1. Comer, Fundamentals of Abnormal Psychology, 7e Disorders Featuring Somatic Symptoms Chapter 8 Slides & Handouts by Karen Clay Rhines, Ph.D.

2. 2 Comer, Fundamentals of Abnormal Psychology, 7e Disorders Featuring Somatic Symptoms  Psychological factors may contribute to somatic, or bodily, illnesses in a variety of ways  The idea that stress and related psychosocial factors may contribute to physical illnesses has ancient roots, yet it had few proponents before the 20 th century

3. Disorders Featuring Somatic Symptoms  Over the course of the 20th century, however, numerous studies convinced medical and clinical researchers that psychological factors, such as stress, worry, and perhaps even unconscious needs, can contribute to bodily illness  DSM-5 lists a number of disorders in which bodily symptoms or concerns are the primary features 3 Comer, Fundamentals of Abnormal Psychology, 7e

4. Factitious Disorder  Sometimes when physicians cannot find a medical cause for a patient’s symptoms, he or she may suspect other factors are involved.  Patients may malinger, intentionally fake illness to achieve external gain (e.g., financial compensation, military deferment)  Patients may be manifesting a factitious disorder - intentionally producing or faking symptoms simply out of a wish to be a patient 4 Comer, Fundamentals of Abnormal Psychology, 7e

5. Factitious Disorder  Known popularly as Munchausen syndrom, people with a factitious disorder often go to extremes to create the appearance of illness  Many secretly give themselves medications to produce symptoms  Patients often research their supposed ailments and are impressively knowledgeable about medicine 5 Comer, Fundamentals of Abnormal Psychology, 7e

6. Factitious Disorder  Clinical researchers have a hard time determining the prevalence of this disorder as patients hide the true nature of their problem  Overall, the pattern appears to be more common in women than men and the disorder usually begins during early adulthood 6 Comer, Fundamentals of Abnormal Psychology, 7e

7. Factitious Disorder  Factitious disorder seems to be particularly common among people who (a) received extensive medical treatment as children, (2) carry a grudge against the medical profession, or (3) have worked as a nurse, lab technician, or medical aide 7 Comer, Fundamentals of Abnormal Psychology, 7e

8. Factitious Disorder  The precise causes of factitious disorder are not understood, although clinical reports have pointed to factors such as depression unsupportive parental relationships, and an extreme need for social support 8 Comer, Fundamentals of Abnormal Psychology, 7e

9. Factitious Disorder  Psychotherapists and medical practitioners often become angry at people with a factitious disorder, feeling that they are wasting their time  People with the disorder, however, feel they have no control over their problems and often experience great distress 9 Comer, Fundamentals of Abnormal Psychology, 7e

10. 10 Comer, Fundamentals of Abnormal Psychology, 7e Factitious Disorder  In a related pattern, factitious disorder imposed on another, known popularly as Munchausen syndrome by proxy, parents make up or produce physical illnesses in their children

11. Conversion Disorder and Somatic Symptom Disorder  When a bodily ailment has an excessive and disproportionate impact on the individual, no apparent medical cause, or is inconsistent with known medical diseases, doctors may suspect a conversion disorder or somatic symptom disorder 11 Comer, Fundamentals of Abnormal Psychology, 7e

12. Conversion Disorder  Conversion disorder  People with this disorder display physical symptoms that affect voluntary motor or sensory functioning, but the symptoms are inconsistent with known medical diseases  In short, the individuals experience neurological- like symptoms – blindness, paralysis, or loss of feeling – that have no neurological basis 12 Comer, Fundamentals of Abnormal Psychology, 7e

13. Conversion Disorder  Conversion disorder often is hard to distinguish from genuine medical problems  It is always possible that a diagnosis of conversion disorder is a mistake and the patient’s problem has an undetected medical cause  Physicians sometimes rely on oddities in the patient’s medical picture to help distinguish the two  For example, conversion symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesia 13 Comer, Fundamentals of Abnormal Psychology, 7e

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15. Conversion Disorder  Unlike people with factitious disorder, those with conversion disorder don’t consciously want or produce their symptoms  This pattern is called “conversion” disorder because clinical theorists used to believe that individuals with the disorders are converting psychological needs into neurological symptoms 15 Comer, Fundamentals of Abnormal Psychology, 7e

16. Conversion Disorder  Conversion disorder usually begins between late childhood and young adulthood  It is diagnosed in women twice as often as in men  It typically appears suddenly, at times of stress  It is thought to be rare, occurring in at most 5 of every 1,000 persons 16 Comer, Fundamentals of Abnormal Psychology, 7e

