Download Case Studies -Somatoform Disorders

Case Study: Experiment Participant
The following case shows how conditioning procedures are clinically effective in bringing about behavioral changes
related to pain when no physical cause can be identified.
The patient was a 19-year-old man who had been admitted to a hospital with complaints of pain in the lower back, hips,
and both legs, and great difficulty in walking, sitting, and standing. An exhaustive medical study determined that his
symptoms were unrelated to physical causes, and the case was diagnosed as a psychological disorder.
The therapy consisted of visits by a young assistant to the patient's room three times daily. During these visits the
assistant spent approximately ten minutes talking to the patient about topics unrelated to his disorder. During an
initial three-day period she encouraged him to walk but provided him with no reinforcement for doing so. During the
next three-day sequence she instructed the patient to walk and reinforced him when this happened. Reinforcement
consisted of comments such as "Good," "That's great," and ''You're doing fine," accompanied by attention,
friendliness, and smiling. Reinforcements were not given during the following three-day period, but they were
reinstituted during the final three days of the experimental therapeutic program.
-Hersen and others, 1972, pp. 720-721
Case Study: Alice
Alice was referred to the psychological clinic by her physician. Dr. Williams had been Alice's physician for about six
months and in that time period had seen her twenty-three times. Alice had dwelt on a number of rather vague
complaints-general aches and pains, bouts of nausea, tiredness, irregular menstruation, and dizziness. But various tests complete blood workups, X-rays, spinal tap, and so on- had not revealed any pathology.
Upon meeting her therapist, Alice immediately let him know that she was a somewhat reluctant client: "I'm here only
because I trust Dr. Williams and she urged me to come. I'm physically sick and don't see how a psychologist is going to
help." But when Alice was asked to describe the history of her physical problems, she quickly warmed to the task.
According to Alice, she had always been sick. As a child she had had episodes of high fever, frequent respiratory infections,
convulsions, and her first two operations, appendectomy and tonsillectomy. As she continued her somewhat loosely
organized chronological account of her medical history, Alice's descriptions of her problems became more and more
colorful (and probably exaggerated as well): "Yes, when I was in my early twenties I had some problems with vomiting. For
weeks at a time I'd vomit up everything I ate. I'd even vomit up liquids, even water. Just the sight of food would make me
vomit. The smell of food cooking was absolutely unbearable. I must have been vomiting every ten minutes."
During her twenties Alice had gone from one physician to another. She saw several gynecologists for her menstrual
irregularity and dyspareunia (pain during intercourse) and had dilatation and curettage (scraping the lining of the uterus).
She had been referred to neurologists for her headaches, dizziness, and fainting spells, and they had performed EEGs, spinal
taps, and even a CAT scan. Other physicians had ordered X-rays to look for the possible causes of her abdominal pain and
EKGs for her chest pains. Both rectal and gallbladder surgery had also been performed.
When the interview finally shifted away from Alice's medical history, it became apparent that she was a highly anxious
person in many situations, particularly those in which she thought she might be evaluated by other people. Indeed, some of
her physical complaints could be regarded as consequences of anxiety. Furthermore, her marriage was quite shaky, and she
and her husband were considering divorce.