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

Somatoform Disorders Hypochondriasis Hypochondriasis Statistics Statistics 1-14% 1-14% Not more prevalent in elderly Not more prevalent in elderly Culture Culture Koro Koro dhat dhat

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

Hypochondriasis Treatment Treatment CBT CBT Psychodynamic approach Psychodynamic approach

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

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

Somatization Disorder Treatment Treatment Gate-keeper Gate-keeper Rapport Rapport

Conversion Disorder 1 or more symptoms affecting voluntary motor or sensory function suggesting neurological condition 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 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 Symptom is not intentionally produced/feigned

Conversion Disorder Closely related disorders Closely related disorders Malingering Malingering Factitious disorders Factitious disorders Statistics Statistics 1-30% in neurological settings 1-30% in neurological settings

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

Body Dysmorphic Disorder Preoccupation w/ imagined defect in appearance, if slight physical anomaly is present, one’s concern is markedly excessive Preoccupation w/ imagined defect in appearance, if slight physical anomaly is present, one’s concern is markedly excessive Preoccupation causes sign. distress or impairment Preoccupation causes sign. distress or impairment

Body Dysmorphic Disorder Etiology Etiology OCD relationship OCD relationship Treatment Treatment Pain Disorder Pain Disorder ?