Ch 8 Disorders Featuring Somatic Symptoms

Disorders Featuring Somatic Symptoms

DSM-5 Categories

• Identification of somatic symptoms in DSM-5

• Primarily caused by psychological factors

• Symptoms trigger excessive anxiety or concern

Specific Disorders Introduced

• Factitious Disorder

• Conversion Disorder

• Somatic Symptom Disorder

• Illness Anxiety Disorder

• Psychological Factors Affecting Other Medical Conditions

Factitious Disorder

Definition and Characteristics

• Imposed on Self

  • False creation of physical or psychological symptoms

  • Deceptive production of injury or disease, even without external rewards

  • Presentation of oneself as ill, damaged, or hurt

  • Munchausen Syndrome: Specific subtype where individuals intentionally produce symptoms.

• Imposed on Another

  • False creation of physical or psychological symptoms in another person

  • Deceptive production of injury or disease in another, even without external rewards

  • Presentation of the other person (victim) as ill, damaged, or hurt

  • Munchausen Syndrome by Proxy: A specific type of factitious disorder where a caregiver induces illness in someone they are caring for.

Links to Factitious Disorder

• Poor social support or relationships, and little family life

• Extensive medical treatment during childhood

• Possessing a grudge against the medical profession

• Employment in medical fields such as nurse, lab technician, or aide

Causes and Treatment

• Causes: Precise causes are not understood.

• Treatment: Clinicians have not developed dependably effective treatments for this disorder.

Conversion Disorder and Somatic Symptom Disorder

Conversion Disorder

• Characterized by neurological-like symptoms inconsistent with known neurological or medical diseases.

• Typically starts in late childhood or young adulthood, often appearing suddenly during extreme stress.

• Symptoms are not consciously wanted or purposely produced.

Example of Conversion Disorder

• Glove Anesthesia: A conversion symptom where the entire hand, from fingertips to wrist, becomes numb.

Somatic Symptom Disorder

• Involves at least one upsetting or repeatedly disruptive physical symptom.

• Accompanied by an unreasonable amount of thoughts, feelings, and behaviors related to the symptom.

• Symptoms generally persist for more than 6 months.

Patterns and Prevalence

• Somatization Pattern: Long-lasting physical ailments without a physical basis; characterized by dramatic and exaggerated presentations. Prevalence is 4%.

• Predominant Pain Pattern: A known or unknown source of pain, often developing after an initial accident or illness.

Commonalities

• Both types of disorders can occur in response to severe stress.

• Historically viewed as forms of escape from stress.

• Individuals may present symptoms of both disorders.

• Theorists often explain and treat these two groups of disorders in similar ways.

Theories and Explanations of Disorders

Psychodynamic Theories (Freud's View)

• Historical perspective under which underlying emotional conflicts are converted into physical symptoms.

• Two defense mechanisms:

  • Primary Gain: The reduction of anxiety from the conflict by developing symptoms.

  • Secondary Gain: The benefits gained from being sick, such as attention and sympathy.

  • Notion of a distorted Electra Complex.

Contemporary Psychodynamic Theories

• Disagree with Freud on specific points but acknowledge the presence of unconscious childhood conflicts leading to anxiety.

• This anxiety may manifest as physical pain.

Cognitive-Behavioral View

• Suggests that physical symptoms are maintained through reinforcement.

• Symptoms might foster distance from unpleasant relationships and serve as mechanisms to draw attention.

• The model posits that secondary gains result from exhibiting symptoms.

• Note: This view has not been widely tested and lacks strong empirical support.

Comparison of Disorders

Multicultural View

• Some Western clinicians critique excessive focus on somatic symptom disorders, viewing it as a cultural bias.

• Many non-Western cultures often consider the formation of somatic complaints as normative.

Treatment Strategies for Disorders

General Approaches

• Focus on the cause of the disorder includes:

  • Insight therapy

  • Exposure therapy

  • Drug therapies

• Focus on the symptoms includes:

  • Education

  • Behavioral reinforcement

  • Cognitive restructuring

Illness Anxiety Disorder

Definition

• Characterized by excessive preoccupation with thoughts or high anxiety about having or contracting a serious illness.

