Chapter Ten: Disorders Featuring Somatic Symptoms

Factitious Disorder

• Malingering: Intentionally feigning illness to achieve some external gain
• Factitious disorder/Munchausen syndrome: A disorder in which a person feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person.
• Ppl go to extremes to create the appearance of illness
  • Take meds secretly
  • Inject drugs
  • Laxatives
  • Fake high fevers
• Research their supposed ailments and are knowledgeable about medicine
• Common among people who
  • received extensive treatment for a medical problem as children
  • carry a grudge against the medical profession
  • have worked as nurse, lab tech, or medical aide
• More common in women than men
• Men often have more severe cases
• Onset during early adulthood
• Factitious disorder imposed on another/Munchausen syndrome by proxy: Parents or caretakers make up or produce physical illnesses in their children

Conversion Disorder and Somatic Symptom Disorder

Conversion Disorder

• Conversion Disorder: A disorder in which a person's bodily symptoms affect their voluntary motor and sensory functions, but the symptoms are inconsistent with known medical diseases

• Hard to distinguish from a genuine medical problem

• Glove Anesthesia: Conversion symptom where numbness begins sharply at the wrist and extends evenly right to the fingertips

  • Real neurological damage is rarely as abrupt or evenly spread out

• Those with conversion disorder do not consciously want or purposely produce their symptoms

• Usually begins between late childhood and young adulthood

• Often appears suddenly and at times of extreme stress

Somatic Symptom Disorder

• Somatic Symptom Disorder: A disorder in which people become excessively distressed, concerned, and anxious about bodily symptoms they’re experiencing, and their lives are disproportionately disrupted by the symptoms

• The person’s concerns are disproportionate to the seriousness of the bodily problems

• Somatization Pattern: The individual experiences a large and varied number of bodily symptoms

  • Experience many long-last physical ailments
  • Ailments have little or no physical basis
  • Also known as Briquet’s syndrome
  • Symptoms
  • Pain symptoms: headaches, chest pain
  • Gastrointestinal symptoms: nausea, diarrhea
  • Sexual symptoms: erectile or menstrual difficulties
  • Neurological-type symptoms: double vision, paralysis
  • Ppl describe their many symptoms in dramatic and exaggerated terms
  • Feel anxious and depressed
  • Pattern lasts for many years, doesn’t disappear completely without therapy
  • 4% in US per yr
  • Women experience this much more commonly than men
  • Begins between adolescence and young adulthood
  • Victims of childhood or recent sexual abuse are more likely to develop this pattern in adulthood

• Predominant Pain Pattern: The person’s primarily bodily problem is the experience of pain

  • Fairly common
  • Can begin at any age
  • Women are more than men to experience it
  • Often develops after an accident or during an illness that has caused genuine pain, which then takes on a life of its own
  • Gregory House’s leg

What Causes Conversion and Somatic Symptom Disorders?

• Previous explanations
  • Excessive and uncontrolled emotions underlie the bodily symptoms found in conversion and somatic symptom disorder
  • Caused by psychological processes
• Psychodynamic view
  • Hysterical disorders represented a conversion of underlying emotional conflicts into physical symptoms and concerns
  • Electra complex: Each girl experiences sexual feelings for her father and at the same time recognizes that she must compete with her mother for his affection
  • If a child’s parents overreach to her sexual feelings, the Electra conflict will be unresolved and the child will reexperience sexual anxiety throughout her life
  • Some women hide their sexual feelings by unconsciously converting them into physical symptoms and concerns
  • Sufferers of these disorders have unconscious conflicts carried forth from childhood, which arouse anxiety, and they convert this anxiety
  • Primary gain: Bodily symptoms keep their internal conflicts out of awareness
  • Secondary gain: Their bodily symptoms further enable them to avoid unpleasant activities or to receive sympathy from others
• Cognitive-Behavioral View
  • The physical symptoms of these disorders yield important benefits to sufferers, so the sufferers learn to display the bodily symptoms more and more prominently
  • People who are familiar with an illness will more readily adopt its physical symptoms
  • Conversion and somatic symptom disorders are forms of self-expression, providing a means of people to reveal emotions that would otherwise be difficult to convey
  • Purpose of the conversion is to communicate extreme feelings in a physical language that is familiar and comfortable for the person with the disorder
• Multicultural models
  • Western bias sees somatic reactions as an inferior way of dealing with emotions
  • The transformation of personal distress into somatic complaints is the norm in many non-Western cultures
  • Viewed as a socially correct, medically correct, and less stigmatizing reaction to life’s stressors
  • Both bodily and psychological reactions to life events are often influenced by one’s culture

How Are Conversion and Somatic Symptom Disorders Treated?

