PSYC 407 1st Edition Lecture 9 Outline of Last Lecture I. Introduction to Obsessive Compulsive DisorderII. Causes and Associations with OCDIII. Types of OCD TreatmentsIV. Summary of Anxiety DisordersOutline of Current Lecture II. What is Somatoform Disorders?A. Types of Somatoform DisordersIII. What is Hypochondriasis Disorder?IV. What is Somatization Disorder?V. What is Conversion Disorder?VI. What is Pain Disorder?VII. What is Body Dysmorphic disorder?Current LectureSomatoform and Dissociative DisordersSomatoform Disorders- Soma –meaning “body”- Fulltime Preoccupation with health and/or body appearance and functioning- No identifiable medical condition causing the physical complaintsSomatoform Disorders• Types of DSM-IV-TR somatoform disorders• –Hypochondriasis• –Somatization disorder• –Conversion disorder• –Pain disorder• –Body dysmorphic disorderHypochondriasisClinical description• –Exaggeration of physical complaints which have no clear cause• –Severe anxiety about the possibility of having a serious disease• –Strong disease conviction (you are SURE you have it)• –Medical reassurance does not seem to help (or helps for short time)• –Duration of 6 months• Hypo -underThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.• •Chondra-ribs• •“Hypochondra” disorders were abdominal• disorders like ulcers that seemed to have no known cause• This person tends to have a constant focus on body sensations.• The slightest sensation causes an increased focus on the body.• The act of focusing may increase symptomsHypochondriasis: Causes and Treatment• Cognitive perceptual distortions seems to be a misinterpretation of a body sensation; ambiguous stimuli seen as threatening; go to medical doctor.• Different from illness phobia where person avoids anything that might make them sick• Familial history of illness. Emphasis on certain organ-systems• May benefit from the sick role• Stressful events may precipitate.HypochondriasisStatistics• –Good prevalence data are lacking• –Onset at any age• –Runs a chronic course• –Equal genderHypochondriasis: Causes and Treatment• Trusting relationship• Challenge illness-related misinterpretations but don’t say “It’s all in your mind”.• Teach them how sx. can be 'created'• –Provide more substantial and sensitive reassurance• Stress management and coping strategies• ID and change emotions that trigger anxiety.Somatization DisorderClinical description:• –Extended history of physical complaints before age 30• –Substantial impairment in social or occupational functioning• –Concern about the symptoms, not what they might mean; not as fearful as hypochondriasis• –Symptoms become the person’s identity; whole life revolves around this8 Symptoms (must have) {for the most part a women’s diseases}• 4 pain•2 GI (besides pain)•1 sexual•1 pseudoneurological–(like double vision, poor coordination, dysphagia)• Rare condition• –Onset usually in adolescence• –Mostly affects unmarried, low SES women• –Runs a chronic courseSomatization Disorder: Causes and Treatment• Familial history of lots of focus on illness• Weak behavioral inhibition system• This has an association w/antisocial personality disorder• Insensitive to signals of punishment and neg. consequences of own behavior- No treatment with demonstrated effectiveness exists- Reduce the tendency to visit numerous medical specialists- Assign “gatekeeper” physician- Reduce supportive consequences of talk about physical symptomsConversion Disorder• Conversion of anxiety from unconscious conflicts into physical symptoms• Allowed the anxiety to dissipate without feeling itClinical description– Physical problem that lacks physical or organic pathology– Malfunctioning often involves sensory-motor areas– Persons may show “la belle indifference”, to the connection between sx and psychology– Retain most normal functions, but lack awareness (no insight)REMEMBER: we are all capable of receiving and processing information in sensory channels without being awake, outside of mour conscious awarenessPhysical Malfunctions• Paralysis• Blindness• Mutism• Muscle weakness• Loss of touch or feeling somewhere• Dysphagia (trouble swallowing)• In blindness they say they can’t see but they don’t trip over objectsStatistics– Rare condition, with a chronic intermittent course– Seen primarily in females– Onset usually in adolescence– Common in some cultural and/or religious groups– Precipitated by marked stress (52-93% of cases)Conversion Disorder Causes– Freudian psychodynamic view is still popular• Related to hysteria• Unacceptable impulses converted to physical sx.– May learn by observing another– Emphasis on the role of past trauma and conversion (preceded by stress)• Trauma must be avoided but you can’t run away. Get sick, but that’s not acceptable either so deny itConversion Disorder: Treatment- Psychoanalysis brings childhood conflicts into awarness and get rid of need to cover it up- CBT- Core strategy is attending to the trauma- Reduce supportive consequences of talk about physical symptomso (Remove sources of secondary gain)CBT ModelIncreased attention to bodyAttribution to illnessWorry, catastrophizing, increase arousalCommunication of distressHelp-seekingAvoidance, disabilitySocial responses reinforceImportant to distinguish conversion disorder from1. Malingering (get out of something)2. Factitious disorders (to assume the sick role) also Munchausen’s by proxyMalingering (consciously done)• Behavior has specific goal:– To avoid something (work, military) or to achieve a goal (insurance settlement)• Sx disappear when they get what they want• Etiology: need to be taken care of– Associated w/ borderline personality disorderFactitious Disorders (consciously done)• Sx feigned to assume the sick role for the attention• Sx can be subjective, self-injury, or exaggeration of existing sx.• Sx are physical or psychological, but consciously adopted.• Goal is to become a medical patient• Grady, 1999)• Miss Scott• Hospitalized at more than 600 hospitals• 42 operations (most not needed)• “It started as what I did when I needed someone to look after me; Then it