PSYCH CHAPTER 6

• Somatic Symptom Disorder

  Pain is real and it hurts whether there are clear physical reasons for pain or not
• Pierre Briquet (French Physician)


  Briquet’s syndrome
• Pierre Briquet (French Physician)


  Described patients who came to see him with seemingly endless lists of somatic complaints for which he could find no medical basis
• Illness Anxiety Disorder 


  Formerly known as “hypochondriasis”.
• Illness Anxiety Disorder 


  Anxiety or fear that one has a serious disease.
• Illness Anxiety Disorder 


  Preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease
• Disease Conviction


  A difficult-to-shake belief that they have a disease
• Illness Anxiety Disorder 


  Physical symptoms are either not experienced at the present time or are very mild.
• Illness Anxiety Disorder 


  Severe anxiety is focused on the possibility of having or developing a serious disease. Reassurance from physicians does not seem to help.
• Illness Anxiety Disorder 


  Less concerned with any specific physical symptom and more worried about the idea that she was either ill or developing an illness.
• Patients with panic disorder typically fear immediate symptom-related catastrophes that may occur during the few minutes they are having a panic attack.
• Continue to seek the opinions of additional doctors in an attempt to rule out disease and are more likely to demand unnecessary medical treatments.
• Somatic symptom disorders focus on a long-term process of illness and disease
• Koro


  A belief, accompanied by severe anxiety and sometimes panic, that the genitals are retracting into the abdomen.
• Koro


  Guilty about excessive masturbation, unsatisfactory intercourse, or promiscuity. Prevalent in Chinese men.
• Dhat 


  anxious concern about losing semen, something that obviously occurs during sexual activity
• Dhat 


  A vague mix of physical symptoms, including dizziness, weakness, and fatigue. Prevalent in India.
• Causes of Somatic Symptom Disorder 


  Disorders of cognition or perception with strong emotional contributions.

  Faulty interpretation of physical signs and sensations.

  Tend to interpret ambiguous stimuli as threatening.
• Causes

  Somatic symptom disorders run in families.

  Nonspecific: tendency to overrespond to stress
• Treatment

  Cognitive Behavioral Treatments

  Reassurance and Education can be effective.
• Treatment

  Explanatory Therapy

  Devote sufficient time to all concerns the patient may have and attend to the “meaning” of the symptoms.
• Exposure Therapy 


  Repeatedly confronting the patient to stimuli that are relevant for health anxieties without using any avoidance and safety behaviors
• Psychological Factors Affecting Medical Condition 


  The presence of a diagnosed medical condition such as asthma, diabetes, or severe pain clearly caused by a known medical condition such as cancer that is adversely affected (increased in frequency or severity) by one or more psychological or behavioral factors.
• Conversion Disorder (Functional Neurological Symptom Disorder) 


  Physical malfunctioning without any physical or organic pathology.

  Paralysis o Blindness

  Total Mutism

  Loss of the sense of touch
• Aphonia 


  Difficulty Speaking
• Astasia-Abasia 


  Weakness in legs and difficulty keeping balance, with the result of falling often
• Globus Hystericus


  lump in the throat that makes it difficult to swallow, eat, or sometimes talk
• Conversion Disorder (Functional Neurological Symptom Disorder) 


  Often seem to be precipitated by marked stress.

  Stress takes in the form of a physical injury.
• Conversion


  The anxiety resulting from unconscious conflicts somehow was “converted” into physical symptoms to find expression.
• Functional 


  Refers to a symptom without an organic cause.
• Unconscious Mental Processes


  Case of Anna O. o Nursing her dying father.

  Suddenly she found herself imagining (dreaming?) that a black snake was moving across the bed, about to bite her father.

  Paralysis

  Forgot to speak her native language (German)

  Deafness
• Catharsis 


  purging or releasing

  Breuer coined this term.

  The therapeutic reexperiencing of emotionally traumatic events
• Statistics

  Conversion disorder may occur with other disorders, particularly somatic symptom disorder.

  Comorbid anxiety and mood disorders are also common.

  Found primarily in women.

  Typically develop during adolescence or slightly thereafter

  Often disappear after a time, only to return later in the same or similar form when a new stressor occurs.
• 4 Basic Processes in the Development of Conversion Disorder (Freud)

  1 Individual experiences a traumatic event.

  2 Because the conflict and the resulting anxiety are unacceptable, the person represses the conflict, making it unconscious.

  3 Anxiety continues to increase and threatens to emerge into consciousness, and the person “converts” it into physical symptoms, thereby relieving the pressure of having to deal directly with the conflict

  4 The individual receives greatly increased attention and sympathy from loved ones and may also be allowed to avoid a difficult situation or task.
• Primary Gain (under 3rd cause) 


  Reinforcing event that maintains the conversion symptom
• Secondary Gain (under the 4th choice) 


  attention/avoidance
• Causes

  Experienced a traumatic event that must be escaped at all costs.

  Simply running away is unacceptable in most cases, the socially acceptable alternative of getting sick is substituted; But getting sick on purpose is also unacceptable, so this motivation is detached from the person’s consciousness. •
• Causes

  Major mood disorders and severe traumatic stress, especially sexual abuse, are common among children and adolescents with the conversion disorder of pseudo-seizures.

  Tends to occur in less educated, lower socioeconomic groups where knowledge about disease and medical illness is not well developed.

  Prior experience with real physical problems, usually among other family members, tends to influence the later choice of specific conversion symptoms.
• Treatment

  Identify and attend to the traumatic or stressful life event, if it is still present.

  Reduce any reinforcing or supportive consequences of the conversion symptoms.
• Factitious Disorder 


  • Symptoms are under voluntary control.

  • No obvious reason for voluntarily producing the symptoms except, possibly, to assume the sick role and receive increased attention.