Somatoform disorders include a variety of conditions in which psychological conflicts become translated into physical problems or complaints which cause distress or impairment in a person's life. In fact, the symptom reported by the individual probably would not correspond to the symptoms of any real physical disorder.
Conversion disorder is the translation of unacceptable drives or troubling conflicts into bodily motor or sensory symptoms that suggest a neurological or medical condition. Involves loss or alteration of bodily function even though there is no real physical impairment. Freud called this hysterical neurosis , implying it was a physical reaction to anxiety neurosis. La Belle Indifference: The “beautiful” lack of concern shown by some (though certainly not all) conversion disorder patients, in which the individual may pay little attention to the symptom and dismisses it as minor even though it is actually incapacitating.
This condition is difficult to diagnose. Disorder is rare, runs in families, more often in women, appears in adulthood, symptoms recur.
The difference between somatization disorder and conversion disorder is that somatization disorder involves multiple and recurrent bodily symptoms, rather than a single physical complaint.
Although such clients may appear to be “faking” a complex medical problem, they are not consciously attuned to the ways their psychological problems are being expressed physically. Because they do not consider their difficulties to have an emotional cause, these people do not seek psychotherapy. Somatization disorder is relatively rare. Sufferers may have grown up in homes with frequent illnesses. They compulsively seek medical and surgical treatment for their vague and unsubstantiated physical problems.
In some instances, there really is something abnormal about the body part, but the person’s concern is grossly exaggerated.
Some spend hours a day looking at the supposed “defect” in mirrors, whereas others go to great lengths to avoid any reflection of their “grotesque” problem People with BDD may seek cosmetic surgery or other medical treatment to correct their imagined defects. Research suggests that more than half of the people with BDD have personality disorders.
Hypochondriacs believe or fear that they have a serious illness, but they do not. Unlike conversion disorder or somatization disorder, hypochondriasis does not involve extreme bodily dysfunction or unexplainable medical symptoms. Instead, the hypochondriac misinterprets or exaggerates normal bodily occurrences.
Sufferers can be so concerned with trying to maintain good health that they become almost fanatical about their bodies. The course of hypochondriasis tends to be stable over time. Because clients often react with anger and impatience when they feel their concerns are not taken seriously, they often provoke intense frustration and exasperation in those trying to help them recognize the psychological origins.
Phenomena sometimes confused with somatoform disorders are malingering and factitious disorders. Malingering: The fabrication of physical or psychological symptoms for some ulterior motive. Factitious disorder: Conditions in which people fake symptoms or disorders, not for the purpose of any particular external gain but because of an inner need to maintain a sick role. They present themselves as dramatically as possible, trying to create scenarios in which their illness plays a starring role. Munchausen's syndrome: An extreme form of factitious disorder in which the individual goes to great lengths to maintain a sick role. The person’s whole life becomes consumed with the pursuit of medical care, inflicting injury on themselves to look sick and make hospitalization necessary. In factitious disorder with psychological symptoms , the individual feigns psychological problems. Symptoms tend to be vague and fail to correspond to any particular psychological disorder. In factitious disorder by proxy (or Munchausen’s syndrome by proxy ), a person induces symptoms in another person who is under that individual’s care. Desire for attention seems to motivate these individuals. Some cases are so extreme that murder takes place.
Primary gain is the avoidance of burdensome responsibilities because one is “disabled.” Secondary gain is the sympathy and attention the sick person receives from other people. An integrative explanation best explains somatoform disorders as an interplay of biological factors, learning experiences, emotional factors, and faulty cognitions.
Most contemporary approaches to treating somatoform disorders involve exploring the person’s needs to play the sick role, evaluating the contribution of stress in the person’s life, and providing the client with behavioral techniques to control symptoms. Irrespective of the specific techniques used, the clinician must develop a trusting and supportive relationship with the client and should be cautious about challenging the physical symptoms that are so real to client.
Intense emotional stress can increase vulnerability to getting sick and can seem to slow down recovery from an ailment. The DSM-IV diagnostic category psychological factors affecting medical conditions includes situations in which psychological or behavioral factors have an adverse effect on a medical condition.