• Ppl with these disorders usually seek psychotherapy only as a last resort
• Many therapists focus on the causes of these disorders (trauma or anxiety tied to the physical symptoms) in their therapies
• Psychodynamic Therapists
  • Try to help those with somatic symptoms become conscious of and resolve their underlying fears
  • Eliminating the need to convert anxiety into physical symptoms
• Cognitive-Behavioral Therapists
  • Exposure treatments
  • Expose clients to features of their triggers
  • Clients will become less anxious over the course of repeated exposures and more able to face the upsetting events directly
• Biological therapists
  • Use antidepressant drugs to help reduce anxiety and depression in patients with these disorders
• Other therapists address the physical symptoms of the disorders rather than the causes
  • Education
  • Explain the disorder to patients
  • Offer emotional support
  • Hope that the physical symptoms will disappear soon
  • Reinforcement
  • Arrange for the removal of rewards for a client’s symptoms
  • Arrange for the increase of rewards for healthy behaviors
  • Cognitive Restructuring
  • Guide clients to think differently about the nature and causes of physical symptoms and illness

Illness Anxiety Disorder

• Previously known as Hypochondriasis
• Illness Anxiety Disorder: A disorder in which people are chronically anxious about and preoccupied with the notion that they have or are developing a serious medical illness, despite the absence of somatic symptoms
• Repeatedly check their body for signs of illness
• Misinterpret various bodily events as signs of serious medical problems
• Some people recognize that their concerns are excessive, but many do not
• Illness fears are acquired through classical conditioning / modeling
• People w the disorder are so sensitive to and threatened by bodily cues that they come to misinterpret them
• treatments
  • Same kinds that treat OCD
  • Antidepressant Drugs
  • Exposure and Response Prevention

Psychophysiological Disorders

• Psychophysiological Disorders: Disorders in which biological, psychological, and sociocultural factors interact to cause or worsen a physical illness

• Also known as psychological factors affecting other medical conditions / psychophysiological

Traditional Psychophysiological Disorders

• Ulcers: Lesions that form in the wall of the stomach or of the duodenum

  • Causes burning sensations or pain in the stomach, occasional vomiting, and stomach bleeding
  • 25 mil + in US have it at some point in their lives
  • Often caused by an interaction of stress factors and physiological factors
  • Stress Factors: Environmental pressure, intense feelings of anger/anxiety
  • Physiological Factors: Bacteria H. pylori

• Asthma: A disease marked by the narrowing of the trachea and bronchi, resulting in shortness of breath, wheezing, coughing, and a choking sensation

  • 70% of all cases appear to be caused by an interaction of stress factors and physiological factors
  • Stress Factors: Environmental pressures, anxiety
  • Physiological Factors: Allergies to specific substances, slow-acting sympathetic nervous system, weakened respiratory system

• Insomnia: Difficulty falling asleep or maintaining sleep

  • Chronic insomniacs have insomnia that lasts months or years
  • Feel like they’re almost constantly awake
  • Often very sleepy during the day and may have difficulty functioning
  • Caused by a combination of psychosocial factors and physiological problems
  • Psychosocial factors: High levels of anxiety or depression
  • Physiological problems: Overactive arousal system, certain medical ailments

• Chronic Headaches: Frequent intense aches of the head or neck that aren’t caused by another physical disorder

  • Muscle Contraction / Tension Headaches: A headache caused by a narrowing of muscles surrounding the skull
  • Migraine Headaches: A very severe headache that occurs on one side of the head, often preceded by a warning sensation and sometimes accompanied by dizziness, nausea, or vomiting
  • Blood vessels in the brain narrow, so that the flow of blood to parts of the brain is reduced
  • The same blood vessels later expand, so that blood flows through them rapidly, stimulating many neuron endings and causing pain
  • Caused by an interaction of stress factors and physiological factors
  • Stress Factors
    • Environmental pressures
    • General feelings of helplessness, anger, anxiety, or depression
  • Physiological Factors
    • Abnormal activity of the neurotransmitter serotonin
    • Vascular problems
    • Muscle weakness

• High Blood Pressure

  • Hypertension: State of chronic high blood pressure
  • Blood pumped through the body’s arteries by the heart produces too much pressure against the artery walls
  • Interferes with the proper functioning of the entire cardiovascular system
  • Essential hypertension

• Coronary Heart Disease

  • Caused by a blocking of the coronary arteries
  • Coronary Arteries: The blood vessels that surround the heart and are responsible for carrying oxygen to the heart muscle
  • Psychosocial Factors: Job stress, high levels of anger/depression
  • Physiological Factors: High cholesterol, obesity, hypertension, smoking, lack of exercise

• What factors contribute to psychophysiological disorders?

