Somatoform Disorders

1
Somatoform Disorders

• Hypochondriasis
• Origin of the word--hypochondria
• Characterized by
• Anxiety that one has a serious disease
• Preoccupied with bodily symptoms, misinterpreting
  them as indicative of disease
• Focus on long-term process of illness (contrast
  to PD)
• Preoccupation persists despite medical
  reassurance
• Not delusionary intensity
• Six months

2
Somatoform Disorders

• Hypochondriasis
• Statistics
• 1-14
• Not more prevalent in elderly
• Culture
• Koro
• dhat

3
Hypochondriasis

• Etiology
• Disorder of cognition or perception (cycle)
• 1st begins with a trigger (information, event,
  illness)
• 2nd, perceived threat
• 3rd, apprehension
• 4th, Increased focus on body and checking
  behavior
• 5th, preoccupation w/ perceived change in bodily
  sensations
• 6th, misinterpretation of sensations
• 7th, perceived threat
• Other factors
• Stressful life events
• incidence of illness during childhood
• sick role

4
Hypochondriasis

• Treatment
• CBT
• Psychodynamic approach

5
Somatization Disorder

• Initially referred to as Briquets Syndrome
• Criteria
• History of many physical complaints before age 30
  over several yrs
• 4 pain symptoms
• 2 GI symptoms
• 1 sexual symptom
• 1 pseudoneurological symptom
• Either
• Cannot be explained by general medical condition
• There is a general medical condition, but
  complaints exceed what would be expected

6
Somatization Disorder

• Statistics
• 4
• More frequently observed in females
• Etiology
• Similar pathogenesis to hypochondriasis
• Strongly linked in family/genetic studies to ASPD
• Behavioral Inhibition System
• Sensitive to threat or danger
• Avoid situations or signals suggesting threat or
  danger
• Both diagnoses have a weak BIS
• Both strive for short-term gain at the expense of
  long-term gain

7
Somatization Disorder

• Treatment
• Gate-keeper
• Rapport

8
Conversion Disorder

• 1 or more symptoms affecting voluntary motor or
  sensory function suggesting neurological
  condition
• Psych factors judged to be associated w/ symptom
  b/c initiation or exacerbation of symptom is
  preceded by conflicts or other stressors
• Symptom is not intentionally produced/feigned

9
Conversion Disorder

• Closely related disorders
• Malingering
• Factitious disorders
• Statistics
• 1-30 in neurological settings

10
Conversion Disorder

• Etiology
• Freud
• 1st process individual experiences a traumatic
  event w/ unacceptable, unconscious conflict
• 2nd process person represses anxiety
• 3rd process as anxiety increases, unconscious
  converts it into physical symptom to avoid
  anxiety
• Primary Gain
• 4th process individual receives increased
  attention and sympathy from love ones, and avoids
  responsibilities
• Secondary Gain

11
Body Dysmorphic Disorder

• Preoccupation w/ imagined defect in appearance,
  if slight physical anomaly is present, ones
  concern is markedly excessive
• Preoccupation causes sign. distress or impairment

12
Body Dysmorphic Disorder

• Etiology
• OCD relationship
• Treatment
• Pain Disorder
• ?