17. Somatic Symptom Disorder  People with somatic symptom disorder become excessive distressed, concerned, and anxious about bodily symptoms that they are experiencing  Two patterns of somatic symptom disorder have received particular attention:  Somatization pattern  Predominant pain pattern 17 Comer, Fundamentals of Abnormal Psychology, 7e

18. Somatic Symptom Disorder  People with a somatization pattern experience many long-lasting physical ailments that have little or no organic basis  Also known as Briquet’s syndrome  A sufferer’s ailments often include pain symptoms, gastrointestinal symptoms, sexual symptoms, and neurological symptoms  Patients usually go from doctor to doctor in search of relief 18 Comer, Fundamentals of Abnormal Psychology, 7e

19. Somatic Symptom Disorder  Somatization pattern  Patients with this pattern often describe their symptoms in dramatic and exaggerated terms  Most also feel anxious and depressed  The pattern typically lasts for many years  Symptoms may fluctuate over time but rarely disappear completely without therapy 19 Comer, Fundamentals of Abnormal Psychology, 7e

20. 20 Comer, Fundamentals of Abnormal Psychology, 7e Somatic Symptom Disorder  Somatization pattern  Between 0.2% and 2% of all women in the U.S. experience a somatization pattern in any given year (compared with less than 0.2% of men)  The pattern often runs in families and begins between adolescence and young adulthood

21. Somatic Symptom Disorder  Predominant pain pattern  If the primary feature of somatic symptom disorder is pain, the individual is said to have a predominant pain pattern  Although the precise prevalence has not been determined, this pattern appears to be fairly common  The pattern often develops after an accident or illness that has caused genuine pain  The pattern may begin at any age, and more women than men seem to experience it 21 Comer, Fundamentals of Abnormal Psychology, 7e

22. What Causes Conversion and Somatic Symptom Disorder?  For many years, conversion and somatic symptom disorders were referred to as hysterical disorders  This label was to convey the prevailing belief that excessive and uncontrolled emotions underlie the bodily symptoms  Today’s leading explanations come from the psychodynamic, behavioral, cognitive, and multicultural models  None has received much research support, and the disorders are still poorly understood 22 Comer, Fundamentals of Abnormal Psychology, 7e

23. 23 Comer, Fundamentals of Abnormal Psychology, 7e What Causes Conversion and Somatic Symptom Disorder?  The psychodynamic view  Freud believed that hysterical 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 of development (ages 3 to 5)…

24. What Causes Conversion and Somatic Symptom Disorder?  The psychodynamic view  During this stage, Freud believed that 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, however, girls repress these sexual feelings  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 24 Comer, Fundamentals of Abnormal Psychology, 7e

25. What Causes Conversion and Somatic Symptom Disorder?  The psychodynamic view  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 25 Comer, Fundamentals of Abnormal Psychology, 7e

26. What Causes Conversion and Somatic Symptom Disorder?  The psychodynamic view  Psychodynamic theorists propose that two mechanisms are at work in hysterical disorders:  Primary gain: bodily symptoms keep internal conflicts out of conscious awareness  Secondary gain: bodily symptoms further enable people to avoid unpleasant activities or receive sympathy from others 26 Comer, Fundamentals of Abnormal Psychology, 7e

27. What Causes Conversion and Somatic Symptom Disorder?  The behavioral view  Behavioral theorists propose that the physical symptoms of hysterical 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 27 Comer, Fundamentals of Abnormal Psychology, 7e

28. What Causes Conversion and Somatic Symptom Disorder?  The cognitive view  Some cognitive theorists propose that conversion and somatic symptom disorders are forms 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 28 Comer, Fundamentals of Abnormal Psychology, 7e

29. What Causes Conversion and Somatic Symptom Disorder?  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  The lesson to be learned from multicultural findings is that both bodily and psychological reactions to life events are often influenced by one’s culture 29 Comer, Fundamentals of Abnormal Psychology, 7e

30. How Are Conversion and Somatic Symptom Disorders Treated?  People with conversion and somatic symptom disorders usually seek psychotherapy only as a last resort  They believe their problems are completely medical 30 Comer, Fundamentals of Abnormal Psychology, 7e

31. How Are Conversion and Somatic Symptom Disorders Treated?  Many therapists focus on the causes of the disorders and apply techniques including:  Insight – often psychodynamically oriented  Exposure – client thinks about traumatic event(s) that triggered the physical symptoms  Drug therapy – especially antianxiety and antidepressant medication 31 Comer, Fundamentals of Abnormal Psychology, 7e

32. 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 32 Comer, Fundamentals of Abnormal Psychology, 7e