  • Biological Factors
  • Defects in the autonomic nervous system
  • Specific biological problems
    • Weak gastrointestinal system
    • Weak respiratory system
    • Ppl who have temporary rises in bp when stressed
  • Psychological Factors
  • Repressive Coping Style: A reluctance to express discomfort, anger, or hostility
    • Ppl with this style tend to have a sharp rise in bp and heart rate when stressed
  • Type A personality style
    • Consistently angry, cynical, driven, impatient, competitive, and ambitious
    • Interact with the world in a way that produces continual stress
    • Often leads to coronary heart disease
  • Type B personality style
    • More relaxed, less aggressive
    • Less concerned about time
    • Less likely to develop cardiovascular deterioration
  • Sociocultural Factors
  • Impoverished people have more psychophysiological disorders, poorer health, and poorer health outcomes
  • High rate of psychophysiological and mother medical disorders among African Americans
    • Economic factors
    • Dangerous living environments
    • Unsatisfying jobs
    • Physiological predisposition
    • Repeated experiences of racial discrimination constitute special stressors
  • Hispanic Health Paradox

New Psychophysiological Disorders

• The greater the amount of life stress, the greater the likelihood of illness
• Psychoneuroimmunology: The study of the connections between stress, the body’s immune system, and illness
  • Stress can interfere with the activity of lymphocytes and other parts of the immune system
  • Increases a person’s susceptibility to viral and bacterial infections
• Why and when does stress interfere with the immune system?
  • Biochemical activity
  • Sympathetic Nervous System
    • Triggers the release of norepinephrine
    • An extended release of norepinephrine can influence the immune system adversely
  • Hypothalamic-Pituitary-Adrenal Pathway
    • Triggers the release of cortisol and other stress hormones
    • An extended release of these hormones can contribute to poorer immune system functioning
  • Behavioral changes
  • Becoming anxious or depressed
  • Sleep badly, eat poorly, exercise less, smoke or drink more
  • These behaviors slow down the immune system
  • Personality style
  • Ppl who respond to life stress with optimism and resilience experience better immune system functioning and are better prepared to fight off illness
  • Men with a general sense of hopelessness die at above-average rates from heart disease and critical illnesses
  • Degree of social support
  • People with few social supports who feel lonely tend to have poorer immune functioning in the face of stress
  • Social support and affiliation may actually help protect people from stress, poor immune system functioning, and subsequent illness
    • Can also help speed up recovery from illness or surgery

Psychological Treatments for Physical Disorders

• Behavior medicine: The field of treatment that combines psychological and physical approaches to treat or prevent medical problems

Relaxation Training

• Relaxation Training: A treatment procedure that teaches clients to relax at will so they can calm themselves in stressful situations

• Widely used in the treatment of high blood pressure

Biofeedback

• Biofeedback: A technique in which a client is given info about physiological reactions as they occur and learns to control the reactions voluntarily

• EMG: A device that provides feedback about the level of muscular tension in the body

Meditation

• Meditation: Technique of turning one’s concentration inward, achieving a slightly changed state of consciousness, and temporarily ignoring all stressors

• Mantra: A particular sound that people utter when meditating to help them focus their attention

• Used to help manage pain and treat all kinds of problems

• Mindfulness Meditation: A person pays attention to the feelings, thoughts, and sensations that are flowing through their mind during meditation, but they do so with detachment and objectivity and without judgment

  • Used in particular by patients suffering from severe pain

Hypnosis

• Hypnosis: People are guided by a hypnotist into a sleeplike, suggestible state during which they can be directed to act in unusual ways, feel unusual sensations, remember forgotten events, or forget remembered events

• Self-hypnosis: Some people are able to induce their own hypnotic state with training

• Used as an aid to psychotherapy and to help treat many physical conditions

• Particularly helpful in the control of pain

Other Psychological Treatments

• Cognitive-Behavioral Interventions
  • self-instruction / stress inoculation training
• Support Groups and Emotion Expression
• Combination Approaches

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