This document discusses somatization disorder and somatoform disorders. It provides definitions and criteria for somatization disorder according to the DSM-IV-TR. Key points include: Somatization disorder is characterized by physical symptoms that cannot be fully explained by medical issues. It is relatively uncommon compared to other somatoform disorders. Patients experience significant distress and impairment. Somatization disorder results in high personal and societal costs due to impairment and overuse of medical resources. Theories about the causes include inherited traits like emotional reactivity and negative affect, as well as deficient emotion regulation skills and maladaptive coping behaviors.
psychiatry.Somatoform disorders animation part i.(dr.nzar)student
Somatoform disorders involve patients who believe their suffering comes from undiagnosed physical issues. This document discusses somatization disorder specifically. It is characterized by multiple medically unexplained symptoms affecting multiple body systems. Factors associated with somatization disorder include abuse history, depression, and high levels of somatization. Both physical and sexual abuse history are independently linked to increased gastric sensitivity. Physical abuse history and somatization are also independently associated with slower gastric emptying. Psychological processes may influence gastric function through brain-gut pathways.
Diagnostic criteria for somatization disorderovalaz
Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.
This document provides an overview of somatoform disorders, dissociative disorders, and related conditions. It describes somatoform disorders as involving physical symptoms that cannot be fully explained medically and are often described dramatically. Specific somatoform disorders discussed include conversion disorder, hypochondriasis, and factitious disorder. Conversion disorder involves neurological symptoms from psychological stress. Hypochondriasis involves excessive health concerns. Factitious disorder involves feigning or inducing illness for secondary gain. Dissociative disorders disrupt consciousness and arise as a defense against trauma. Treatment involves psychotherapy and anxiolytics or antidepressants depending on the condition.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
The document summarizes several somatoform disorders including somatization disorder, conversion disorder, hypochondriasis, dysmorphic disorder, and pain disorder. It describes the key symptoms, diagnostic criteria, etiology, and treatment approaches for each disorder. The disorders are characterized by physical symptoms that cannot be fully explained by medical factors and are believed to be linked to underlying psychological issues. Treatment generally involves cognitive behavioral therapy, medication, and helping patients address the psychological stressors contributing to their somatic complaints.
Somatoform disorders are a group of mental illnesses characterized by physical symptoms that cannot be fully explained by medical factors. Key features include symptoms not being imaginary, but also not correlating with medical test results. Common types are somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, pain disorder, and undifferentiated somatiform disorder. These disorders are thought to involve both psychosocial factors like how symptoms are interpreted emotionally, as well as potential biological and genetic components. Treatment involves both medical evaluation and psychological or psychiatric approaches.
Somatoform disorders are psychiatric conditions characterized by physical symptoms that cannot be fully explained by medical factors. The document defines and describes several somatoform disorders according to DSM-IV criteria, including their symptoms, causes, diagnosis, and treatment approaches. Key disorders discussed are somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, and pain disorder. Psychotherapy and pharmacotherapy are commonly used to treat underlying psychological factors and any comorbid mood or anxiety conditions.
psychiatry.Somatoform disorders animation part i.(dr.nzar)student
Somatoform disorders involve patients who believe their suffering comes from undiagnosed physical issues. This document discusses somatization disorder specifically. It is characterized by multiple medically unexplained symptoms affecting multiple body systems. Factors associated with somatization disorder include abuse history, depression, and high levels of somatization. Both physical and sexual abuse history are independently linked to increased gastric sensitivity. Physical abuse history and somatization are also independently associated with slower gastric emptying. Psychological processes may influence gastric function through brain-gut pathways.
Diagnostic criteria for somatization disorderovalaz
Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.
This document provides an overview of somatoform disorders, dissociative disorders, and related conditions. It describes somatoform disorders as involving physical symptoms that cannot be fully explained medically and are often described dramatically. Specific somatoform disorders discussed include conversion disorder, hypochondriasis, and factitious disorder. Conversion disorder involves neurological symptoms from psychological stress. Hypochondriasis involves excessive health concerns. Factitious disorder involves feigning or inducing illness for secondary gain. Dissociative disorders disrupt consciousness and arise as a defense against trauma. Treatment involves psychotherapy and anxiolytics or antidepressants depending on the condition.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
The document summarizes several somatoform disorders including somatization disorder, conversion disorder, hypochondriasis, dysmorphic disorder, and pain disorder. It describes the key symptoms, diagnostic criteria, etiology, and treatment approaches for each disorder. The disorders are characterized by physical symptoms that cannot be fully explained by medical factors and are believed to be linked to underlying psychological issues. Treatment generally involves cognitive behavioral therapy, medication, and helping patients address the psychological stressors contributing to their somatic complaints.
Somatoform disorders are a group of mental illnesses characterized by physical symptoms that cannot be fully explained by medical factors. Key features include symptoms not being imaginary, but also not correlating with medical test results. Common types are somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, pain disorder, and undifferentiated somatiform disorder. These disorders are thought to involve both psychosocial factors like how symptoms are interpreted emotionally, as well as potential biological and genetic components. Treatment involves both medical evaluation and psychological or psychiatric approaches.
Somatoform disorders are psychiatric conditions characterized by physical symptoms that cannot be fully explained by medical factors. The document defines and describes several somatoform disorders according to DSM-IV criteria, including their symptoms, causes, diagnosis, and treatment approaches. Key disorders discussed are somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, and pain disorder. Psychotherapy and pharmacotherapy are commonly used to treat underlying psychological factors and any comorbid mood or anxiety conditions.
Somatoform disorders are a group of mental illnesses characterized by physical symptoms that cannot be fully explained by a medical condition. Key somatoform disorders include:
- Somatization disorder/somatic symptom disorder, characterized by multiple physical symptoms and excessive thoughts about health.
- Conversion disorder, where psychological factors cause neurological or sensory symptoms like paralysis.
- Hypochondriasis, characterized by excessive fears about having a serious illness despite medical reassurance.
- Body dysmorphic disorder, characterized by a preoccupation with an imagined physical defect.
- Pain disorder, characterized by severe pain that is the main focus. Treatment involves psychotherapy and medication management.
This document discusses somatoform disorders, which are psychiatric disorders characterized by physical symptoms that cannot be fully explained by a medical condition. It defines several types of somatoform disorders, including somatization disorder, conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. It provides diagnostic criteria and characteristics of each disorder. It also discusses approaches to diagnosis, treatment involving CBT and referral to mental health professionals, and follow-up care.
Somatoform disorders are characterized by physical symptoms that cannot be explained medically despite the individual's belief that the symptoms are real. They include somatization disorder, conversion disorder, pain disorder, and hypochondriasis. Diagnosis involves ruling out physical causes through medical evaluation. Treatment focuses on psychotherapy to help express emotions verbally rather than physically, establish adaptive behaviors, and restructure beliefs. Medication may be used for comorbid mood disorders but not the somatoform symptoms themselves.
This document discusses somatoform disorders. It begins by defining somatoform disorders as mental illnesses characterized by physical symptoms that cannot be fully explained medically and cause impairment. Key points include: somatoform disorders involve the presentation of physical complaints due to psychological factors; they are characterized by multiple somatic complaints and persistent healthcare seeking despite reassurance; and common types include somatization disorder, conversion disorder, and hypochondriasis. Treatment involves identifying and addressing the underlying psychological causes through cognitive behavioral therapy and other approaches.
Somatization disorder is characterized by physical symptoms that cannot be fully explained medically and are thought to arise from psychological factors. People with pain disorder experience severe, prolonged pain that significantly impacts their daily lives. Hypochondriasis involves excessive fears about having a serious illness despite medical evaluations finding no physical causes. These somatoform disorders are influenced by predisposing factors like family dynamics, past illnesses, and psychological theories. Treatment involves psychotherapy, behavioral therapy, and sometimes medication.
Dr. Ziad N. Arandi discusses somatoform disorders, which are characterized by physical symptoms that cannot be fully explained by medical factors. He outlines four main somatoform disorders - somatization disorder, hypochondriasis, pain disorder, and conversion disorder - providing details on diagnostic criteria, prevalence, characteristics, and treatment approaches for each. The goal in managing somatoform disorders is control rather than cure through supportive psychotherapy, behavioral modification, relaxation therapy, and medication if needed.
This document defines and describes several somatoform disorders and related conditions, including: somatization disorder, pain disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, factitious disorder, and malingering. These conditions are characterized by physical symptoms that cannot be fully explained by medical factors, and appear to be influenced by psychological issues. They involve preoccupations with health, pain experiences, or imagined physical defects that are distressing and disruptive to the individual.
somatoform disorders are characterized by persistent requests for medical attention because of physical complaints that cannot be sufficiently explained by medical causes.
Somatoform disorders involve physical symptoms that cannot be fully explained by a medical condition. Common symptoms include pain, nausea, and fatigue. Treatment focuses on developing a supportive patient-practitioner relationship and psychotherapy to help patients understand psychological factors contributing to their symptoms.
