SOMATOFORM

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SOMATOFORM DISSOCIATIVE DISORDERS

• JACK L. BODDEN, Ph.D.

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SOMATOFORM DISORDERS
Soma is Greek for body. Somatoform disorders
are disorders which have in common physical
symptoms and complaints that suggest the presence
of a medical condition but without any evidence
of physical findings to account for them. In
these cases the individual is preoccupied with or
concerned about some aspect of his/her health or
appearance such that it causes distress and/or
impairments in functioning. In these disorders
the individual is not faking it. The disturbance
is manifest not in mood or affect but in physical
sensations or symptoms.
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HYPOCHRONDRIASIS

• Person is preoccupied with fears of getting or
  having a serious disease (which they do not
  have).
• The fear or preoccupation persists in spite of
  appropriate evaluation and reassurance.
• The preoccupation must last for at least 6 months
• The preoccupation causes clinically significant
  distress or impairment.

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Characteristics of Hypochrondriasis
Person is very focused on the body and how it
functions.
Person seems to be ever vigilant for health
problemslooking for trouble.
These individuals are usually in good health and
are sincere in their concerns.
There seems to be a strong anxiety component
present in these disorders.
These disorders are not well understood compared
to some other disorders we have examined.
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POSSIBLE CAUSES OF HYPOCHRONDRIASIS

• MOST WIDELY ACCEPTED EXPLANATION IS THAT IT IS A
  DISORDER OF COGNITION AND PERCEPTION. THAT IS,
  THE PERSON HAS RATHER FIXED BELIEFS ABOUT CAUSES
  OF DISEASE IN SELF AND OTHERS THAT LEAD TO FAULTY
  ASSUMPTIONS ABOUT SYMPTOMS DISEASES.
• THE PERSON IS HYPERVIGILANT, MISINTERPRETING OR
  MISPERCEIVING BODY SENSATIONS/SIGNS IN LIGHT OF
  THEIR FAULTY BELIEFS ABOUT DISEASE.
• SECONDARY REINFORCEMENT MAY PLAY A ROLE IN
  MAINTAINING SYMTOMS

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Interestingly, hypochrondriacal
tendencies/complaints usually diminish if the
person develops a real medical condition. Why
might that be?
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TREATMENT FOR HYPOCHRONDRIASIS

• CBT can be helpful and usually involves response
  prevention (Not checking on their body or
  getting reassurances), reframing beliefs about
  illness, and even inducing innocuous sx by
  intentonally focusing on parts of their body in
  order to learn that selective perception plays a
  major role in their symptoms.

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TREATMENT CONTINUED

• Some evidence that medication (SSRIs) can be
  helpful
• Relaxation and hypnosis may be of some value
• Working with family to reduce 2nd gain for sx

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SOMATIZATION DISORDER
This disorder is characterized by many different
complaints of physical ailments over at least
several years beginning before the age of 30,
that are not adequately explained by independent
findings of physical illness/injury and that lead
to medical treatments.
Additionally, the following criteria must have
been met at some time during the disturbance
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• Four pain symptoms in different sites
• Two GI symptoms other than pain.
• One sexual symptom
• One pseudoneurological symptom

Symptoms are not intentionally produced or faked.
Somatization disorder patients often develop
iatrogenic medical problems because of all the
tests and procedures they have done to them.
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The clinical picture seen in Somatization
Disorder and Hypochrondriasis seem similar, and
they are. The main differences are
Persons with hypochrondriasis are convinced they
have the disorder and seem to be more anxious
about it.
Persons with Somatization Disorder have many more
sx and usually a more extensive medical history.
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CAUSAL FACTORS IN SOMATIZATION DISORDERS

• Generally not well understood.
• Appear to run in families
• More common among women
• More common in lower SES
• Selective attention to bodily SX
• Self perception as weak and sickly

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TREATMENT FOR SOMATIZATION DISORDERS

• Role of primary care physician may be key to
  managing problems and avoiding unnecessary
  medical tests and interventions. Use of
  noncontingent medical appointments very
  important.
• Supportive psychotherapy plays some role in care.
• Difficult to Treat.

