2.  Common Features Common Features  Lots of Physical Complaints Lots of Physical Complaints  Appear to be Medical Conditions Appear to be Medical Conditions  No Identifiable Medical Cause No Identifiable Medical Cause  Pathological Concern About Pathological Concern About – Physical Appearance Physical Appearance – Functioning of Their Bodies Functioning of Their Bodies  Common Features Common Features  Lots of Physical Complaints Lots of Physical Complaints  Appear to be Medical Conditions Appear to be Medical Conditions  No Identifiable Medical Cause No Identifiable Medical Cause  Pathological Concern About Pathological Concern About – Physical Appearance Physical Appearance – Functioning of Their Bodies Functioning of Their Bodies

3.  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder

4.  Clinical Description Clinical Description  Ancient Roots Ancient Roots  Physical Complaints Physical Complaints  No Known Medical Cause No Known Medical Cause  Severe Anxiety / Fear About Severe Anxiety / Fear About Possibly Having a Serious Disease  Reassurance Doesn’t Help Reassurance Doesn’t Help  Clinical Description Clinical Description  Ancient Roots Ancient Roots  Physical Complaints Physical Complaints  No Known Medical Cause No Known Medical Cause  Severe Anxiety / Fear About Severe Anxiety / Fear About Possibly Having a Serious Disease  Reassurance Doesn’t Help Reassurance Doesn’t Help

5.  Clinical Description Clinical Description  Essential Problem is Anxiety Essential Problem is Anxiety  Preoccupied With Bodily Symptoms Preoccupied With Bodily Symptoms  Misinterpretation of Symptoms Misinterpretation of Symptoms  Strong Disease Conviction Strong Disease Conviction  Many Medical Visits and Tests Many Medical Visits and Tests  Clinical Description Clinical Description  Essential Problem is Anxiety Essential Problem is Anxiety  Preoccupied With Bodily Symptoms Preoccupied With Bodily Symptoms  Misinterpretation of Symptoms Misinterpretation of Symptoms  Strong Disease Conviction Strong Disease Conviction  Many Medical Visits and Tests Many Medical Visits and Tests

6. Why not Classify Such Persons With an Illness Phobia? Why not Classify Such Persons With an Illness Phobia?

7.  Facts and Statistics Facts and Statistics  1% to 14% Medical Patients 1% to 14% Medical Patients  Equal Rates (Males vs. Females) Equal Rates (Males vs. Females)  May Occur Any Time May Occur Any Time  Strong Disease Conviction Strong Disease Conviction  Many Medical Visits and Tests Many Medical Visits and Tests  Facts and Statistics Facts and Statistics  1% to 14% Medical Patients 1% to 14% Medical Patients  Equal Rates (Males vs. Females) Equal Rates (Males vs. Females)  May Occur Any Time May Occur Any Time  Strong Disease Conviction Strong Disease Conviction  Many Medical Visits and Tests Many Medical Visits and Tests

8.  Causes Causes  Disorder of Cognition / Perception Disorder of Cognition / Perception  More Disease in Family More Disease in Family  More Illness Concern in Family More Illness Concern in Family  More Attention for Sick Behavior More Attention for Sick Behavior  Causes Causes  Disorder of Cognition / Perception Disorder of Cognition / Perception  More Disease in Family More Disease in Family  More Illness Concern in Family More Illness Concern in Family  More Attention for Sick Behavior More Attention for Sick Behavior

9.  Psychological Treatment Psychological Treatment  Modify Illness Perceptions Modify Illness Perceptions  Evoke Bodily Sensations Evoke Bodily Sensations  Provide “Appropriate” Reassurance Provide “Appropriate” Reassurance  More Research is Needed! More Research is Needed!  Psychological Treatment Psychological Treatment  Modify Illness Perceptions Modify Illness Perceptions  Evoke Bodily Sensations Evoke Bodily Sensations  Provide “Appropriate” Reassurance Provide “Appropriate” Reassurance  More Research is Needed! More Research is Needed!

10.  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder

11.  Clinical Description Clinical Description  Briquet’s Syndrome Briquet’s Syndrome  Many Physical Complaints Many Physical Complaints  No Known Medical Cause No Known Medical Cause  Little Concern About Symptoms Little Concern About Symptoms La Belle Indifference  Life Revolves Around Symptoms Life Revolves Around Symptoms  Clinical Description Clinical Description  Briquet’s Syndrome Briquet’s Syndrome  Many Physical Complaints Many Physical Complaints  No Known Medical Cause No Known Medical Cause  Little Concern About Symptoms Little Concern About Symptoms La Belle Indifference  Life Revolves Around Symptoms Life Revolves Around Symptoms

12.  Facts and Statistics Facts and Statistics  Extremely Rare Extremely Rare  About 4.4% of Population About 4.4% of Population  Onset in Adolescence Onset in Adolescence  Females > Males Females > Males  Often a Chronic Condition Often a Chronic Condition  Facts and Statistics Facts and Statistics  Extremely Rare Extremely Rare  About 4.4% of Population About 4.4% of Population  Onset in Adolescence Onset in Adolescence  Females > Males Females > Males  Often a Chronic Condition Often a Chronic Condition