The document discusses somatoform disorders, which are characterized by physical symptoms that cannot be fully explained by a medical condition. Patients express psychological conflicts through bodily symptoms unconsciously. Common somatoform disorders include conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. Treatment involves developing coping skills, increasing awareness of emotional factors, relaxation techniques, medication for comorbid conditions, and focusing on functioning rather than physical symptoms.
This document discusses several somatic symptom and dissociative disorders including somatic symptom disorder, illness anxiety disorder, conversion disorder, and their diagnostic criteria and features. Somatic symptom disorder involves physical symptoms that cause significant distress or impairment, along with excessive thoughts about the symptoms. Illness anxiety disorder involves severe health anxiety without corresponding physical symptoms. Conversion disorder was historically called hysteria and involves neurological symptoms like paralysis that cannot be explained physically.
This document discusses somatoform and dissociative disorders as defined in the DSM-IV. Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and are thought to be linked to psychological issues. Dissociative disorders involve disruptions or breakdowns in consciousness, memory, identity or perception. The document provides overviews of specific disorders including their defining features, causes, prevalence and treatment approaches. These include conversion disorder, pain disorder, hypochondriasis and dissociative disorders like dissociative identity disorder.
D, a 10-year-old boy, presented with deteriorating vision but no medical cause was found. During the consultation, it was revealed he lived with a stepfather he did not like and had family relationship issues. After discussing his difficult family situation, D reported that his vision had returned to normal. This suggests he may have been experiencing a somatoform disorder where psychological or emotional factors were affecting his physical symptoms.
Somatiform disorders are characterized by physical symptoms that cannot be explained physically. They result from psychological factors and cause significant impairment. The disorders include somatization disorder, hypochondriasis, somatoform autonomic dysfunction, and persistent somatoform pain disorder. Treatment involves ruling out physical causes, evaluating psychological stressors, and using antidepressants, psychotherapy, and alternative therapies to help patients develop more effective coping strategies.
Somatic Symptom Disorder is a mental disorder characterized by persistent and clinically significant somatic complaints coupled with excessive thoughts, feelings, and behaviors about the symptoms. There are four types of somatic symptom disorders including complex somatic symptom disorder, factitious disorder, conversion disorder, and somatic symptoms not otherwise specified. Diagnosis requires one or more somatic symptoms as well as excessive somatic concerns. Common somatic symptoms include headaches, stomach aches, and in rare cases, blindness or inability to walk. Somatic Symptom Disorder prevalence ranges from 1.5-21% depending on age, with stress and trauma as potential biological and environmental contributors. Treatment involves psychotherapy and cognitive-behavioral therapy, though convincing patients the symptoms are mental not physical can be challenging.
Somatoform& disaasociative disorders nov 9IMH chennai
This document provides definitions and information about somatoform and dissociative disorders. It discusses key somatoform disorders like hypochondriasis, conversion disorder, and body dysmorphic disorder. It also outlines the five dissociative disorders including depersonalization disorder, dissociative amnesia, dissociative fugue, dissociative trance disorder, and dissociative identity disorder. For each disorder, it discusses characteristics, causes, prevalence, and treatment approaches.
Somatoform disorders are a group of mental disorders characterized by physical symptoms that cannot be fully explained by a general medical condition. Key features include physical complaints with no adequate medical explanation that cause significant distress or impairment. Somatization disorder involves multiple somatic complaints over several years, while conversion disorder involves neurological symptoms that are psychologically caused. Hypochondriasis involves excessive worry about having a serious illness despite medical reassurance. Treatment focuses on psychotherapy and treating any underlying mental health conditions.
This document provides an overview of conversion disorder, including:
- Definitions, related illnesses, risk factors and symptoms of conversion disorder
- Neurobiological frameworks for conversion disorder involving altered attention, awareness and affect dysregulation
- The importance of comprehensive assessment including objective neurological exams, diagnostic imaging, and screening tools
- A case review of 34 patients with conversion motor paralysis who underwent rehabilitation treatment, with most showing improvement.
Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and cause significant distress. Somatic symptom disorder involves preoccupation with fears of illness for 6+ months. Illness anxiety disorder is a preoccupation with being sick without actual symptoms. Conversion disorder involves psychological stress converting to motor or sensory symptoms. Treatment focuses on reassurance, psychotherapy, and addressing underlying psychiatric conditions.
This document provides information on several dissociative and somatic symptom disorders. It defines dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder. It also covers somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder, factitious disorder, and Munchausen syndrome. The diagnostic criteria for each disorder are outlined, including symptoms, duration, and impacts on functioning.
This document summarizes the rationale for the new diagnosis of somatic symptom disorder (SSD) in the DSM-5. The authors explain that SSD represents a consolidation of several previously separate diagnoses from the DSM-IV. It aims to address numerous issues with the previous somatoform disorder categories, such as unclear terminology, overreliance on the concept of "medically unexplained symptoms," overlapping criteria between diagnoses, and low reliability and prevalence rates in clinical practice. The new SSD criteria emphasize persistent somatic symptoms along with disproportionate thoughts, feelings and behaviors related to the symptoms, rather than focusing only on a lack of medical explanation for symptoms.
Lay health beliefs refer to non-medical beliefs about health that individuals hold based on factors like culture, experiences, and socioeconomic status. These beliefs influence how individuals interpret symptoms and seek treatment. Several influential theories aim to understand lay health beliefs and illness behaviors, including attribution theory, the sick role, stigma, health-seeking behavior models, and illness cognition models. The health belief model also seeks to explain health behaviors based on individuals' perceptions of threats, benefits, and their ability to act.
Somatoform disorders are a group of mental illnesses characterized by physical symptoms that cannot be fully explained by a medical condition. Key somatoform disorders include:
- Somatization disorder/somatic symptom disorder, characterized by multiple physical symptoms and excessive thoughts about health.
- Conversion disorder, where psychological factors cause neurological or sensory symptoms like paralysis.
- Hypochondriasis, characterized by excessive fears about having a serious illness despite medical reassurance.
- Body dysmorphic disorder, characterized by a preoccupation with an imagined physical defect.
- Pain disorder, characterized by severe pain that is the main focus. Treatment involves psychotherapy and medication management.
This document discusses somatoform disorders, which are psychiatric disorders characterized by physical symptoms that cannot be fully explained by a medical condition. It defines several types of somatoform disorders, including somatization disorder, conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. It provides diagnostic criteria and characteristics of each disorder. It also discusses approaches to diagnosis, treatment involving CBT and referral to mental health professionals, and follow-up care.
Somatoform disorders are characterized by physical symptoms that cannot be explained medically despite the individual's belief that the symptoms are real. They include somatization disorder, conversion disorder, pain disorder, and hypochondriasis. Diagnosis involves ruling out physical causes through medical evaluation. Treatment focuses on psychotherapy to help express emotions verbally rather than physically, establish adaptive behaviors, and restructure beliefs. Medication may be used for comorbid mood disorders but not the somatoform symptoms themselves.
This document discusses somatoform disorders. It begins by defining somatoform disorders as mental illnesses characterized by physical symptoms that cannot be fully explained medically and cause impairment. Key points include: somatoform disorders involve the presentation of physical complaints due to psychological factors; they are characterized by multiple somatic complaints and persistent healthcare seeking despite reassurance; and common types include somatization disorder, conversion disorder, and hypochondriasis. Treatment involves identifying and addressing the underlying psychological causes through cognitive behavioral therapy and other approaches.
Somatization disorder is characterized by physical symptoms that cannot be fully explained medically and are thought to arise from psychological factors. People with pain disorder experience severe, prolonged pain that significantly impacts their daily lives. Hypochondriasis involves excessive fears about having a serious illness despite medical evaluations finding no physical causes. These somatoform disorders are influenced by predisposing factors like family dynamics, past illnesses, and psychological theories. Treatment involves psychotherapy, behavioral therapy, and sometimes medication.
Dr. Ziad N. Arandi discusses somatoform disorders, which are characterized by physical symptoms that cannot be fully explained by medical factors. He outlines four main somatoform disorders - somatization disorder, hypochondriasis, pain disorder, and conversion disorder - providing details on diagnostic criteria, prevalence, characteristics, and treatment approaches for each. The goal in managing somatoform disorders is control rather than cure through supportive psychotherapy, behavioral modification, relaxation therapy, and medication if needed.
This document defines and describes several somatoform disorders and related conditions, including: somatization disorder, pain disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, factitious disorder, and malingering. These conditions are characterized by physical symptoms that cannot be fully explained by medical factors, and appear to be influenced by psychological issues. They involve preoccupations with health, pain experiences, or imagined physical defects that are distressing and disruptive to the individual.
somatoform disorders are characterized by persistent requests for medical attention because of physical complaints that cannot be sufficiently explained by medical causes.
