Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Disorders Featuring Somatic Symptoms Chapter 10

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Disorders Featuring Somatic Symptoms Stress and anxiety also contribute to several other kinds of disorders, particularly disorders that focus on somatic and dissociative symptoms Disorders focusing on somatic symptoms are problems that appear to be medical but are actually caused by psychosocial factors –Unlike psychophysiological disorders, in which psychosocial factors interact with genuine physical ailments, somatoform disorders are psychological disorders masquerading as physical problems

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Disorders Featuring Somatic Symptoms These disorders include: –_________ disorder –_________ Disorder

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Disorders Featuring Somatic Symptoms These groups of disorders have much in common: –Both may occur in response to severe stress –Both have traditionally been viewed as forms of escape from stress –A number of individuals suffer from both types of disorders –Theorists and clinicians often explain and treat the two groups of disorders in similar ways

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Are Disorders Featuring Somatic Symptoms? People with these disorders suffer actual changes in their physical functioning –These disorders are often hard to distinguish from genuine medical problems –It is always possible that a diagnosis is a mistake and that the patient's problem has an undetected organic cause

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Facticious Disorder A disorder in which an individual feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person Popularly known as Munchausen Syndrome

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Facticious Disorder The precise causes of factitious disorder are not understood, although clinical reports have pointed to factors such as depression, unsupportive parental relationships during childhood, and an extreme need for social support Clinicians have been unable to develop dependably effective treatments for this disorder

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Conversion Disorder A psychosocial conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning –Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling Most conversion disorders begin between late childhood and young adulthood They are diagnosed in women twice as often as in men They usually appear suddenly, at times of stress, and are thought to be rare

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Conversion Disorder Conversion disorders are often similar to “genuine” medical ailments, physicians sometimes rely on oddities in the patient’s medical picture to help distinguish the two Symptoms may be at odds with the way the nervous system is known to work

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Somatic Symptom Disorder People with somatic symptom disorder become excessively distressed, concerned, and anxious about bodily symptoms that they are experiencing, and their lives are greatly disrupted by the symptoms The symptoms are longer-lasting but less dramatic than those found in conversion disorder In some cases, the symptoms have no known cause

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Somatization Pattern People with somatization disorder have many long-lasting physical ailments that have little or no organic basis –Also known as Briquet’s syndrome To receive a diagnosis, a patient must have a range of ailments, including several pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological symptom Patients usually go from doctor to doctor in search of relief

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Predominant Pain Pattern Pain disorder associated with psychological factors –Patients may receive this diagnosis when psychosocial factors play a central role in the onset, severity, or continuation of pain –Although the precise prevalence has not been determined, it appears to be fairly common The disorder often develops after an accident or illness that has caused genuine pain –The disorder may begin at any age, and more women than men seem to experience it

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? Previously called hysterical disorders Widely considered unique and in need of special explanation –No explanation has received much research support, and the disorders are still poorly understood

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? The psychodynamic view Freud believed that these disorders represented a conversion of underlying emotional conflicts into physical symptoms Because most of his patients were women, Freud centered his explanation on the psychosexual development of girls and focused on the phallic stage (ages 3 to 5) During this stage, girls develop a pattern of sexual desires for their fathers (the Electra complex) and recognize that they must compete with their mothers for his attention Because of the mother's more powerful position, girls repress these sexual feelings

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? The psychodynamic view Freud believed that if parents overreact to such feelings, the Electra complex would remain unresolved and the child might re-experience sexual anxiety throughout her life Freud concluded that some women unconsciously hide their sexual feelings in adulthood by converting them into physical symptoms Today's psychodynamic theorists take issues with Freud's explanation of the Electra conflict They continue to believe that sufferers of these disorders have unconscious conflicts carried from childhood

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? The psychodynamic view Psychodynamic theorists propose that two mechanisms are at work in these disorders: Primary gain: symptoms keep internal conflicts out of conscious awareness Secondary gain: symptoms further enable people to avoid unpleasant activities or receive sympathy from others

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? The behavioral view Behavioral theorists propose that the physical symptoms of these disorders bring rewards to sufferers May remove individual from an unpleasant situation May bring attention from other people In response to such rewards, people learn to display symptoms more and more This focus on rewards is similar to the psychodynamic idea of secondary gain, but behaviorists view the gains as the primary cause of the development of the disorder

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? The cognitive view Some cognitive theorists propose that these disorders are a form of communication, providing a means for people to express difficult emotions Like psychodynamic theorists, cognitive theorists hold that emotions are being converted into physical symptoms This conversion is not to defend against anxiety but to communicate extreme feelings

