Arousal Disorder
    • Reduced/no sexual interest and arousal; lasts 6+ months; causes distress

Sexual Desire Disorders: Causes

  • Biological: Irregular hormone levels (Prolactin, Testosterone, Estrogen), excessive neurotransmitter activity (Serotonin, Dopamine), medications, physical illness & chronic pain.
  • Psychological: Stress, anger, past trauma, psychological disorders, relationship issues, self-esteem issues.
  • Sociocultural: Gendered pressures, unrealistic expectations, unhappy relationship, cultural standards.

Disorders of Excitement

  • For men: Inability to attain/maintain erection.
  • For women: Difficulty attaining/maintaining lubrication.
  • Premature Ejaculation
    • Ejaculation within 1 minute; causes distress.
    • Causes: Genetic predisposition, serotonin receptors, penis sensitivity.
  • Delayed Ejaculation
    • Significant delay/infrequency/absence of ejaculation; causes distress.
    • Causes: Performance anxiety, masturbation habits, hypoactive sexual desire.

Disorders of Excitement/Orgasm

  • Female orgasmic disorder
    • Delay, infrequency, or absence of orgasm; causes distress.
    • Causes: Medical issues, depression, childhood trauma, relationship issues, social expectations.

Disorders of Sexual Pain

  • Dysfunctions with physical discomfort during intercourse.
  • Causes: Medical issues, menopausal changes, physical causes (Dyspareunia), fear responses.
  • Genito-pelvic pain/penetration disorder
    • Difficulty with vaginal penetration, pain during penetration, fear of pain, pelvic muscle tensing; causes distress.

Treatment for Sexual Disorders: General Focus

  • Modern sex therapy is short-term and instructive.
  • Treatment
    • Cognitive Behavioural, Behaviour therapy, Biological