Somatoform disorders involve physical symptoms that cannot be fully explained by a medical condition. Common symptoms include pain, nausea, and fatigue. Treatment focuses on developing a supportive patient-practitioner relationship and psychotherapy to help patients understand psychological factors contributing to their symptoms.
The document discusses somatoform disorders, which are characterized by physical symptoms that cannot be fully explained by a medical condition. Patients express psychological conflicts through bodily symptoms unconsciously. Common somatoform disorders include conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. Treatment involves developing coping skills, increasing awareness of emotional factors, relaxation techniques, medication for comorbid conditions, and focusing on functioning rather than physical symptoms.
This document discusses several somatic symptom and dissociative disorders including somatic symptom disorder, illness anxiety disorder, conversion disorder, and their diagnostic criteria and features. Somatic symptom disorder involves physical symptoms that cause significant distress or impairment, along with excessive thoughts about the symptoms. Illness anxiety disorder involves severe health anxiety without corresponding physical symptoms. Conversion disorder was historically called hysteria and involves neurological symptoms like paralysis that cannot be explained physically.
This document discusses somatoform and dissociative disorders as defined in the DSM-IV. Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and are thought to be linked to psychological issues. Dissociative disorders involve disruptions or breakdowns in consciousness, memory, identity or perception. The document provides overviews of specific disorders including their defining features, causes, prevalence and treatment approaches. These include conversion disorder, pain disorder, hypochondriasis and dissociative disorders like dissociative identity disorder.
D, a 10-year-old boy, presented with deteriorating vision but no medical cause was found. During the consultation, it was revealed he lived with a stepfather he did not like and had family relationship issues. After discussing his difficult family situation, D reported that his vision had returned to normal. This suggests he may have been experiencing a somatoform disorder where psychological or emotional factors were affecting his physical symptoms.
Somatiform disorders are characterized by physical symptoms that cannot be explained physically. They result from psychological factors and cause significant impairment. The disorders include somatization disorder, hypochondriasis, somatoform autonomic dysfunction, and persistent somatoform pain disorder. Treatment involves ruling out physical causes, evaluating psychological stressors, and using antidepressants, psychotherapy, and alternative therapies to help patients develop more effective coping strategies.
Somatic Symptom Disorder is a mental disorder characterized by persistent and clinically significant somatic complaints coupled with excessive thoughts, feelings, and behaviors about the symptoms. There are four types of somatic symptom disorders including complex somatic symptom disorder, factitious disorder, conversion disorder, and somatic symptoms not otherwise specified. Diagnosis requires one or more somatic symptoms as well as excessive somatic concerns. Common somatic symptoms include headaches, stomach aches, and in rare cases, blindness or inability to walk. Somatic Symptom Disorder prevalence ranges from 1.5-21% depending on age, with stress and trauma as potential biological and environmental contributors. Treatment involves psychotherapy and cognitive-behavioral therapy, though convincing patients the symptoms are mental not physical can be challenging.
Somatoform& disaasociative disorders nov 9IMH chennai
This document provides definitions and information about somatoform and dissociative disorders. It discusses key somatoform disorders like hypochondriasis, conversion disorder, and body dysmorphic disorder. It also outlines the five dissociative disorders including depersonalization disorder, dissociative amnesia, dissociative fugue, dissociative trance disorder, and dissociative identity disorder. For each disorder, it discusses characteristics, causes, prevalence, and treatment approaches.
Somatoform disorders are a group of mental disorders characterized by physical symptoms that cannot be fully explained by a general medical condition. Key features include physical complaints with no adequate medical explanation that cause significant distress or impairment. Somatization disorder involves multiple somatic complaints over several years, while conversion disorder involves neurological symptoms that are psychologically caused. Hypochondriasis involves excessive worry about having a serious illness despite medical reassurance. Treatment focuses on psychotherapy and treating any underlying mental health conditions.
This document provides an overview of conversion disorder, including:
- Definitions, related illnesses, risk factors and symptoms of conversion disorder
- Neurobiological frameworks for conversion disorder involving altered attention, awareness and affect dysregulation
- The importance of comprehensive assessment including objective neurological exams, diagnostic imaging, and screening tools
- A case review of 34 patients with conversion motor paralysis who underwent rehabilitation treatment, with most showing improvement.
Somatoform disorders involve physical symptoms that cannot be fully explained by medical factors and cause significant distress. Somatic symptom disorder involves preoccupation with fears of illness for 6+ months. Illness anxiety disorder is a preoccupation with being sick without actual symptoms. Conversion disorder involves psychological stress converting to motor or sensory symptoms. Treatment focuses on reassurance, psychotherapy, and addressing underlying psychiatric conditions.
This document provides information on several dissociative and somatic symptom disorders. It defines dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder. It also covers somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder, factitious disorder, and Munchausen syndrome. The diagnostic criteria for each disorder are outlined, including symptoms, duration, and impacts on functioning.
This document summarizes the rationale for the new diagnosis of somatic symptom disorder (SSD) in the DSM-5. The authors explain that SSD represents a consolidation of several previously separate diagnoses from the DSM-IV. It aims to address numerous issues with the previous somatoform disorder categories, such as unclear terminology, overreliance on the concept of "medically unexplained symptoms," overlapping criteria between diagnoses, and low reliability and prevalence rates in clinical practice. The new SSD criteria emphasize persistent somatic symptoms along with disproportionate thoughts, feelings and behaviors related to the symptoms, rather than focusing only on a lack of medical explanation for symptoms.
Lay health beliefs refer to non-medical beliefs about health that individuals hold based on factors like culture, experiences, and socioeconomic status. These beliefs influence how individuals interpret symptoms and seek treatment. Several influential theories aim to understand lay health beliefs and illness behaviors, including attribution theory, the sick role, stigma, health-seeking behavior models, and illness cognition models. The health belief model also seeks to explain health behaviors based on individuals' perceptions of threats, benefits, and their ability to act.
The document discusses functional somatic syndromes, which are conditions characterized more by symptoms and suffering than identifiable tissue abnormalities. These syndromes include chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and others. While the causes are not fully understood, these syndromes are thought to involve biological, psychological, and social factors and often involve high rates of psychiatric comorbidity, symptom overlap between syndromes, and refractoriness to standard medical treatments.
The document discusses functional somatic syndromes, which are characterized more by symptoms, suffering, and disability than by demonstrable tissue abnormalities. These syndromes include conditions like chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. They share similarities in phenomenology, high rates of co-occurrence between syndromes, and higher than expected rates of psychiatric comorbidity. While discrete causes may be found for some patients, psychosocial factors like the belief of having a serious disease, expectations that the condition will worsen, the "sick role", and alarming media portrayals perpetuate the distress of these patients.
Relapse Prevention In The Dual Diagnosedcelenaheine
This document discusses relapse prevention in individuals with dual diagnoses of substance abuse disorders and mental illness. It provides an overview of several key points:
1) Dually diagnosed individuals are a heterogeneous group with substance abuse and either Axis I disorders like depression/anxiety or Axis II personality disorders.
2) Common challenges in diagnosis and treatment include differentiating psychiatric symptoms from substance effects and comorbidities.
3) Successful treatment requires tailored, integrated programs addressing both disorders through approaches like cognitive behavioral therapy and relapse prevention.
4) Future research is still needed on the roles of specific mental illnesses in substance abuse and factors influencing abstinence.
This document outlines the sixth version of the Standards of Care published by the Harry Benjamin International Gender Dysphoria Association for the treatment of gender identity disorders. It covers diagnostic concepts and nomenclature, treatment approaches for children and adults, and guidelines for hormone therapy and gender-affirming surgeries. The overarching treatment goal is helping individuals find lasting comfort with their gender identity to maximize well-being. Flexibility is emphasized to meet patients' unique needs within clinical guidelines.
This study examined the relationship between personality traits, cognitive factors, and functional impairment in fibromyalgia patients. 74 fibromyalgia patients completed questionnaires measuring the big five personality traits, pain catastrophizing, pain anxiety, pain vigilance, and functional impairment. Results showed that neuroticism and conscientiousness predicted pain catastrophizing, and neuroticism, openness, and agreeableness predicted pain anxiety. Neuroticism had an indirect effect on pain anxiety through pain catastrophizing. Neuroticism also showed a trend toward moderating the relationship between impairment and pain anxiety. The findings support the fear-avoidance model of pain and provide insight into how personality relates to cognitive and emotional dimensions of pain in fibromyalgia.