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? The multicultural view Some theorists believe that Western clinicians hold a bias that sees somatic symptoms as an inferior way of dealing with emotions The transformation of personal distress into somatic complaints is the norm is many non-Western cultures As we saw in Chapter 6, reactions to life's stressors are often influenced by one's culture

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Conversion and Somatic Symptom Disorders? A possible role for biology The impact of biological processes on these disorders can be understood through research on placebos and the placebo effect Placebos: substances with no known medicinal value Treatment with placebos has been shown to bring improvement to many – possibly through the power of suggestion but likely because expectation triggers the release of endogenous chemicals Perhaps traumatic events and related concerns or needs can also trigger our “inner pharmacies” and set in motion the bodily symptoms of conversion and somatic symptom disorders

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved How Are Conversion and Somatic Symptom Disorders Treated? People with conversion and somatic symptom disorders usually seek psychotherapy only as a last resort Individuals with preoccupation disorders typically receive the kinds of treatments applied to anxiety disorders, particularly OCD: –Antidepressant medication –Exposure and response prevention (ERP) –Cognitive-behavioral therapies

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved How Are Conversion and Somatic Symptom Disorders Treated? Treatments for these disorders often focus on the cause of the disorder and apply the same kind of techniques used in cases of PTSD, particularly: –Insight – often psychodynamically oriented –Exposure – client thinks about traumatic event(s) that triggered the physical symptoms –Drug therapy – especially antidepressant medication

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved How Are Conversion and Somatic Symptom Disorders Treated? Other therapists try to address the physical symptoms of these disorders, applying techniques such as: –Suggestion – usually an offering of emotional support that may include hypnosis –Reinforcement – a behavioral attempt to change reward structures –Confrontation – an overt attempt to force patients out of the sick role Researchers have not fully evaluated the effects of these particular approaches on these disorders

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Illness Anxiety Disorder People with this disorder unrealistically interpret bodily symptoms as signs of a serious illness –Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating Although some patients recognize that their concerns are excessive, many do not

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychophysiological Disorders: Psychological Factors Affecting Other Medical Conditions In addition to affecting psychological functioning, stress can also have great impact on physical functioning

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychophysiological Disorders: Psychological Factors Affecting Other Medical Conditions Psychophysiological (psychosomatic) disorders: disorders in which biological, psychological, and sociocultural factors interact to cause or worsen a physical illness. Early versions of the DSM labeled these illnesses psychophysiological, or psychosomatic, disorders –DSM-5 also labels them as psychological factors affecting medical condition

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Factors Affecting Medical Conditions 1. The presence of a general medical condition. 2. Psychological factors adversely affecting the general medical condition in one of the following ways: –(a) Influencing the course of the general medical condition. –(b) Interfering with the treatment of the general medical condition. –(c) Posing additional health risks. –(d) Stress-related physiological responses precipitating or exacerbating the general medical condition.

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Traditional Psychophysiological Disorders Ulcers –Lesions in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding –Experienced by over 25 million people at some point in their lives –Causal psychosocial factors: Environmental pressures, intense feelings of anger or anxiety Bacterial infection Asthma –A narrowing of the body's airways that makes breathing difficult –Affects up to 25 million people in the U.S. each year –Causal psychosocial factors: Environmental pressures or anxiety Allergies, a slow-acting sympathetic nervous system, weakened respiratory system

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Traditional Psychophysiological Disorders Insomnia –Difficulty falling asleep or maintaining sleep –Affects 10% of people in the U.S. each year –Causal psychosocial factors: High levels of anxiety or depression Overactive arousal system, certain medical ailments Chronic headaches –Frequent intense aches of the head or neck that are not caused by another physical disorder Tension headaches affect 45 million Americans each year Migraine headaches affect 23 million Americans each year –Causal psychosocial factors: Environmental pressures; general feelings of helplessness, anger, anxiety, depression Abnormal serotonin activity, vascular problems, muscle weakness

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Traditional Psychophysiological Disorders Hypertension –Chronic high blood pressure, usually producing few outward symptoms –Affects 75 million Americans each year –Causal psychosocial factors: Constant stress, environmental danger, general feelings of anger or depression 10% caused by physiological factors alone Obesity, smoking, poor kidney function, high proportion of collagen (rather than elastic) tissue in an individual's blood vessels Coronary heart disease –Caused by blockage in the coronary arteries –The term refers to several problems, including myocardial infarction (heart attack) –Nearly 18 million people in the US suffer from some form of coronary heart disease It is the leading cause of death in men older than 35 years and women older than 40 –Causal psychosocial factors: Job stress, high levels of anger or depression High level of cholesterol, obesity, hypertension, the effects of smoking, lack of exercise

