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

\