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PAIN DISORDER
The person with a Pain Disorder complains of
severe and persistent pain in one or more areas
of the body. The pain sx cause significant
distress and/or impairment in functioning.
Psychological factors are judged to have an
important role in the pain. The sx are not
intentionally produced or faked. There are two
subtypes
1. Pain Disorder associated with psychological
factors
2. Pain Disorder associated with medical
condition and psychological factors.
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BODY DYSMORPHIC DISORDER
BDD involves a preoccupation with certain aspects
of the body. Persons with BDD are obsessed with
some perceived flaw (or imagined flaw) in their
appearance, and the preoccupation is so intense
as to cause significant distress and or
impairment in social or occupational function.
These are not minor concerns but greatly
exaggerated concerns about flaws that are often
not seen by others. (This disorder probably
creates a lot of business for plastic surgeons.)
Causation is not well understood but is believed
to be closely linked to OCD. A similar
disturbance in body image is also seen in some
eating disorders (anorexia nervosa).
Unfortunately, not a lot is known about effective
treatments, but it is assumed that BDD should be
treated much like OCD.
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Conversion Disorder
Conversion Disorders involve one or more SX
affecting voluntary motor or sensory functions
that suggest a neurological or other medical
condition. Psychological factors are judged to
be associated with the SX because they were
preceded by conflicts or stressors. SX cannot be
fully explained by a medical condition. SX cause
distress/dysfunction. Symptoms can be thought of
as falling into one of 4 categories
Sensory
Motor
Seizures
Mixture of above
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Treatment for Conversion Disorder
Not a lot of good research on effective
treatments exists. Clinical experience suggests
that hypnosis can be helpful.
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DISTINGUISHING AMONG CONDITIONS

• Symptoms which are produced intentionally that
  are motivated by external incentices?Malingering.
• Symptoms not under conscious control?
• Conversion Disorder.
• Symptoms produced in order to play the sick role?
  Factitious Disorder (a separate categrory in DSM
  IV).

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Are they Faking it?
Not always possible to tell, but those who are
faking usually very defensive, evasive, and
suspicious when asked about SX. Conversion
disorder patients are usually more than willing
to discuss their symptoms.
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FACTITIOUS DISORDER
This is a rather puzzling disorder in which the
patient intentionally produces physical or
psychological SX in order to assume the sick
role, and there are no external incentives
involved. If the SX are produced in another
(usually in a child) it is called Factitious
Disorder by Proxy.
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DISSOCIATIVE DISORDERS

• This category includes a group of disorders that
  involve disruptions of a persons normal
  integrative functions of consciousness, memory,
  identity or perception. The term dissociation
  refers to the minds capacity to engage in
  complex mental activity in channels split off
  from or independent of conscious awareness.
  Included are
• Depersonalization Disorder
• Amnesia Fugue
• Dissociative Identity Disorder

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DEPERSONALIZATION DISORDER

• Person experiences persistent or recurrent
  experiences of feeling detached from, and as if
  one is an outside observer of, ones mental
  processes or body.
• Reality testing remains intact
• SX do not occur in course of another condition
  (e.g. Schizophrenia)
• Treatment ???

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AMNESIA FUGUE

• Dissociative Amnesia one or more episodes of
  inability to recall important personal
  information too extensive to be explained by
  ordinary forgetfulness.
• Dissociative Fugue sudden, expected travel away
  from home or work with inability to recall ones
  past coupled with confusion about personal
  identity or the assumption of a new identity.
  Symptoms cause distress/impairment in
  functioning.
• Conditions not well understoodoften assumed that
  these states are triggered by severe and
  unacceptable actions/trauma which the person
  cannot face or integrate into self concept.

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DISSOCIATE IDENTITY DISORDER
This condition was formerly known as Multiple
Personality Disorder. The book and movie by the
same title, Three faces of Eve, portrays the
condition. The disorder involves the presence of
2 or more distinct identities, each with its own
relatively enduring pattern of perceiving,
relating to and thinking about the environment
and self. At least 2 of the personalities take
control of the persons behavior. There is also
an inability to recall important personal
information that is too extensive to be explained
by ordinary forgetting. There is little known
about and much controversy surrounding the
condition and even its prevalence rates.
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THE END