Research-Based Interventions: Dissociative Identity Disorder 1
THIS IS AN EXAMPLE PLEASE DO NO COPY DO NOT PLAGiarism
Research-Based Interventions: Dissociative Identity Disorder
“Dissociative identity disorder is characterized by the presence of two or more identities or personality states, each with its relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self” (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). There are many characteristics used that accompany Dissociative Disorder (DID). One method to understanding would be to know how the disorders are classified and defined. DID may be conceptualized effectively using the diathesis-stress model. There are many different intervention strategies for this disorder as well. Over time researchers have discovered the most effective treatments and interventions that can be used regarding DID. When one dissociates, the person may not have conscious awareness of what is happening (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
Peer-reviewed Articles
One limitless, longitudinal, naturalistic, and prospective study investigated childhood maltreatment (CM) in adult intimate partner violence (IPV) victims among Dissociative Disorder (DD) patients with Dissociative Identity Disorder with CM rates of 80-95% and severe dissociative symptoms (Webermann, Brand, & Chasson, 2014). The methods of this study include 275 DD outpatient therapy patients who completed a self-reported measure of dissociation (Webermann, Brand, & Chasson, 2014). Analyses assessed associations between CM typologies, trait dissociation, and IPV (Webermann, Brand, & Chasson, 2014). The results of this study include emotional and physical child abuse associated with childhood witnessing of domestic violence, physical, and emotional IPV (Webermann, Brand, & Chasson, 2014) Two-tailed independent samples t -tests and z-tests were used in this study to represent data as well. “As an effect size, odds ratios (ORs) were calculated to predict the likelihood of a participant being in an abusive adult relationship if they experienced a particular type of CM” (Webermann, Brand, & Chasson, 2014, p. 5).
A double-blind study was conducted including 15 females with DID compared to 23 without psychopathology., chosen by self-disclosure results of a questionnaire along with a structured clinical interview by psychiatrists The objective was to examine the volumetric differences between amygdala and hippocampal volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). These researchers used MRI to measure volumes of the amygdala and hippocampus. The results included the volume of the hippocampus being 19.2 % smaller and the amygdala being 31.6% smaller in patients with DID when compared to the other subjects without psychopath ...
A Critical Look at Clinical PsychologyThe .docxransayo
A Critical Look at Clinical Psychology
The DSM
“Patchwork of scientific data, cultural values, political compromises, and the material for making insurance claims”
The 1980 edition revision tried to mimic a biomedicine style
In Psychiatric diagnosis, etiology is rarely known
Reliability remains a big problem
The 1980 edition began to define conditions by listing symptoms. Revision was an effort to portray psychiatry as a branch of medicine which would boost credibility of the field and ensure financial viability. However in biomedicine, diagnosis are based on etiology > that is causes rather than symptoms. And they would then test for various causes of said symptoms. In psychiatric diagnosis, etiology, is rarely known. Ex. Schizophrenia (combination of things). Reliability remains a big problem with the DSM. Just because not every clinician may give the same individual the same diagnosis. -> could be due to cultural values, ethnicity or socioeconomic status.
Homosexuality
Multiple theories that classified homosexuality as a disease
Psychiatrist and psychoanalyst Edmund Bergler infamously wrote in a book for general audiences, “I have no bias against homosexuals; for me they are sick people requiring medical help... Still, though I have no bias, I would say: Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner... [their] shell is a mixture of superciliousness, fake aggression, and whimpering. Like all psychic masochists, they are subservient when confronted with a stronger person, merciless when in power, unscrupulous about trampling on a weaker person”
On December 15, 1973, the Board of Directors of the APA declassified homosexuality per se as a mental disorder from the DSM-II
Judgements of Normality depend on social norms, cultural standards and local customs. Grief is another example. Talk about different cultures
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Questions to ask after Video:
What are some things that you noticed within the video?
What are the explicit ideas expressed in this video?
What’s the overall message?
Political Economy of Clinical Psychology
1980’s revision involved “medicalization”
Adoption of the language of medicine. Including terms like: disease, symptoms, patient, syndrome, relapse, diagnosis and prognosis.
Introduction of managed care
Intrusion of pharmaceutical companies
Conflict of interest between pharmaceutical companies and psychiatrists
Drastic cuts in funds for mental health care
The 1980 revision of the DSM involved medicalization. Meaning they adopted the language of medicine to understand and describe psychological suffering. This language would include disease, symptoms, patient, syndrome, relapse, diagnosis and prognosis.So now that the field of psychiatry identified itself as a “medical” specialty, the research efforts concentrated on searching for biological bases of suffering and pharmaceutical treatments. Politica.
Somatic symptom disorder is a mental illness characterized by debilitating physical symptoms that cannot be explained by a medical condition. It is believed to develop due to factors such as genetic vulnerability, trauma, and cultural norms that emphasize physical over psychological suffering. In North America, the rise of somatic symptom disorder can be attributed to a hyper-medicalized society and neoliberal ideals that encourage individuals to see themselves as autonomous and responsible for their own health and well-being.
This document provides an overview of factitious disorder, including its history, definitions, subtypes, proposed causes and risk factors, demographics of those affected, treatment approaches, and diagnostic testing considerations. It describes how factitious disorder was first documented by Galen and later studied by Richard Asher in 1951. Key points covered include the deliberate falsification of physical or psychological symptoms for the purpose of assuming the sick role, potential psychodynamic drivers like seeking attention or nurturing, and challenges in treating those diagnosed due to lack of follow through.
Schizophrenia and diagnosis by Angeline Davidkellula
This document provides information about schizophrenia, including its clinical characteristics, biological and psychological explanations, and biological and psychological therapies.
It outlines the main clinical characteristics of schizophrenia such as psychotic symptoms that involve a break from reality, lack of insight into their condition, and both positive symptoms like delusions and hallucinations as well as negative symptoms like flattened affect and social withdrawal.
It also discusses issues surrounding the classification and diagnosis of schizophrenia in terms of reliability and validity. There are differences between classification systems like the DSM and ICD that can impact reliability. Factors like cultural biases, variability between countries, and studies showing poor reliability of diagnoses also pose challenges. However, improvements have been made to increase standardization and reliability
Somatoform and dissociative disorders involve physical symptoms that cannot be fully explained by medical conditions. Somatoform disorders include somatization disorder, where patients experience many physical complaints without clear medical causes. Treatment focuses on limiting attention and reinforcement of symptoms, as well as addressing any underlying psychiatric issues. Conversion disorder involves psychological stress converting into physical symptoms like paralysis or seizures. Symptoms often resolve spontaneously with supportive therapy.
Men are increasingly experiencing body image issues and eating disorders. Research estimates 5-10% of eating disorder cases are men, though many go undiagnosed due to stigma. Men experience body dissatisfaction, negative self-perception, excessive exercise, steroid use, and disordered eating behaviors driven by cultural pressures to obtain muscular physiques. LGBTQ men especially are at higher risk, as they face additional pressures within their communities to attain ideal bodies. Research aims to better understand the nature, prevalence, and risk factors of these conditions in men.
1 Fears and Phobias A significant change to.docxAASTHA76
1
Fears and Phobias
A significant change to the DSM-5 is the separation of diagnoses formerly grouped together in
the DSM-IV. Anxiety disorders no longer include obsessive-compulsive disorders, which are
now their own classification (obsessive-compulsive and related disorders). Also separated from
anxiety disorders are posttraumatic stress disorder and acute stress disorder, which are now
included in the classification of trauma- and stressor-related disorders.
Anxiety Disorders
There are few changes to the diagnoses in this classification that directly impact individuals
under the age of 18. In fact, the primary change has been the re-grouping of disorders to more
accurately reflect associations in diagnostic criteria. This revised classification includes
separation anxiety disorder, selective mutism (formerly included in disorders usually first
diagnosed in infancy, childhood, or adolescence in the DSM-IV), specific phobia, social anxiety
disorder (formerly social phobia), panic disorder, agoraphobia, generalized anxiety disorder,
anxiety due to another medical condition, other specified anxiety disorder, and unspecified
anxiety disorder.
The diagnosis anxiety disorder not otherwise specified has been removed, and two new
diagnoses added: other specified anxiety disorder and unspecified anxiety disorder. Both of these
diagnoses represent significant clinical distress or impairment based on anxiety disorder
diagnostic criteria, but do not meet full criteria for a specific diagnosis. Clinicians should use
other specified anxiety disorder and add the specific reason for the more general diagnosis (e.g.,
short duration of symptoms or cultural association). The latter diagnosis—unspecified anxiety
disorder—is used when clinicians cannot (or choose not to) identify reasons for an inability to
make a more specific diagnosis, yet clearly observe multiple criteria from the anxiety disorders
classification.
Below is a summary of additional changes to the diagnoses in this classification that may impact
individuals under the age of 18.
Social Anxiety Disorder (Social Phobia)
The preferred diagnostic descriptor is now social anxiety disorder, reflecting a more specific
association with symptomology. Wording of criteria has been altered to be more clear and
applicable across social situations and age ranges. For children, anxiety must occur in peer
settings (i.e., not exclusively with adults); the requirement that the child must exhibit a capacity
for age-appropriate social interaction with familiar people has been removed. Also, consistency
across ages has been supported by the requirement of duration to be at least six months (for all
ages) and by the deletion of the need for individuals over 18 to recognize the fear is
unreasonable.
