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