• Typically, there are no substantial somatic symptoms present.

• Individuals may exhibit an unduly high number of health-related behaviors or dysfunctional health-avoidance behaviors.

• Concerns persist for at least 6 months.

Demographics

• This disorder can manifest at any age but most often starts in early adulthood.

• Affects men and women equally.

Treatment Approaches

• Theoretical explanations and treatment approaches are similar to those for anxiety disorders, such as Obsessive-Compulsive Disorder (OCD).

• Treatments include drug therapy and cognitive-behavioral approaches.

Psychological Factors Affecting Other Medical Conditions

Historical Context

• Early DSM labels included psychophysiological (psychosomatic) disorders.

• The DSM-5 uses the term psychological factors affecting other medical conditions.

Disorder Characteristics

• These disorders differ from factitious, conversion, and illness anxiety disorders by involving significant medical symptoms and conditions.

• These conditions can lead to serious physical damage.

Mechanisms of Impact

• Psychophysiological Disorders: Individuals possess a medical condition that is negatively impacted by psychological factors.

• These factors can affect the course of the medical condition, create obstacles to treatment, and introduce new health risks.

Examples of Psychophysiological Disorders

• Ulcers

• Asthma

• Insomnia

• Chronic Headaches

• Migraine Headaches

• Hypertension

Contributing Variables

1. Biological Factors

   • Defects in the autonomic nervous system (ANS) may contribute to these disorders.

   • Other specific biological anomalies might also be involved.

2. Psychological Factors

   • Needs, attitudes, emotions, personality traits, or coping styles can cause individuals to overreact to stressors, increasing the risk of developing these disorders.

3. Sociocultural Factors

   • Stressors from adverse social conditions, such as poverty, health problems, and discrimination, interact with biological and psychological factors to exacerbate the development of these disorders.

Relationship Between Physical Illness and Stress

• The Social Adjustment Rating Scale (1967): Investigated the correlation between life stress and illness onset.

• The scale linked various stressors to a wide array of physical conditions but lacks specificity for certain population stress reactions.

Most Stressful Life Events

For Adults (Social Readjustment Rating Scale)

• Death of spouse

• Divorce

• Marital separation

• Jail term

• Death of close family member

• Personal injury or illness

• Marriage

• Job loss

• Marital reconciliation

• Retirement

• Changes in health of family member

• Pregnancy

For Students (Undergraduate Stress Questionnaire)

• Death of a family member or a friend

• High frequency of tests

• Finals week challenges

• Application processes for graduate school

• Victimization experiences

• Overlapping deadlines

• Relationship challenges such as breakups or infidelity

New Developments in Psychophysiological Disorders

• Recognition that many physical illnesses are linked to psychosocial stress.

• Psychoneuroimmunology: Studies how stress impacts the immune system, particularly through the interactions of stress, anxiety levels, and behavioral changes on immune response.

• Key findings indicate that stress can weaken lymphocyte activity, impairing the immune system's defense mechanisms.

Influences on the Immune System

• Biochemical Activity: Stress affects various stress pathways including:

  • Sympathetic nervous system

  • Hypothalamic-pituitary-adrenal (HPA) pathway

• Behavioral Changes: Poor health behaviors arising from anxiety or depression can undermine immune function.

• Personality Style: Resilient personality traits promote better health outcomes.

• Social Support: High levels of loneliness and poor affiliation can exacerbate health conditions, whereas supportive therapy can mitigate health risks.

Psychological Treatments for Physical Disorders

• Behavioral Medicine: Integrates psychological and physical therapeutic methods to manage or prevent medical issues.

• Specific methods include:

  • Relaxation training

  • Biofeedback (e.g., EMG feedback)

  • Meditation techniques

  • Hypnosis practices

  • Cognitive-behavioral interventions

  • Participation in support groups and emotional expression therapies

  • Combination approaches that merge multiple treatment strategies for optimal care.