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Disorders Focusing on Somatic Symptoms

Disorders focusing on somatic symptoms are
problems that appear to be medical but are
actually caused by psychosocial factors

Unlike psychophysiological disorders, in which
psychosocial factors interact with genuine physical
ailments, somatoform disorders are psychological
disorders masquerading as physical problems
Disorders Focusing on Somatic Symptoms
These disorders include:
Factitious
disorder
Conversion
disorder
Somatic
symptom
disorder
Illness
anxiety
disorder
Body
dysmorphic
disorder
What Are Disorders focusing on Somatic
Symptoms?

People with these disorders suffer actual changes
in their physical functioning
These disorders are often hard to distinguish from
genuine medical problems
 It is always possible that a diagnosis is a mistake and
that the patient's problem has an undetected organic
cause

Facticious Disorder


A disorder in which an
individual feigns or
induces physical
symptoms, typically for
the purpose of assuming
the role of a sick person
Popularly known as
Munchausen Syndrome
Facticious Disorder


The precise causes of factitious disorder are not
understood, although clinical reports have pointed
to factors such as depression, unsupportive
parental relationships during childhood, and an
extreme need for social support
Clinicians have been unable to develop
dependably effective treatments for this disorder
Conversion Disorder

A psychosocial conflict or need is converted into
dramatic physical symptoms that affect voluntary
or sensory functioning




Symptoms often seem neurological, such as paralysis,
blindness, or loss of feeling
Most conversion disorders begin between late
childhood and young adulthood
They are diagnosed in women twice as often as
in men
They usually appear suddenly, at times of stress,
and are thought to be rare
Conversion Disorder


Conversion disorders
are often similar to
“genuine” medical
ailments, physicians
sometimes rely on
oddities in the patient’s
medical picture to help
distinguish the two
Symptoms may be at
odds with the way the
nervous system is
known to work
Somatic Symptom Disorder



People with somatic symptom disorder become
excessively distressed, concerned, and anxious
about bodily symptoms that they are
experiencing, and their lives are greatly disrupted
by the symptoms
The symptoms are longer-lasting but less
dramatic than those found in conversion disorder
In some cases, the symptoms have no known
cause
Somatization Pattern

People with somatization disorder have many
long-lasting physical ailments that have little or no
organic basis



Also known as Briquet’s syndrome
To receive a diagnosis, a patient must have a
range of ailments, including several pain
symptoms, gastrointestinal symptoms, a sexual
symptom, and a neurological symptom
Patients usually go from doctor to doctor in
search of relief
Predominant Pain Pattern

Pain disorder associated with psychological
factors
Patients may receive this diagnosis when psychosocial
factors play a central role in the onset, severity, or
continuation of pain
 Although the precise prevalence has not been
determined, it appears to be fairly common



The disorder often develops after an accident or illness that has
caused genuine pain
The disorder may begin at any age, and more women
than men seem to experience it
What Causes Conversion and Somatic Symptom
Disorders?


Previously called hysterical disorders
Widely considered unique and in need of special
explanation

