Abnormal Psychology Chapter Eight Notes What Are Somatoform Disorders page 266 281 Somatoform disorders a group of conditions that involve physical symptoms and complaints suggesting the presence of a medical condition but without any evidence of physical pathology to account for them Patients are typically preoccupied with their state of health and with various presumed disorders or diseases of bodily organs Patients have no control over symptoms and are not faking or trying to deceive others Malingering versus factitious disorder people who deliberately and consciously feign disability or illness o Malingering person is intentionally producing or grossly exaggerating physical symptoms and is motivated by external incentive such as avoiding work or military service or evading criminal prosecution o Factitious the person intentionally produces psychological or physical symptoms or both but there are no external incentives person s goal is simply to obtain and maintain the personal benefits that playing the sick role may provide including attention and concern of family and medical personnel Hypochondriasis o Hypochondriasis people are preoccupied either with fears of contracting a serious disease or with the idea that they actually have such a disease even though they do not they are not reassured by the results of a medical evaluation and condition must persist for at least six months o Patients generally resist the idea that their problem is a psychological one that might best be treated by a psychologist or psychiatrist o One of the two most commonly seen somatoform disorders with a prevalence estimated at 2 to 7 o Occurs equally as often in men and women and can start at almost any age but early adulthood is the most common o Often suffer from mood disorders panic disorder or other somatoform disorders o Often highly preoccupied with bodily functions minor physical abnormalities and or vague and ambiguous physical sensations o Many people think it is closely related to anxiety disorders o Patients past experiences with illnesses lead to the development of a set of dysfunctional assumptions about symptoms and diseases that may predispose a person to developing hypochondriasis o Hypochondriacal tendencies are reduced by the occurrence of serious medical conditions o Cognitive behavioral treatment can be very effective short treatment only 6 to 16 sessions can be delivered in a group format Cognitive components focus on assessing the patient s beliefs about illness and modifying misinterpretations of bodily sensations Behavioral techniques include having patients induce innocuous symptoms by intentionally focusing on parts of their body so that they can learn that selective perception of bodily sensations plays a major role in their symptoms o Treatment produced large changes in hypochondriacal symptoms and beliefs as well as in levels of anxiety and depression o Certain antidepressant medications especially SSRIs may be effective but not as effective as CBT Somatization Disorder o Somatization disorder characterized by many different complaints of physical ailments over at least several years beginning before age 30 that are not adequately explained by independent findings of physical illness or injury and that lead to medical treatment or to significant life impairment o Most often seen among patients in primary medical care settings in cultures all over the world o Other symptoms that must be met 8 of the 33 specified Four pain symptoms experienced with respect to at least four different sites or functions Two gastrointestinal symptoms other than pain such as nausea bloating diarrhea or vomiting when not pregnant One sexual symptom other than pain such as sexual indifference or dysfunction menstrual irregularity or vomiting throughout pregnancy One pseudoneurological symptom suggestive of a neurological condition such as various symptoms that mimic sensory or motor impairments like loss of sensation or involuntary muscle contraction in hand o Difference between hypochondriasis patients aren t convinced that they have an organic disease and there are multiple symptoms o Usually begins in adolescence is believed to be three to ten times more common in women than men and tens to occur more among less educated individuals and in lower socioeconomic classes o Lifetime prevalence 0 2 to 2 in women less than 0 2 in men o Very commonly co occurs with several other disorders including major depression panic disorder phobic disorders and generalized anxiety disorder o Relatively chronic condition with poor prognosis although sometimes the disorder remits spontaneously o Evidence that it runs in families o Tend to see bodily sensations as somatic symptoms o Medical management with cognitive behavioral treatments may be quite helpful One treatment that is moderately effective involves identifying one physician who will integrate the patient s care by seeing the patient at regular visits and by providing physical exams focused on new complaints Focus of treatment is to change the way the patient thinks about bodily sensations teaching a variety of coping strategies and reducing any secondary gain the patients may receive from physicians and family members Pain Disorder o Pain disorder characterized by the experience of persistent and severe pain in one or more areas of the body that is not intentionally produced or feigned been shown to reduce pain intensity Conversion Disorder medical condition may contribute to the pain but psychological factors must be judged to play an important role o May be acute duration of less than 6 months or chronic duration of over 6 months o Prevalence is unknown but more common in women than men o Comorbid with anxiety or mood disorders which may occur first or may arise later as a consequence of the pain disorder o Pain can increase when it is reinforced by attention sympathy or avoidance of unwanted activities o Cognitive behavioral techniques have been widely used in the treatment of both physical and psychogenic pain syndromes usually include relaxation training support and validation that the pain is real scheduling of daily activities cognitive restructuring and reinforcement of no pain behaviors o Anti depressants especially the tricyclic antidepressants and certain SSRIs have o Conversion disorder involves a pattern in which symptoms or deficits affecting sensory or voluntary motor functions lead one to think that a patient has a medical or