33. 33 Comer, Fundamentals of Abnormal Psychology, 7e Illness Anxiety Disorder  People with illness anxiety disorder, previously known as hypochondriasis, experience chronic anxiety about their health and are concerned that they are developing a serious medical illness, despite the absence of somatic symptoms

34. 34 Comer, Fundamentals of Abnormal Psychology, 7e Illness Anxiety Disorder  They repeatedly check their bodies for signs of illness and misinterpret 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

35. Illness Anxiety Disorder  Although this disorder can begin at any age, it starts most often in early adulthood, among men and women in equal numbers  Between 1% and 5% of all people experience the disorder  For most patients, symptoms rise and fall over the years 35 Comer, Fundamentals of Abnormal Psychology, 7e

36. Illness Anxiety Disorder  Theorists explain this disorder much as they explain various anxiety disorders:  Behaviorists: classical conditioning or modeling  Cognitive theorists: oversensitivity to bodily cues 36 Comer, Fundamentals of Abnormal Psychology, 7e

37. Illness Anxiety Disorder  Individuals with illness anxiety disorder typically receive the kinds of treatments applied to OCD:  Antidepressant medication  Exposure and response prevention (ERP)  Cognitive-behavioral therapies 37 Comer, Fundamentals of Abnormal Psychology, 7e

38. Psychophysiological Disorders: Psychological Factors Affecting Medical Condition  About 85 years ago, clinicians first identified a group of physical illnesses that seemed to result from an interaction of biological, psychological, and sociocultural factors  Early versions of the DSM labeled these illnesses psychophysiological, or psychosomatic, disorders  DSM-5 labels them as psychological factors affecting medical condition 38 Comer, Fundamentals of Abnormal Psychology, 7e

39. 39 Comer, Fundamentals of Abnormal Psychology, 7e Psychophysiological Disorders: Psychological Factors Affecting Medical Condition  It is important to recognize that these psychophysiological disorders bring about actual physical damage  They are different from the factitious, conversion, somatic symptom, and illness anxiety disorders that are accounted for primarily by psychological factors

40. 40 Comer, Fundamentals of Abnormal Psychology, 7e Traditional Psychophysiological Disorders  Before the 1970s, the best known and most common of the psychophysiological disorders were ulcers, asthma, insomnia, chronic headaches, high blood pressure, and coronary heart disease  Recent research has shown that many other physical illnesses may also be caused by an interaction of psychosocial and physical factors

41. 41 Comer, Fundamentals of Abnormal Psychology, 7e 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  Causal physiological factors:  Bacterial infection

42. 42 Comer, Fundamentals of Abnormal Psychology, 7e Traditional Psychophysiological Disorders  Asthma  A narrowing of the body’s airways that makes breathing difficult  Affects up to 25 million people in the U.S. each year  Most victims are children or young teens at the time of first attack  Causal psychosocial factors:  Environmental pressures or anxiety  Causal physiological factors:  Allergies, a slow-acting sympathetic nervous system, weakened respiratory system

43. 43 Comer, Fundamentals of Abnormal Psychology, 7e 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  Causal physiological factors:  Overactive arousal system, certain medical ailments

44. 44 Comer, Fundamentals of Abnormal Psychology, 7e Traditional Psychophysiological Disorders  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  Causal physiological factors:  Abnormal serotonin activity, vascular problems, muscle weakness

45. 45 Comer, Fundamentals of Abnormal Psychology, 7e 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  Causal physiological factors:  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

46. Traditional Psychophysiological Disorders  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  Causal physiological factors:  High level of cholesterol, obesity, hypertension, the effects of smoking, lack of exercise 46 Comer, Fundamentals of Abnormal Psychology, 7e

47. 47 Comer, Fundamentals of Abnormal Psychology, 7e What Factors Contribute to Psychophysiological Disorders?  A number of variables contribute to the development of psychophysiological disorders, including:  Biological factors  Psychological factors  Sociocultural factors

48. 48 Comer, Fundamentals of Abnormal Psychology, 7e What Factors Contribute to 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  For example, a weak gastrointestinal system may create a predisposition to developing ulcers

49. 49 Comer, Fundamentals of Abnormal Psychology, 7e What Factors Contribute to Psychophysiological Disorders?  Psychological factors  According to many theorists, certain needs, attitudes, emotions, or coping styles may cause people to overreact repeatedly to stressors – increasing their chances of developing psychophysiological disorders  Examples: a repressive coping style, a Type A personality style, feelings of hostility and time urgency