Separation Anxiety Disorder
This disorder—formerly included in disorders usually first diagnosed in infancy, childhood, or
adolescence—has been moved to the anxi.
Psychological responses-to-illness-textbook-of-psychosomatic-medicineFreids Mal
This document discusses psychological responses to illness. It begins by outlining some of the common stresses that accompany medical illness and hospitalization, including separation from friends/family, loss of independence, and threats to one's sense of self and identity. It then describes how personality, coping styles, and defense mechanisms influence how individuals subjectively experience illness. The document presents different frameworks for understanding psychological responses without exclusively endorsing any single theory. It provides an overview of topics like denial, emotional responses, and behavioral responses to illness.
This document summarizes a study that examined the relationship between body image disturbance, body dysmorphic disorder (BDD), and behavioral principles from Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP). The study hypothesized that higher levels of body image disturbance would be correlated with greater experiential avoidance (as measured by ACT principles) and difficulties expressing emotions interpersonally (as measured by FAP principles). Results supported these hypotheses and also found that experiential avoidance and interpersonal expression difficulties predicted meeting criteria for BDD and severity of BDD symptoms. The study provides empirical support for integrating intrapersonal and interpersonal conceptualizations of body image issues.
This document discusses factitious disorder, including factitious disorder imposed on self and factitious disorder imposed on another. It defines the disorders, provides diagnostic criteria, and discusses epidemiology, etiology, history, and nosology. Factitious disorder involves the intentional falsification or simulation of physical or psychological signs and symptoms for psychological reasons.
Respond to at least two colleagues by explaining how they could use .docxcarlstromcurtis
Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client's awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
The document discusses innovative STEM education programs in Indonesia and New York that use project-based and experiential learning methods. These methods aim to improve student engagement, which is linked to academic success. The Integrated Ecology Curriculum and SAInS programs show promising results, including reduced dropout risk indicators and increased student participation. The key message is that engagement-focused instructional approaches can effectively teach STEM subjects and impact educational outcomes.
RJohnson Overview of UI Partnership Climate Mitigationbeccane
This document outlines a partnership between the University of Indonesia and Columbia University to establish a Research Center for Climate Change. The center aims to build capacity in Indonesia to mitigate climate change through reducing emissions from deforestation and forest degradation. It will provide academic programs, professional development, and societal outreach on topics like forest carbon credits and innovative methods to reduce forest loss. The goal is to prepare Indonesian society to limit emissions, protect forests and livelihoods, and conserve biodiversity.
RJ Portfolio Online course PBL text excerptbeccane
This document provides an overview of a course on sustainable communities that uses the Integrated Ecology Curriculum (IEC) and Understanding by Design (UBD) frameworks. The IEC emphasizes local environments, hands-on research techniques, and literacy. UBD involves backward planning where lessons are designed based on desired results. The course introduces these frameworks and has students develop a project-based ecology unit for their classroom using local resources.
The document is an introduction to the Certificate in Conservation and Environmental Sustainability program offered through the Center for Environmental Research and Conservation (CERC). It provides an overview of the following:
- CERC was founded in 1997 to provide education and training in conservation science through courses taught by faculty from partner organizations.
- The goal is to empower professionals to be better environmental stewards. The certificate program teaches the interconnectedness of ecology, conservation, sustainability and economics.
- Courses are offered evenings and weekends to accommodate working professionals. The 12-course certificate can be completed in as little as 9 months or up to 3 years. Courses fall under categories including science, case studies, tools, and environmental policy/
The document proposes expanding an existing environmental journalism program through a collaboration between the Columbia School of Journalism and the Center for Environment, Economy, and Society. The expanded program would include:
1) Three journalism fellowships providing tuition and stipends for study and an intensive journalistic project.
2) Two environmental journalism institutes per year, one in the Dominican Republic and one in New York, attended by 15-20 journalists and fellows. Experts would address current issues.
3) A budget of $527,500 is requested to fund staff time, travel, lodging, stipends and fellowship costs for the expanded multi-year program.
The Center for Environment, Economy, and Society (CEES) has developed an Integrated Ecology Curriculum (IEC) implemented in 5 NYC public middle schools serving over 1,000 students. The IEC focuses on hands-on field investigations to teach science and other subjects in an integrated way. It has led to significant decreases in truancy, suspensions, and course failures along with increases in standardized test scores. The IEC provides authentic learning experiences, develops students' higher-order thinking skills, and increases engagement—benefiting students academically and personally.
This document provides an overview of the Integrated Ecology Curriculum (IEC) program developed by Columbia University's Center for Environment, Economy, and Society. The 3-sentence summary is:
The IEC program uses environmental science as a framework for project-based, place-based middle school learning to increase scientific literacy, engagement, and academic outcomes; it provides intensive teacher training and develops integrated, field-based projects to teach real-world skills; evaluation found decreases in absenteeism and suspensions along with increases in standardized test scores at IEC schools compared to peers.
RJohnson Portfolio-USAID Project Final Report Exec Summary (9 pages)beccane
This report summarizes the School Action for Innovations in Science (SAInS) program, which aimed to improve STEM education in Indonesian high schools over 3 years from 2012-2015. Key activities included a study tour of US STEM programs, developing strategic action plans for 3 partner schools and IPB university, workshops on curriculum reform and using Fab Labs, and implementing action plans with support from embedded experts. These efforts reached over 5,000 students and trained many teachers. The program also disseminated resources through a website, an annual science fair, and expanding IPB's role in teacher training. Evaluations found growth in STEM instruction and interest in the partner schools as well as demand from other schools and districts
This document provides lessons learned from the SAInS project, which aimed to promote innovative science instruction in Indonesian schools. Key lessons include:
1) Schools prioritized innovations that aligned with the existing curriculum due to incentives from assessments and policies. Teachers struggled to implement new pedagogies without sustained guidance.
2) Indonesian personnel policies, like frequent principal changes and incentives prioritizing classroom teaching, posed challenges for project implementation and teacher participation in non-classroom activities.
3) Hands-on learning labs (FabLabs) generated student excitement but required dedicated lab managers to help teachers integrate the labs into classroom instruction across different subject areas. Strong administrative support and involvement of multiple teachers was also important
RJohnson Portfolio USAID Project Report Example STEM activities (10 pages)beccane
This document provides examples of STEM projects completed by schools in the SAInS (School Action for Innovations in Science) program in Indonesia. It describes two exemplary projects:
1) At SMA 1 Kepanjen, students conducted an interdisciplinary project on the economic and environmental potential of landfill waste. They studied decomposition biology, biogas extraction, and the social impacts on waste pickers through fieldwork at the local landfill.
2) At SMA Kornita Bogor, students used 3D printers to create tactile books for blind children. Working with a local school for the blind, they designed 3D models, printed them, and assembled the books to support literacy for
RJohnson Portfolio USAID Project Report Example STEM activities (10 pages)
Rjohnson paper psy745
1. JOHN JAY COLLEGE OF CRIMINAL JUSTICE
Somatization and
Somatoform Disorders
Conceptualization and Assessment
Rebecca Johnson
12/1/2011
2. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 1
Somatization Disorder is one of five somatoform disorders listed in the DSM-IV-TR,
along with Conversion Disorder, Hypochondria, Pain Disorder, and Body Dysmorphic Disorder.
These conditions are defined by physical symptoms that are not explained by physical disease or
bodily pathology; or whose severity is greatly in excess to what would be expected in any
present medical illness. Unlike malingering or factitious patients—who profess false symptoms
to gain benefit or out of desire to inhabit a sick role, respectively-- patients with somatoform
disorders do not consciously or intentionally feign symptoms. Symptoms are truly experienced,
and cause considerable distress and impairment. Medically Unexplained Symptoms (MUS) have
also been referred to in the literature as Functional Somatic Symptoms (FSS), drawing attention
to the fact that despite apparent lack of medical cause they function identically to any “real”
somatic symptom.
Somatization is commonplace: the presentation of FSS is nearly universal in across
cultures globally (Aragona, Monteduro, Colosimo, Maisano, & Geraci, 2008). Patients with
unexplained symptoms appear in medical offices very often, with studies giving esti mates that
as many of 52% of all doctor visits and 30% of all primary care visits are prompted by one or
more FSS (Kirmayer, Groleau, Looper, & Dominicé, 2004). Thus somatization in itself isn’t
unusual; it crosses the threshold into pathological somatoform illness based on the number and
persistence of symptoms, distress and impairment deriving from the symptoms, and overuse of
medical services once medical cause has been ruled out.
Although Somatization Disorder is the primary focus of this review, research studies
often collectively examine somatoform disorders1--especially when considering controversies of
1
Briefly, the othersomatoform disordersinclude Hypochondria (fear or conviction that one has a specific illness);
Pain Disorder (where patientspresent only pain symptoms); Conversion Disorder (presentation of pseudo-
3. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 2
classification and diagnosis—or FSS as a construct independent of any particular diagnosis.
