1. Somatic Symptom and Related Disorders A Closer Look at Psychological Disorders

2. Somatic Symptom Disorders Somatic is a fancy word that just means dealing with the body. These disorders are characterized by physical symptoms brought about by psychological distress. The term hysteria was more commonly used in Freud’s time to refer to unexplainable fainting, paralysis, or deafness.

3. Somatic Symptom Disorder and Illness Anxiety Disorder These diagnoses replaced Hypochondriasis in the DSM-5. In both of these, there is a high level of anxiety about health. The only difference between them is that one has actual health/physical symptoms accompanying the extreme worry, and the other one doesn’t. Somatic symptom disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms. To be diagnosed with SSD, the individual must be persistently symptomatic (typically at least for 6 months). Illness Anxiety Disorder is similar, with high health anxiety, but in this case, there are little to no somatic symptoms.  A person who is in good health becomes preoccupied with imaginary ailments.  Sufferers spend a lot of time looking for signs and symptoms of a serious illness and often misinterpret minor aches, bruises, etc. as early signs of a fatal illness.  They often become “experts” on their most feared diseases.

4. Examples of Illness Anxiety Disorder Brain TumorBrain Tumor Watch at home: http://www.youtube.com/watch?v=Ao 7KEvXCSBM http://www.youtube.com/watch?v=Ao 7KEvXCSBM Doctor VisitDoctor Visit Watch at home: http://www.youtube.com/watch?v=lkIQ 39538Ig&feature=related http://www.youtube.com/watch?v=lkIQ 39538Ig&feature=related Billy Bob Thornton in Bandits: http://www.youtu be.com/watch?v =7ip23mlJQnI http://www.youtu be.com/watch?v =7ip23mlJQnI

5. Conversion Disorder Conversion disorder is the conversion (change) of emotional difficulties into the loss of a specific physiological function. While the loss of function is real, no actual physical damage is present. Conversion disorders are rare, accounting for only about 2 percent of diagnoses. How do conversion disorders differ from regular disabilities? They tend to appear when the person is under extreme stress The symptoms may be physiologically impossible or improbable (Ex: “glove anesthesia,” where lack of feeling stops abruptly at the wrist, even though nerves extend through the arm) The person may show remarkably little concern about what most people would think was a rather serious problem And finally…

6. Figure 14.10: Glove anesthesia. In conversion disorders, the physical complaints are sometimes inconsistent with the known facts of physiology. For instance, given the patterns of nerve distribution in the arm shown in (a), it is impossible that a loss of feeling in the hand exclusively, as shown in (b), has a physical cause, indicating that the patient’s problem is psychological in origin.

7. Conversion Disorder (cont.) …Most psychologists believe that people suffering from conversion disorders unconsciously invent physical symptoms to gain freedom from unbearable conflict Examples: A woman who lived in terror of blurting out things she did not want to say lost the power of speech. A college student experienced total blindness every Monday morning, but her vision would begin to return by Friday evening and was fully restored in time for weekend social activities

8. Ricky Bobby? Talladega Nights Watch at home: http://www.youtube.com/watch?v=NV40bc6yA7chttp://www.youtube.com/watch?v=NV40bc6yA7c

9. Factitious Disorder The most severe type of factitious disorder was originally called Munchausen syndrome (named for Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences). People with this syndrome deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample).  Watch a patient with factitious disorder featured on Grey’s Anatomy here: https://www.youtube.com/watch?v=ze3KtUvDKR0 https://www.youtube.com/watch?v=ze3KtUvDKR0 There is also Factitious Disorder Imposed on Another (formerly Factitious Disorder by Proxy, or Muchausen by Proxy), where the patient actually presents another individual (victim) as the one who is experiencing medical illness or injury.  Watch a scene from the movie The Sixth Sense here: https://www.youtube.com/watch?v=JqW9iC0DAHM https://www.youtube.com/watch?v=JqW9iC0DAHM

10. Etiology of Somatic Symptom Disorders Individuals with somatoform disorders are not simply faking an illness, which would be termed malingering (like pretending you have cancer to take fundraising money from people). Personality factors – Somatic disorders often emerge in people with highly suggestible, histrionic personalities (more on this when we talk about personality disorders) Cognitive factors – they also emerge in people who focus excess attention on their physiological processes. Also, cognitively, illness anxiety disorder patients are strongly biased to focus on threat- confirming information but to ignore reassuring information Reaction to stress – Severe stressors may become triggers Learned behaviors – They may be learned avoidance strategies, reinforced by attention and sympathy (a person learns during childhood experiences that symptoms of physical illness bring special attention and care). Sociocultural factors – Asian, Latin American, and African cultures are more likely to experience physical symptoms (headaches, etc.) in response to psychological or interpersonal conflicts. In North America, such conflicts are more likely to be accompanied by anxiety or depression Genetic factors appear to play only a minor role