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Traditional Psychophysiological Disorders A number of variables contribute to the development of psychophysiological disorders, including: –Biological factors –Psychological factors –Sociocultural factors

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Traditional Psychophysiological Disorders Biological factors –Defects in the autonomic nervous system (ANS) are believed to contribute to the development of psychophysiological disorders –Other more specific biological problems may also contribute Psychological factors –Needs, attitudes, emotions, or coping styles may cause people to overreact repeatedly to stressors – increasing their chances of developing psychophysiological disorders Sociocultural factors –Adverse social conditions may set the stage for psychophysiological disorders

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved New Psychophysiological Disorders Since the 1960s, researchers have found many links between psychosocial stress and a wide range of physical illnesses In recent years, more and more illnesses have been added to the list of psychophysiological disorders

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved New Psychophysiological Disorders Are physical illnesses related to stress? –The development of the Social Adjustment Rating Scale in 1967 enabled researchers to examine the relationship between life stress and the onset of illness –Using the Social Adjustment Rating Scale, studies have linked stressors of various kinds to a wide range of physical conditions –Overall, the greater the amount of life stress, the greater the likelihood of illness –Social Adjustment Rating Scale does not take into consideration the particular stress reactions within specific populations

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychoneuroimmunology Psychoneuroimmunology - the relationship between stress and infection

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychoneuroimmunology The immune system identifies and destroys antigens (foreign invaders, such as bacteria) and cancer cells –Lymphocytes - white blood cells that circulate through the lymph system and the bloodstream, attacking invaders Helper T-cells, natural killer T-cells, and B-cells

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychoneuroimmunology Biochemical activity –Stress leads to increased activity by the sympathetic nervous system, including a release of norepinephrine –Endocrine glands reduce immune system functioning during periods of prolonged stress through the release of corticosteroids Behavioral changes –Stress may set in motion a series of behavioral changes – poor sleep patterns, poor eating, lack of exercise, increase in smoking and/or drinking – that indirectly affect the immune system

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychoneuroimmunology Personality style –An individual's personality style (including their level of optimism, constructive coping strategies, and resilience) experience better immune system functioning and are better prepared to fight off illness Social support –People who have less social support and feel lonely seem to display poorer immune functioning when stressed than people who do not feel lonely –Studies have found that social support and affiliation with others may actually protect people from stress, poor immune system functioning, and subsequent illness, and can help speed up recovery from illness or surgery

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Behavioral medicine - the field of treatment that combines psychological and physical interventions to treat or prevent medical problems

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Relaxation training –People can be trained to relax their muscles at will, a process that sometimes reduces feelings of anxiety –Relaxation training can help prevent or treat medical illnesses that are related to stress Often used in conjunction with medication in the treatment of high blood pressure Often used alone to treat chronic headaches, insomnia, asthma, pain after surgery, certain vascular diseases, and the undesirable effects of cancer treatments

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Biofeedback –Patients given biofeedback training are connected to machinery that gives them continuous readings about their involuntary bodily activities Somewhat helpful in the treatment of anxiety disorders, this procedure has been used successfully to treat headaches and muscular disabilities caused by stroke or accident Some biofeedback training has been effective in the treatment of heartbeat irregularities, asthma, migraine headaches, high blood pressure, stuttering, and pain

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Meditation –Although meditation has been practiced since ancient times, Western health care professionals have only recently become aware of its effectiveness in relieving physical distress –Meditation is a technique of turning one's concentration inward and achieving a slightly changed state of consciousness Meditation has been used to manage pain, treat high blood pressure, heart problems, insomnia, and asthma

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Hypnosis –Individuals who undergo hypnosis are guided into a sleeplike, suggestible state during which they can be directed to act in unusual ways, to remember unusual sensations, or to forget remembered events With training, hypnosis can be done without a hypnotist (self- hypnosis)

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Cognitive interventions –People with physical ailments have sometimes been taught new attitudes or cognitive responses as part of treatment One intervention is stress inoculation training, in which patients are taught to rid themselves of negative self- statements and to replace these with coping self-statements

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Emotion expression and support groups –If negative psychological symptoms (e.g., depression, anxiety) contribute to a person's physical ills, intervention to reduce these emotions should help reduce the ills –These techniques have been used to treat a variety of illnesses including HIV, asthma, cancer, headache, and arthritis

Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychological Treatments for Physical Disorders Combination approaches –Studies have found that the various psychological interventions for physical problems tend to be equal in effectiveness Psychological treatments are often of greatest help when they are combined and used with medical treatment