DSM-IV criteria for Somatization Disorder (SD) proper include all of the following: 4 pain
symptoms related to different bodily locations or functions ; 2 gastrointestinal symptoms; 1
sexual or reproductive symptom; and 1 neurological symptom (such as numbness, weakness,
dizziness). The patient’s history of symptoms must begin before age 30, occur over several
years, and result in significant social, occupational or other impairment. They must also, of
course, not be better explained by medical illness or condition or by use of a substance.
Incidence and Prevalence
Because SD diagnosis requires such pervasive and longstanding symptomology, it is one
of the least common somatic disorders. Lifetime prevalence of somatoform disorders overall is
about 1% , but the rate is only 0.4%-0.75% for SD (Ladwig, Marten-Mittag, Erazo, & Gündel,
2001) As many as 5x more women than men are affected by somatoform disorders (Karvonen et
al., 2004) with the gender difference for SD as high as 10 x greater for women2(Mai, 2004).
Somatization disorder is more common as well in persons of low economic or social status
(Cwikel, Zilber, Feinson, & Lerner, 2008).
The High Cost of Somatoform Disorders
Somatization disorder and FSS bring high personal and societal costs. Patients typically
spend years with painful and debilitating symptoms that defy explanation or effective treatment
and render them unable to effectively maintain employment, social interaction, or personal
relationships. One strong indication of the level of impairment is the fact that SD patients spend
neurological symptoms subsequent to a trauma or stressor); and Body Dysmorphic Disorder (pre-occupation with
perceived bodily defect or abnormality)
2
The gendergap in diagnosisis significantly smaller for Pain Disorder and Hypochondria than for Somatization
Disorder, Conversion Disorder , and Body Dysmorphic Disorder.(Ladwig, et al., 2001) (Kuwabara et al., 2007)
4. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 3
an average of 7 days of every month in bed (Bass, Peveler, & House, 2001). SD patients have
much higher suicide rates than other Axis I or Axis II disorders, prompting clinical advice to
screen for SD among depressed patients—or for suicidal ideation in SD patients—as it represents
a specific suicide risk. (Chioqueta & Stiles, 2004) Frustration is shared by doctors as well, who
spend a disproportionate percentage of time and effort treating SD patients, with little positive
effect. One line of research in recent years is devoted specifically to evaluating effective
strategies for physicians dealing with SD patients (García-Campayo, Claraco, Sanz-Carrillo,
Arévalo, & Monton, 2002).
SD and other somatoform disorders become societally important when considering the
marked overuse of medical services, and the associated medical and social costs. In an attempt
to explain symptoms and find relief, SD sufferers make frequent medical appointments, request
and receive myriad diagnostic tests, and undergo invasive and expensive treatments and even
surgeries, in the quest for relief. Studies find that SD patients tend to follow cycles of testing and
treatment that may be repeated and duplicated with multiple doctors over time (Crimlisk et al.,
2000). As a result SD patients use an estimated 9 times the level of medical services of non-SD
patients3 and one particularly telling finding revealed that somaticizers received more surgeries
over a 10 year period than patients with identified medical diagnoses. (Fink, 1992). In the United
States, this over-utilization of medical services translates to a financial cost of $256 billion a
year in the United States, due to incremental costs solely attributable to somatization (Barsky,
Orav, & Bates, 2005).
Conceptualization and Diagnosis
3
This is reduced to 2x when controlled for the costs of comorbid physical and psychological conditions
5. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 4
Somatoform illness is baffling, distressing, and costly; it therefore has attracted much
research attention over the past century. Professional discussions leading up to the publication of
the DSM-V have prompted controversy over the validity of the classification and
conceptualization of these disorders as a coherent group. The most basic concern is the
possibility for medical illness to be incorrectly diagnosed as somatization. As medical science
advances, there remains the ever-present possibility that medical causes heretofore unknown will
be discovered for some FSS, thus revealing a so-called mental disorder to be physical after all.
Even disregarding that possibility, the subjective criteria used for diagnosing somatization may
be problematic, as they typically require clinicians to define “excessive” symptoms and distress
in contrast to presumably normal levels. There are those who believe the current grouping of
somatoform disorders itself is flawed, bringing together disorders arbitrarily on the basis of
“bodily” symptoms, even though they may manifest differing etiology and presentation (Birket-
Smith & Mortensen, 2002; Noyes, Stuart, & Watson, 2008).
Various research studies have questioned the validity of the current diagnostic categories,
particularly in light of the fact that FSS may appear in many other disorders that are not
considered to be somatoform. For example, many mood disorders have somatic symptoms
specifically listed amongst their diagnostic criteria. Furthermore some somatoform disorders
may arguably better belong to another diagnostic category. For instance, many researchers
contend that Body Dysmorphic Disorder (BDD) ought to be considered a variant of obsessive
compulsive disorder, since its obsessional quality is more clinically salient than its focus on
bodily disfigurement (Merskey & Mai, 2005).
Some researchers also argue for a reclassification of FSS in general, with SD, Pain
Disorder, and Hypochondria listed as variants of a newly termed Health Anxiety Disorder. This
6. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 5
would be described by four criteria on a continuum, emphasizing the primary role of anxiety in
the disorders: 1) pre-occupation with the body, with heightened attention to bodily function and
sensation; 2) disease conviction ranging from slight suspicion to delusional belief in the presence
of disease; 3) fear of disease ranging from slight worry to obsessional anxiety; and 4) safety-
seeking or confirmatory behaviors ranging from simple self-checking and verbal reassurance-
seeking, to invasive and potentially iatrogenic procedures including surgery. (Creed, 2011).
Etiology
Many different theories about the causes and origins of somatization have been put forth
over the past century, beginning with Sigmund Freud’s classic conceptualization of “hysteria” as
the conversion of anxiety and repressed psychic distress into physical manifestations (Merskey &
Mai, 2005) . This led to hypotheses that psychological defenses such as repression and denial
cause somatization. While this belief was broadly held for much of the 20th Century it lacked
empirical support. Recently, a large, multi-country study of over 25,000 patients found no
association between physical symptoms and psychological symptoms, tending to invalidate this
etiological view (Simon, VonKorff, Piccinelli, Fullerton, & Ormel, 1999).
Research in the past 30 years has investigated other potential causal and risk factors for
somatoform illness. Those with the strongest research support include: inherited risk for
emotional responsivity to physical sensations; deficient emotional self-regulation; learned
behaviors and attitudes; and environmental factors.
Etiology: Inherited Risk for Emotional Response to Symptoms
The first category describes a set of inherited traits including somatic sensitivity, high
emotional reactivity to stimuli, and a predisposition to negative affect (studied operationally
7. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 6
often in terms of the personality trait of neuroticism). A study of 1688 mono- and di-zygotic
twins, and non-twin siblings, has found that inherited risk factors contribute about 30% to the
etiology of Somatization disorder (Kendler, Martin, Heath, & Eaves, 1995) According to this
perspective, somaticizing patients are thought to be especially sensitive to physical sensations,
and to swift intense and generally negative emotional reactions to, and interpretations of, these
sensations. Hammad, Barsky & Regestein (2001) studied both affective and CNS response in
SD patients vs. non-somaticizing controls, and found that SD patients have a lower threshold for
affective response to stimuli, and evince greater autonomic arousal in response, with slower
recovery to baseline and quicker re-arousal upon repeated exposure to stimulus. (Hammad,
Barsky, & Regestein, 2001). Barsky had earlier developed a theory of “somatosensory
amplification” by which a patient focuses on bodily sensations, perceives them as intense and
disturbing, and interprets them to be pathological. Continued attention to the symptoms, and
conformational bias against any information that refutes the patients’ suspicion of illness, creates
a feedback loop of emotional distress and autonomic arousal that amplifies anxiety and symptom
severity. (Barsky, 1992). The Hammad et. al. study (Hammad, et al., 2001) found that
hyperarousal was indeed positively correlated to somatization in participants, indicating that
somatically disordered patients were not only more easily aroused but also less likely to be able
to distinguish between physically threatening vs. non-threatening stimuli. This makes SD
patients less able to filter out irrelevant sensations, to habituate to them, and to inhibit reactive
central nervous system arousal.
High levels of arousal and emotional reactivity become translated into distress and health
anxiety when interpreted through the lens of negative affect. A tendency for negative affectivity
is thought to be an inherited, stable personality trait according to various personality theories,
8. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 7
and is encompassed by the personality factor of “neuroticism” described by the Five Factor
model of personality(Feldman, Cohen, Doyle, Skoner, & Gwaltney, 1999). Some research
indicates that a predisposition to negative affect is at least as influential an etiological factor for
SD, as somatic sensitivity. One study specifically compared the relative influence of each,
finding that in emotional reactivity is mediated by a negative bias in reporting style and not by
somatosensory amplification/symptom perception hypothesis. Thus negativity is more
responsible for FSS than either emotional reactivity itself or somatic sensitivity (Aronson,
Barrett, & Quigley, 2006).
