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Somatoform and Dissociative Disorders • What is a Somatoform Disorder? • A physical ailment that has no apparent medical cause • Different from • Psychosomatic disorders: actual physical illnesses exacerbated by psychological symptoms (e.g., hypertension exacerbated by stress)• Malingering: deliberate faking of illness to avoid unpleasant situations• Factitious disorders: deliberate faking of illness to gain medical attention (e.g., Munchausen’s disorder) • Hysterical Somatoform Disorders • Actual changes in physical functioning• Difficult to distinguish from actual medical problems• Conversion disorder• Somatization disorder• Pain disorder associated with psychological factors • Conversion Disorder • Checklist: • One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological disorder or other medical condition• Psychological factors judged to be associated with the symptom or deficit• Not intentionally produced or feigned• Not fully explained by a general medical condition or substance• Significant distress or impairment• Somatization Disorder • History of many physical complaints, beginning before the age of 30, that occur over a period of several years and result in treatment being sought or in significant impairment• Physical complaints include all of the following• Four different kinds of pain symptoms• Two gastrointestinal symptoms• One sexual symptom• One neurological-type symptom• Not explained by general medical condition or a drug• Symptoms not intentional or feigned• Pain Disorder • Significant pain as the primary problem• Psychological factors judged to have the major role in the onset, severity, exacerbation• Not explained by general medical condition or a drug• Symptoms not intentional or feignedFactitious Disorder- Has no identifiable physical cause• Intentional feigning of psychological or physical sypmtoms • Motivation is to assume sick role • External incentives absent (e.g., monetary gain)Preoccupation Somatoform Disorders • People misinterpret and overreact to bodily symptoms no matter what other people say• Hypochondriasis• Body dysmorphic disorder • Hypochondriasis • Preoccupations with fears or beliefs that one has a serious disease, lasting for at least 6 months• Persistence of preoccupation despite evaluation and reassurance• Absence of delusions• Significant distress or impairment• Body Dysmorphic Disorder • Preoccupation with an imagined or exaggerated defect in appearance• Significant distress or impairment • Of note, people go to extremes to “fix” their bodies (e.g., several surgeries, excessive dieting)• Psychodynamic Perspective • Psychosocial conflict is manifested or converted into dramatic physical symptoms • Freud – unresolved Electra complex• Current view – unresolved childhood anxiety• Primary gain: symptoms keep internal conflict out of awareness• Secondary gain: symptoms further enable individual to avoid unpleasant activities and/or elicit sympathy from others• Behavioral Perspective • Physical symptoms bring rewards• They get reinforced• Rewards are similar to secondary gains, but behaviorists consider them primary mechanisms• Cognitive Perspective • Physical symptoms are forms of communication• Emotions converted into symptoms • Purpose of conversion is not to defend against anxiety but to communicate extreme feelings in a comfortable manner• Biological Perspective • Placebo effects• “Inner pharmacies”• Multicultural Perspective • High rates of somatization in China, Japan, Arab countries, Latin America• Treatments :• CBT: exposure similar to that for OCD and/or PTSD• Medications: Antidepressants• Psychodynamic: gain insight into the anxiety that is defended


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OSU PSYCH 3331 - Lecture notes

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