Psych213 Chap10

Chapter Ten: Somatoform Disorders

Somatoform Disorders Overview

  • Definition: Disorders characterized by physical symptoms that cannot be fully explained by a medical condition.

  • Hysterical Somatoform Disorders: Actual changes in physical functioning.

Diagnostic Criteria for Factitious Disorder

  • Criteria:

    • Falsification of physical or psychological signs/symptoms.

    • Individual presents themselves as ill, injured, or impaired.

    • Behavior occurs in absence of obvious external reward.

  • Munchausen Syndrome: Intentionally faking symptoms to achieve financial gain or avoid responsibilities.

  • Munchausen Syndrome by Proxy: Caregiver induces symptoms in another for attention or other gain.

Conversion Disorder

  • Criteria:

    • One or more symptoms affecting voluntary motor or sensory function.

    • Evidence of incompatibility between symptoms and actual medical condition.

  • Cultural Factors: More common in rural areas or lower SES populations; occurs more frequently in women.

  • Prevalence: Approximately 5%. Onset can occur as early as age 10 and late as 35.

  • Familial Patterns: Higher incidence noted among first-degree relatives.

Somatic Symptom Disorder

  • Criteria:

    • One or more somatic symptoms.

    • Disproportionate thoughts about seriousness.

    • High levels of anxiety related to symptoms.

    • Excessive time/energy devoted to symptoms.

  • Cultural Considerations: Different perceptions of illness in various cultures.

  • Gender Differences: More prevalent in women (0.2% to 2% prevalence).

  • Familial Patterns: 10–20% higher incidence in first-degree relatives.

  • Comorbidities: Often associated with depression and substance abuse.

Illness Anxiety Disorder

  • Criteria:

    • Preoccupation with fears of having a serious illness despite lack of evidence.

    • Symptoms last for 6 months or longer.

  • Cultural Implications: Caution is advised, especially with alternative healers.

  • Gender Prevalence: Equal between men and women.

Etiology of Somatoform Disorders

  • Psychodynamic Factors:

    • Unconscious conflicts and emotional issues from childhood can manifest as physical symptoms.

    • Primary Gain: Physical symptoms serve as a defense mechanism against emotional conflicts.

    • Secondary Gain: Symptoms provide relief from unpleasant responsibilities.

  • Behavioral Perspective: Reinforcement of the sick role can perpetuate symptoms.

  • Cognitive Perspective: Physical issues arise as a form of communication of unexpressed emotions.

  • Cultural Perspectives: Non-Western cultures may normalize physical conditions like pain disorders.

Diathesis-Stress Model

  • Components:

    • Predisposing factors + precipitating stressors lead to illness.

    • Sensitivity to bodily symptoms is increased.

    • Parental models for illness may affect perception and responses to illness.

Treatment Interventions

  • Psychodynamic Interventions: Utilization of hypnosis to address traumatic feelings.

  • Behavioral Treatments: Education on diseases and symptoms to reduce anxiety.

  • Family Systems Therapy: Involve family to reinforce positive behaviors.

  • Biological Treatments: Use of antidepressants where necessary.

Psychological Factors Influencing Medical Conditions

  • Psychophysiological Disorders: Physical disorders with psychological components (e.g., migraines).

  • Treatment requires both medical intervention and psychotherapy.

  • Factors influencing health:

    1. Psychological changes from stress can produce physiological effects.

    2. Conditions like depression influence health-related behaviors.

    3. Beliefs about illness can impact treatment seeking and adherence.

General Adaptation Syndrome (GAS)

  • Three Stages:

    1. Alarm Stage: Initial response to stress; fight-or-flight reaction.

    2. Resistance Stage: Body adapts to stress; symptoms may resolve.

    3. Exhaustion Stage: Prolonged stress can lead to severe health issues or mortality.

Stress and Coping Mechanisms

  • Life-Change Model: Any major life changes can introduce stressors (e.g., new jobs, moving).

  • Transactional Model: Stress is a transaction between the individual and their environment; perception of control matters.

  • Hardiness: Personality traits that help individuals cope with stress (openness to change, commitment, control).

  • Self-Efficacy and Optimism: High self-efficacy leads to healthier behaviors; optimism positively affects mental health.

Psychological Involvement in Specific Disorders

  • Coronary Heart Disease (CHD): Top cause of mortality; linked with psychological factors like depression and stress.

  • Hypertension: Increased stress can lead to chronic high blood pressure.

  • Headaches: Different types (migraines, tension headaches) related to psychological stressors and sensitivity.

Stress and Immune Function

  • Impact of Stress on Immunity: Stress can impair immune response due to neurohormonal release.

  • Relationships and social support can mediate stress effects on health.

  • Treatment Modalities:

    • Relaxation Techniques: Muscle relaxation, biofeedback.

    • Cognitive Behavioral Interventions: Altering maladaptive thought patterns and promoting coping strategies.