Related to neuroticism/negative affect, alexithymia is a personality construct that seems
to increase the likelihood that symptoms will be misinterpreted. Alexithymia refers to difficulty
in identifying and describing one’s emotions, and such lack of self-understanding and clarity
may trigger or worsen negative emotionality in the face of unexplained physical sensations. De
Gucht and Heister (De Gucht & Heiser, 2003) found a moderate relationship between
alexithymia and somatization while ((Porcelli et al., 2003) found not only a strong association
between alexithymia and the presentation of functional gastrointestinal disorders, but also that
levels of alexithymia are predictive of treatment outcome. [details of studies needed here)
Etiology: Deficient Emotion Self-Regulation Skills
In concert with the inherited factors described above, a second set of factors are thought
to play a part in the development of somatoform disorders. These factors are related to
deficiencies in emotional self- regulation, and in patients’ in strategies for coping with
symptoms. Emotional self-regulation is a fundamental psychological skill that is usually learned
in early infancy, as a child develops self-soothing techniques to respond to physical sensations,
assuage emotional distress, and ensure his or her are needs met (e.g. crying to gain adult
9. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 8
attention; sucking the thumb, clutching a blanket)(Waller & Scheidt, 2006). Emotional regulation
skills are critical at all ages, as they allow individuals to interpret stimuli, evaluate which stimuli
warrant attention and/or emotional response, and calibrate that response to react in an
appropriate way. Failings in emotional self-regulation may have a causal role in FSS, as patients
fail to accurately interpret bodily sensations, give undue attention to non-threatening stimuli, and
become emotionally reactive as a result. Research suggests a cycle where patients with
somatoform disorders often are unable to accurately identify their emotions and sensations
(alexithymia), fail to self-soothe (emotional regulation) in response to their hyper-aroused state
(emotional reactivity); and rely on a limited, rigid and maladaptive set of coping strategies.
Ineffective coping strategies exacerbate their sense of lack of control, which increases anxiety
and negative affect, resulting in greater physical discomfort and emotional distress.
Although psychoanalytic theories of somatization have been generally set aside, there is
nonetheless evidence that use of defensive coping responses can contribute to the development
of somatoform disorders. Several studies have found a link between defensive coping strategies
and FSS, with Brosschot and Aarse describing a specific subset of SD sufferers: highly
defensive copers who show higher anxiety levels than do those using less defensive coping
mechanisms. Defensive coping, including avoidance and repressing behaviors, seems to be a by-
product of greater alexithymia and dissociation between affect and autonomic response, as well
as the cognitive attribution of symptoms more often to physical than to psychological causes.
(Brosschot & Aarsse, 2001).
Etiology: Learned Maladaptive Behaviors
The nature and severity of FSS are highly influenced by personal experience and societal
culture, and their presentation may be part of a repertoire of learned behaviors. Generally
10. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 9
speaking, every individual learns specific and unique meanings of illness, pain and
symptomology within his or her family. Thus some families encourage or embrace an broad
conception of illness, accepting and validating expression of many types of symptoms, including
relatively less severe pain, injuries and discomfort. Other families may discourage the expression
of illness and limit acceptance of only relatively very severe and/or painful symptoms. Families
and intimates also may learn to “communicate by symptom” with shared meanings allowing
symptoms to substitute for direct expression of feelings. For example, children may learn that
when their mother has a headache it means she’s unhappy. These learned attitudes influence the
interpretation and attentional focus paid to symptoms and may result in greater report of FSS in
families with inclusive conception of and high attention to illness. FSS may vary in type or form,
as well, depending on socio-cultural norms. Thus in North America, where heart disease is
prevalent and publicized, somaticizers more often present symptoms such as chest pain and
shortness of breath than do patients in countries where heart disease is less common (Kirmayer
& Young, 1998).
Researchers have found significant evidence that learned attitudes toward health, illness
and particular diseases and symptoms contribute to somatoform disorders. Craig & Boardman
1994 longitudinal study revealed that patients presenting FSS are significantly more likely to
have been sick or witnessed negative health events in childhood (T. K. Craig, Boardman, Mills,
& Daly-Jones, 1993). This exposure may have the effect of making illness seem a more likely
explanation for ambiguous somatic symptoms to FSS patients than to those without illness
experiences in childhood. In addition children and adults witness the secondary benefits gained
by ill members of the family, who may get extra attention, sympathy, and support. It has been
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suggested that personal crisis may trigger somatization by triggering the need for extra care
during crisis (T. K. J. Craig, Drake, Mills, & Boardman, 1994).
Aside from witnessing or experience illness, other environmental factors serve to
heighten the risk of somatoform disorder, particularly parental neglect, non-contingent parenting,
and childhood trauma and abuse. With non-contingent parenting and neglect children receive
inconsistent and unpredictable responses to behavior and events in the home, causing confusion
that can contribute to alexithymia. Furthermore, effective emotional self-regulation-- learned via
stable child-parent interactions early in life—is impeded by childhood neglect and abuse, and
sexual abuse is particularly predictive of dissociative symptoms which may affect accurate
somatic perception and interpretation, both of which are implicated in somatoform illness
(Spitzer, Barnow, Gau, Freyberger, & Grabe, 2008). Post-traumatic stress reactions map closely
to the conditions that put individuals at risk for somatization: hyper-vigilance about physical
safety and bodily integrity, greater emotional reactivity, and negative interpretation of stimuli
(Spitzer et al., 2009). Post-traumatic response may be dissociative as well as overly reactive, so
that Conversion Disorder –characterized by dissociation—is more strongly linked to childhood
trauma than the other somatoform disorders as well. (Brown, Schrag, & Trimble, 2005)
State of the Research
Somatoform disorders are highly studied because of their enigmatic nature and high costs
to individuals and society. Prevalence rates are supported by large-scale and archival studies,
particularly in northern European nations with access to thousands of patients and patient records
in nationalized health care systems. For example one Danish team conducted a population based
survey of 7,466 people for somatization defined as having 6 or more symptoms in 2 or more
locations(Ladwig, et al., 2001). The findings from such a large, random sample pulled from the
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general population should be statistically strong and robust. One limitation, however, derives
from self-reporting bias amongst respondents. Another study in Denmark attempted to correct
for this by using structured interviews to screen a stratified sample of 701 individuals culled
from 1785 consecutive patients in 28 medical practices. The patients were screened for mental
and somatic symptoms and substance abuse, and for a variety of particular psychological
diagnoses, resulting in findings that f 35.9% of the sample met criteria for somatoform disorders
(Toft et al., 2005). In this case, although self-report bias was minimized, the population studied
was not random but already self-identified as patients, which of course resulted in much higher
prevalence findings. Nonetheless prevalence findings seem to be supported by solid research
based on large samples from a variety of community and clinical populations (Cwikel, et al.,
2008; Karvonen, et al., 2004; Kato, Sullivan, & Pedersen, 2010; Ladwig, et al., 2001; Mai,
2004).
One of the most impressive studies – in terms of number of participants--screened over
28,000 twins via blind, computer-assisted, structured questionnaire for various types of FSS.
Confirmation of prevalence findings was incidental , to the main objective of this study, which
was to use latent analysis to discover the best way to categorize types of FSS, to in light of
controversies regarding the classification of somatoform disorders. The authors derived 5 factors
from their data, but their primary finding was that somaticizing patients seem to either present
with a single type of symptom or many diverse symptoms, demonstrating the need for two types
of diagnosis: simple vs. complex somatoform syndromes (Kato, et al., 2010). In addition to this,
the authors used comparative data from mono-zygotic and di-zygotic twins to estimate a 7%-
29% contribution of genetic influence in the development of various somatoform disorders. The
results of this study seem particularly robust given the great number of participants, the blind and
13. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 12
anonymous administration of the survey, and the use of structured questions to garner more
accurate responses. The fact that the respondents were twins allowed the authors to control for
genetic effects as well as ascertain the proportion of genetic influence in contributing to
somatoform disorders.
The Kato (2010) study’s attempt to deduce logical categories for the many types
of FSS, reflects growing advocacy for reassessment of somatoform disorders and possible
reclassification in the DSM-V. Several studies seek support for reclassification by looking at
overlap in symptomology of patients with different disorders. Typical of these studies is one
conducted by Espirito-Santos et al (2009) using twenty-six patients with conversion disorder, 38
with dissociative disorders, 40 with somatization disorder, and a comparison group of 46 patients
taken from a clinical setting. Participants answered questions (using relevant instruments) about
dissociation, somatoform dissociation, and psychopathological symptoms. SD patients and the
controls reported significantly fewer dissociative and somatoform symptoms than did the CD and
Dissociative Disorder patients. This suggests that Conversion Disorder is more closely related in
presentation and etiology to other Dissociative illnesses than to Somatization Disorder, and
should be re-classified accordingly (Espirito-Santo & Pio-Abreu, 2009). These studies are
suggestive but the findings are weakened by their small size, limited and non-controlled
population sampling, and the potential for self-report bias or errors, as well as by the fact that the
results reflect a single instance of testing.