50. What Factors Contribute to Psychophysiological Disorders?  Sociocultural factors  Adverse social conditions may set the stage for psychophysiological disorders  One of society’s most adverse social conditions is poverty  Research also reveals that belonging to an ethnic or cultural minority group increases the risk of developing these disorders and other health problems, but the relationship is complicated 50 Comer, Fundamentals of Abnormal Psychology, 7e

51. New Psychophysiological Disorders  Clearly, biological, psychological, and sociocultural variables combine to produce psychophysiological disorders  In fact, the interaction of psychosocial and physical factors is now considered the rule of bodily function, not the exception  In recent years, more and more illnesses have been added to the list of psychophysiological disorders 51 Comer, Fundamentals of Abnormal Psychology, 7e

52. 52 Comer, Fundamentals of Abnormal Psychology, 7e 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

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54. 54 Comer, Fundamentals of Abnormal Psychology, 7e New Psychophysiological Disorders  Are physical illnesses related to stress?  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  Researchers have even found a relationship between traumatic stress and death

55. 55 Comer, Fundamentals of Abnormal Psychology, 7e New Psychophysiological Disorders  Are physical illnesses related to stress?  One shortcoming of the Social Adjustment Rating Scale is that it does not take into consideration the particular stress reactions within specific populations  For example, members of minority groups may respond to stress differently and women and men have been shown to react differently to certain life changes measured by the scale

56. Psychoneuroimmunology  Researchers have increasingly looked to the body’s immune system as the key to the relationship between stress and infection  This area of study is called psychoneuroimmunology 56 Comer, Fundamentals of Abnormal Psychology, 7e

57. Psychoneuroimmunology  The immune system is the body’s network of activities and cells that identify and destroy antigens (foreign invaders, such as bacteria) and cancer cells  Among the most important cells in this system are the lymphocytes  Lymphocytes are white blood cells that circulate through the lymph system and the bloodstream, attacking invaders  Lymphocytes include helper T-cells, natural killer T- cells, and B-cells 57 Comer, Fundamentals of Abnormal Psychology, 7e

58. Psychoneuroimmunology  Researchers now believe that stress can interfere with the activity of lymphocytes, slowing them down and increasing a person’s susceptibility to viral and bacterial infections  Several factors influence whether stress will result in a slowdown of the system, including biochemical activity, behavioral changes, personality style, and degree of social support 58 Comer, Fundamentals of Abnormal Psychology, 7e

59. Psychoneuroimmunology  Biochemical activity  Stress leads to increased activity by the sympathetic nervous system, including a release of norepinephrine  In addition to supporting nervous system activity, this chemical also appears to slow down the functioning of the immune system  Similarly, the body’s endocrine glands reduce immune system functioning during periods of prolonged stress through the release of corticosteroids  In addition, corticosteroids also trigger increased cytokines, which lead to chronic inflammation 59 Comer, Fundamentals of Abnormal Psychology, 7e

60. Psychoneuroimmunology  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  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 60 Comer, Fundamentals of Abnormal Psychology, 7e

61. Psychoneuroimmunology  Social support  People who have few social supports and feel lonely seem to display poorer immune functioning in the face of stress 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 61 Comer, Fundamentals of Abnormal Psychology, 7e

62. 62 Comer, Fundamentals of Abnormal Psychology, 7e Psychological Treatments for Physical Disorders  As clinicians have discovered that stress and related psychosocial factors may contribute to physical disorders, they have applied psychological treatment to more and more medical problems  The most common of these interventions are relaxation training, biofeedback training, meditation, hypnosis, cognitive interventions, support groups, and therapies designed to increase awareness and expression of emotion

63. 63 Comer, Fundamentals of Abnormal Psychology, 7e Psychological Treatments for Physical Disorders  The field of treatment that combines psychological and physical interventions to treat or prevent medical problems is known as behavioral medicine

64. 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 64 Comer, Fundamentals of Abnormal Psychology, 7e

65. 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 65 Comer, Fundamentals of Abnormal Psychology, 7e

66. 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 66 Comer, Fundamentals of Abnormal Psychology, 7e

67. 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) 67 Comer, Fundamentals of Abnormal Psychology, 7e

68. Psychological Treatments for Physical Disorders  Hypnosis  This technique seems to be particularly helpful in the control of pain; is now used to treat such problems as skin diseases, asthma, insomnia, high blood pressure, warts, and other forms of infection 68 Comer, Fundamentals of Abnormal Psychology, 7e

69. 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 69 Comer, Fundamentals of Abnormal Psychology, 7e

70. Psychological Treatments for Physical Disorders  Support groups and emotion expression  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 70 Comer, Fundamentals of Abnormal Psychology, 7e

71. 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 71 Comer, Fundamentals of Abnormal Psychology, 7e