This diagnosis is given to clients who suffer from a recognized medical condition that is adversely affected by emotional factors including a variety of Axis I disorders (e.g., depression), psychological symptoms (e.g., anxiety), personality traits (e.g., hostility), maladaptive health behaviors (e.g., smoking, drinking), or stress-related physiological responses (e.g., aggravation of ulcers, asthma).
Stress: Unpleasant emotional reaction a person has when he or she perceives an event to be threatening. The stressor is the event itself, which may also be called a stressful life event . Making an effort to reduce stress is called coping . In problem-focused coping , the individual reduces stress by acting to change whatever makes the situation stressful. In emotion-focused coping , a person does not change the situation itself but tries to improve his or her feelings about the situation. Psychoneuroimmunology: The study of connections among stress, nervous system functioning, and the immune system. Emotional expression: Emotion suppression is unhealthy and weakens immune responses. Personality factors: Type A personalities are more susceptible to heart disease and hardening of the blood vessels. Type C personalities are more susceptible to cancer.
Researchers and clinicians have focused on the processes by which people learn to deal with disruptive emotional experiences, and they have developed sophisticated theories and techniques pertaining to coping. Behavioral medicine: An interdisciplinary approach to medical conditions affected by psychological factors that is rooted in learning theory. Stress inoculation training: People are taught to anticipate stressful situations and are given help in practicing ways to control stress when they next encounter the situations.
Although sleep disorders do not technically fall into the category of psychological factors affecting medical conditions, they are relevant to our discussion of these topics. Primary Insomnia: Chronic difficulty sleeping. Primary Hypersomnia: An excessive need for sleep. Circadian Rhythm Sleep Disorder: Disturbance in functioning caused by disruptions in the normal sleep-wake cycle, usually due to rotating work shifts or jet lag. Breathing-Related Sleep Disorder: Frequent awakening because of breathing problems during sleep.
Nightmare Disorder: Recurrent vivid dreams from which a person wakes with detailed recollection of extended frightening images. Sleep Terror Disorder: Experiencing panic attacks during sleep. Sleepwalking Disorder: Recurrent episodes involving sleepwalking. Narcolepsy: Irresistible attacks of sleep that can take place at any time and any place, usually for 10-20 minutes.
Several “selves” or personalities, at least two distinct identities or personality states, called “alters” Core personality, the “I” associated with their given name, the “host” Most alters have distorted sense of time, gaps in memory, “lost” time Considerable skepticism about this diagnosis has emerged in recent years. Even the famous case of Sybil has been contested by psychiatric historians who regard the case as exaggeration and possible fabrication.
Primary explanation offered is that a highly traumatic childhood caused the child to develop alters as fantasy escape from horrors of daily life. However, only a small percentage of traumatized children develop dissociative disorders. Sociocognitive model of dissociative identity disorder: According to this model, clients enact roles they feel (consciously or unconsciously) are demanded by the therapeutic situation. Social attention to the condition, along with unintentional prompting by the therapist, can lead vulnerable individuals to develop this condition.
The goal for many therapists is to integrate the alters into a unified self and develop coping strategies to deal with painful memories of trauma. Through hypnotherapy , clients are encouraged to recall trauma while in a trance. However, a number of professionals have suggested that rather than helping clients discover truth, hypnotherapy increases the likelihood they will produce false memories. Cognitive Behavioral Techniques: Attempt to change dysfunctional attitudes and beliefs and bolster self-esteem
Dissociative amnesia: An inability to remember important personal details and experiences; is usually associated with traumatic or very stressful events. Localized Amnesia - Most common - Can’t recall any details of the event. Selective Amnesia - Recall some, but not all details. Generalized amnesia - Cannot recall anything at all from past life. Continuous Amnesia - Failure to recall past event from a particular date to the present time.
Results from result of trauma, extreme stress, need to escape punishment, or problems. Duration is variable (hours, day, weeks, or months). May assume a new identity, more outgoing than core personality.
Depersonalization can be experienced as a symptom of many conditions, including the effects of mind-altering drugs. It involves feeling that body is “unreal,” perhaps changing in size or shape, being controlled by outside forces, or feeling robotic Depersonalization disorder involves repeated alternation of mind-body perception, ranging from detachment to “out-of-body” feeling, not attributable to mind-altering drugs. The condition is often chronic for certain people, precipitated by stress.