Similar limitations apply to a number of studies that attempt to locate a biophysiological
basis or marker for somatization. These include MRI and SPECT studies of the brain, as well as
measurements of HPA and ANS response, with comparisons between SD and non-SD
participants (Atmaca, Sirlier, Yildirim, & Kayali, 2011; Hakala et al., 2004; Hakala, Vahlberg,
14. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 13
Niemi, & Karlsson, 2006). For example, Hakala, et al (2004) found bilateral enlargement of the
caudate nuclei—a part of the frontal “executive circuit” of the brain dealing with bodily
awareness-- in 10 female SD patients, as compared to 16 female healthy controls. This difference
in brain structure may be implicated in somatization. While these sorts of findings cannot be
faulted in terms of objectivity, they are limited in generalizability by small numbers, and the
interpretation of results requires knowledge about how the specific structures function to
influence somatization. They are useful studies for just this purpose—to suggest avenues for
future study to explain how biophysical processes contribute to somatoform disorders.
Advances in medical imaging and diagnostic technology has led to increased studies the
bio-physiological underpinnings of somatization (Ellenstein, Kranick, & Hallett, 2011). However
most investigators continue to focus on the opposite end of the theoretical spectrum, at the ways
somatization may be the result of environmental factors or learning. Such studies tend to
compare survey or interview data from SD vs. non-SD participants, seeking evidence of
associations between childhood history and somatization (Brown, et al., 2005) Craig, Boardman
et. al. however, undertook a longitudinal study of 45 London patients presenting with multiple
FSS, over 2 years (T. K. Craig, et al., 1993). The South London Somatization Study compared
45 patients with multiple FSS, to 48 matched non-somaticizing patients, and 118 healthy
participants, as to various childhood factors. Compared to non-somatic and healthy controls, the
somaticizing group was significantly more likely to have observed illness in a close friend or
family member during childhood, and more likely to have experienced parental neglect. A
second follow-up in 1994 further assessed whether, within the 38 weeks prior to symptom
emergence –participants experienced stressful events with secondary gain potential. As
hypothesized, significantly more FSS patients than controls had experienced such stressors, and
15. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 14
they were less likely than non-somaticizing controls to use neutralizing coping skills (as opposed
to defensive or other coping skills). This study suffers from the same problem of small sample
size as the earlier cited works, as well as the issues of self-report bias and potential coding error
of patient interviews by researchers. Nonetheless the results gain credibility from the fact that
they were derived from a controlled paired study, from multiple measurements taken over 2
years in order to confirm persistence and consistency of reported histories and changes in
presentation of symptoms.
Childhood experience of illness and early family attitudes are oft-cited precursors to
somatoform disorders, but they are not the only environmental influence. Childhood abuse and
trauma are also strongly associated with somatization. One study found that 54% of patients
with SD reported childhood sexual abuse, compared to 16% patients with mood disorders
(Morrison, 1989). To further understand the link between somatization and childhood abuse,
there have been various studies that compare the incidence and type of abuse reported by
participants with FSS to that reported by non-somaticizing controls (generally patients with
mood disorders such as Major Depressive Disorder). Typically, researchers attempt to increase
the rigor of interview-based studies by using a combination of structured interviews and self-
report, for participants drawn from clinical populations and matched for demographic factors if
possible (Brown, et al., 2005; Mai, 2004; Spitzer, et al., 2008). Using paired controls, Brown and
Schrag conducted precisely such a study with 22 SD patients and 19 medical comparison
patients, who were given structured clinical interviews to assess the childhood family
environment, and screen for several types of childhood trauma as well as dissociative symptoms
often found in somatic patients. The authors found that SD patients reported significantly greater
emotional abuse, more severe physical abuse, and more emotionally distant and unsupportive
16. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 15
family relations than the non-SD controls (Brown, et al., 2005). Chronic abuse was the most
predictive of SD in this study, while other studies have found childhood sexual abuse to be
particularly predictive of Conversion Disorder later in life (Spitzer, et al., 2008). While there
have been quite a few of these studies, and each has found some association between childhood
abuse and somatization, the precise nature of the association is unclear. Different types of abuse
have been implicated in different studies without consistent agreement except for the general
association to trauma. All do share similar limitations, in that they use small samples drawn from
clinical populations, using self-report and interview techniques that may admit bias and error on
the part of both interviewer and subject. Critics of the studies note that abuse in childhood often
coincides with confounding characteristics of home and childhood environment which could be
the source of risk for SD.
An extremely active area of research has to do with the influence of personality
characteristics such as affective negativity and alexithymia. Investigators generally seek to
discern the many complex interactions seemingly in effect between somatization and various
combinations of emotional reactivity, negative affect, and alexithymia and other potential
cognitive deficits. One of the only community-based studies was conducted by (Bailey & Henry,
2007) who sent surveys sent by mail to 565 randomly selected households in New South Wales,
with a response rate of 41% (n=301). The authors sought to explore the relative influence of
alexithymia and negative affectivity on somatization, using a novel alexithymia scale that
provides sub-measures of not only the cognitive aspects of alexithymia (identifying, describing
and analyzing emotions and sensations related to emotions), but also the affective aspects
(capacity for emotional arousal, and fantasizing). They hypothesized a stronger tendency to
somaticize among participants with both cognitive and affective alexithymia (“type I”) vs.
17. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 16
simply cognitive alexithymia with normal affective function (“type II”). In addition they
hypothesize that the effect of either type of alexithymia will be mediated by a tendency toward
negative affect. The survey instruments included three self-report scales including the
alexithymia scale described above, a scale for somatization, and one for depression and anxiety
symptoms. Survey submissions indicating type I or type II alexithymia, vs. no alexithymia, were
culled from the pool and further analyzed with regard to somatization and negative affect.
Results confirmed a stronger association between somatization and type I alexithymia, than
either type II or non-alexithymia. It also found perfect mediation of both identifying and fantasy
subscales of alexithymia by negative affectivity indicating that alexithymia alone does not
predict somatization but interacts with negative affectivity to produce FSS. The validity of the
results are bolstered by the fact that they were anonymously submitted by a fairly large
community-based sample whose demographic makeup was not significantly skewed from the
community as a whole. There are limitations of self-selection and self-report bias, particularly
since respondents were asked to report on recalled memory and observations which can be
notoriously inaccurate. This is all the more so with alexithymic individuals who by definition
may not be able to accurately recall and describe their cognitive and emotional states. However
the study is the first to tease out the differential effects of affective and cognitive aspects of
alexithymia and how these aspects are mediated by negative affectivity, helping to hone in the
precise interactions and providing directions for future investigation.
Future Research Needs
The research somatoform disorders and FSS presentation is quite extensive and has
advanced considerably in recent decades to include greater focus and more robust findings on the
18. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 17
bio-physiological basis for such disorders, as well as ever more nuanced understandings of the
complex interrelation of affective, cognitive, and autonomic function and response. This
represents an attempt to understand the essential nature of somatoform illness in order to better
guide assessment and treatment. Getting beyond the lay conception of symptoms as “all in the
mind” to a more exact understanding of precisely which cognitive, behavioral and physiological
traits underpin FSS, will allow clinicians to develop and implement more targeted and effective
treatment strategies. Such findings also may improve patient motivation for treatment, with
symptomology explained by concrete factors, in a less stigmatizing or blaming way. For this
reason it’s important to improve on existing studies by increasing the numbers and diversity (in
terms of community representation) of participants, and developing ways to overcome the
inherent bias and inaccuracy of many self-report scales and instruments.
In addition, there needs to be more research on how proposed cognitive and affective
deficits and personality styles interact with environmental factors-- such as family history of
illness, and childhood trauma—and with behavioral responses and coping strategies. All of these
combine to create the whole clinical picture, and treatment may need to address all factors to be
effective. Alternatively, research might indicate a need to prioritize treatment of specific factors,
for best effect, thus simplifying a potentially very complicated therapeutic process.
Family and environmental factors can also be more thoroughly investigated to discover
not only exactly which are most predictive of somatization, but also to identify potentially
protective rather than pathological factors. These can be analyzed, to help guide treatment by
promoting conditions that are protective and inhibitive against FSS.
Finally the debate over DSM-V classification of somatoform illness may have significant
impacts on the diagnosis and treatment of FSS and related syndromes. If different somatoform
19. S o m a t o f o r m D i s o r d e r s R . J o h n s o n P a g e | 18
disorders are re-assigned to other Axis I categories, diagnosis rates may change and treatment
may be conceptualized differently to align with treatments already in place for the new
categories. Researchers ought to investigate whether application of those treatments to newly-
inducted somatoform disorders is effective, and how treatment may need to be adjusted for these
specific presentations.
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