No explanation has received much research support,
and the disorders are still poorly understood
What Causes Conversion and Somatic Symptom
Disorders?
The psychodynamic view
• Freud believed that these disorders represented a
conversion of underlying emotional conflicts into physical
symptoms
• Because most of his patients were women, Freud centered
his explanation on the psychosexual development of girls
and focused on the phallic stage (ages 3 to 5)
• During this stage, girls develop a pattern of sexual desires
for their fathers (the Electra complex) and recognize that
they must compete with their mothers for his attention
• Because of the mother's more powerful position, girls
repress these sexual feelings
What Causes Conversion and Somatic Symptom
Disorders?
The psychodynamic view
• Freud believed that if parents overreact to such feelings,
the Electra complex would remain unresolved and the
child might re-experience sexual anxiety throughout her
life
• Freud concluded that some women unconsciously hide
their sexual feelings in adulthood by converting them
into physical symptoms
• Today's psychodynamic theorists take issues with
Freud's explanation of the Electra conflict
• They continue to believe that sufferers of these
disorders have unconscious conflicts carried from
childhood
What Causes Conversion and Somatic Symptom
Disorders?
The psychodynamic view
• Psychodynamic theorists propose that two
mechanisms are at work in these
disorders:
• Primary gain: symptoms keep internal
conflicts out of conscious awareness
• Secondary gain: symptoms further
enable people to avoid unpleasant
activities or receive sympathy from others
What Causes Conversion and Somatic Symptom
Disorders?
The behavioral view
• Behavioral theorists propose that the physical
symptoms of these disorders bring rewards to
sufferers
• May remove individual from an unpleasant situation
• May bring attention from other people
• In response to such rewards, people learn to display
symptoms more and more
• This focus on rewards is similar to the psychodynamic
idea of secondary gain, but behaviorists view the
gains as the primary cause of the development of the
disorder
What Causes Conversion and Somatic Symptom
Disorders?
The cognitive view
• Some cognitive theorists propose that these
disorders are a form of communication,
providing a means for people to express difficult
emotions
• Like psychodynamic theorists, cognitive
theorists hold that emotions are being
converted into physical symptoms
• This conversion is not to defend against
anxiety but to communicate extreme
feelings
What Causes Conversion and Somatic Symptom
Disorders?
The multicultural view
• Some theorists believe that Western clinicians
hold a bias that sees somatic symptoms as an
inferior way of dealing with emotions
• The transformation of personal distress into
somatic complaints is the norm is many
non-Western cultures
• As we saw in Chapter 6, reactions to life's
stressors are often influenced by one's
culture
What Causes Conversion and Somatic Symptom
Disorders?
A possible role for biology
• The impact of biological processes on these disorders
can be understood through research on placebos and
the placebo effect
• Placebos: substances with no known medicinal value
• Treatment with placebos has been shown to bring
improvement to many – possibly through the power of
suggestion but likely because expectation triggers the
release of endogenous chemicals
• Perhaps traumatic events and related concerns or
needs can also trigger our “inner pharmacies” and set
in motion the bodily symptoms of conversion and
somatic symptom disorders
How Are Conversion and Somatic Symptom
Disorders Treated?


People with conversion and somatic symptom
disorders usually seek psychotherapy only as a
last resort
Individuals with preoccupation disorders typically
receive the kinds of treatments applied to anxiety
disorders, particularly OCD:
Antidepressant medication
 Exposure and response prevention (ERP)
 Cognitive-behavioral therapies

How Are Conversion and Somatic Symptom
Disorders Treated?

Treatments for these disorders often focus on the
cause of the disorder and apply the same kind of
techniques used in cases of PTSD, particularly:
Insight – often psychodynamically oriented
 Exposure – client thinks about traumatic event(s) that
triggered the physical symptoms
 Drug therapy – especially antidepressant medication

How Are Conversion and Somatic Symptom
Disorders Treated?

Other therapists try to address the physical
symptoms of these disorders, applying
techniques such as:
Suggestion – usually an offering of emotional support
that may include hypnosis
 Reinforcement – a behavioral attempt to change reward
structures
 Confrontation – an overt attempt to force patients out of
the sick role


Researchers have not fully evaluated the effects
of these particular approaches on these disorders
Illness Anxiety Disorder

People with this disorder unrealistically interpret
bodily symptoms as signs of a serious illness


Often their symptoms are merely normal bodily
changes, such as occasional coughing, sores, or
sweating
Although some patients recognize that their
concerns are excessive, many do not
Body Dysmorphic Disorder

Body dysmorphic disorder

People with this disorder, also
known as dysmorphophobia,
become deeply concerned about
some imagined or minor defect
in their appearance


Most often they focus on wrinkles,
spots, facial hair, swelling, or
misshapen facial features (nose,
jaw, or eyebrows)
Most cases of the disorder begin
in adolescence but are often not
revealed until adulthood