13.  Causes Causes  Family Link Family Link  Link to Antisocial Personality Link to Antisocial Personality – Weak Behavioral Inhibition Weak Behavioral Inhibition – Strong Behavioral Activation Strong Behavioral Activation – Short Term Gain Short Term Gain  Causes Causes  Family Link Family Link  Link to Antisocial Personality Link to Antisocial Personality – Weak Behavioral Inhibition Weak Behavioral Inhibition – Strong Behavioral Activation Strong Behavioral Activation – Short Term Gain Short Term Gain

14.  Treatment Treatment  Difficult to Treat Difficult to Treat  No Proven Treatments No Proven Treatments  Extensive Medical Visits Extensive Medical Visits  Treatment Focuses on Treatment Focuses on – Reduction of Medical Visits Reduction of Medical Visits – Reducing Secondary Gain Reducing Secondary Gain  Treatment Treatment  Difficult to Treat Difficult to Treat  No Proven Treatments No Proven Treatments  Extensive Medical Visits Extensive Medical Visits  Treatment Focuses on Treatment Focuses on – Reduction of Medical Visits Reduction of Medical Visits – Reducing Secondary Gain Reducing Secondary Gain

15.  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder

16.  Clinical Description Clinical Description  Physical Malfunctioning Physical Malfunctioning – Paralysis, Blindness, Aphonia Paralysis, Blindness, Aphonia – Mutism, Lost Sense of Touch Mutism, Lost Sense of Touch  No Organic Pathology No Organic Pathology  Looks Like Neurological Disease Looks Like Neurological Disease  Popularized by Freud Popularized by Freud  Clinical Description Clinical Description  Physical Malfunctioning Physical Malfunctioning – Paralysis, Blindness, Aphonia Paralysis, Blindness, Aphonia – Mutism, Lost Sense of Touch Mutism, Lost Sense of Touch  No Organic Pathology No Organic Pathology  Looks Like Neurological Disease Looks Like Neurological Disease  Popularized by Freud Popularized by Freud

17.  Related Conditions Related Conditions  Malingering or Something Else? Malingering or Something Else? – La Belle Indifference La Belle Indifference – Precipitated by Marked Stress Precipitated by Marked Stress – Can Function Normally Can Function Normally  Factitious Disorders Factitious Disorders – Munchausen’s Syndrome by Proxy Munchausen’s Syndrome by Proxy  Related Conditions Related Conditions  Malingering or Something Else? Malingering or Something Else? – La Belle Indifference La Belle Indifference – Precipitated by Marked Stress Precipitated by Marked Stress – Can Function Normally Can Function Normally  Factitious Disorders Factitious Disorders – Munchausen’s Syndrome by Proxy Munchausen’s Syndrome by Proxy

18.  Facts and Statistics Facts and Statistics  Relatively Rare Relatively Rare  Females > Males Females > Males  Onset Around Adolescence Onset Around Adolescence  Facts and Statistics Facts and Statistics  Relatively Rare Relatively Rare  Females > Males Females > Males  Onset Around Adolescence Onset Around Adolescence

19.  Causes Causes  Experience of Trauma Experience of Trauma  Getting Sick is Acceptable Getting Sick is Acceptable  Symptoms to Escape From the Effects of Trauma Symptoms to Escape From the Effects of Trauma  What Influences Choice of Symptoms? What Influences Choice of Symptoms?  Causes Causes  Experience of Trauma Experience of Trauma  Getting Sick is Acceptable Getting Sick is Acceptable  Symptoms to Escape From the Effects of Trauma Symptoms to Escape From the Effects of Trauma  What Influences Choice of Symptoms? What Influences Choice of Symptoms?

20.  Treatment Treatment  Address the Traumatic Event Address the Traumatic Event  Remove Sources of Secondary Gain Remove Sources of Secondary Gain  No Well Established Treatments No Well Established Treatments  Treatment Treatment  Address the Traumatic Event Address the Traumatic Event  Remove Sources of Secondary Gain Remove Sources of Secondary Gain  No Well Established Treatments No Well Established Treatments

21.  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder

22.  Clinical Description Clinical Description  Pain is Real Pain is Real  Pain May Have Organic Cause Pain May Have Organic Cause  Psychological Factors Maintain Pain Psychological Factors Maintain Pain  Can be Debilitating Can be Debilitating  Clinical Description Clinical Description  Pain is Real Pain is Real  Pain May Have Organic Cause Pain May Have Organic Cause  Psychological Factors Maintain Pain Psychological Factors Maintain Pain  Can be Debilitating Can be Debilitating

23.  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder  Five Somatoform Disorders Five Somatoform Disorders  Hypochondriasis Hypochondriasis  Somatization Disorder Somatization Disorder  Conversion Disorder Conversion Disorder  Pain Disorder Pain Disorder  Body Dysmorphic Disorder Body Dysmorphic Disorder

24.  Clinical Description Clinical Description  Preoccupation With Appearance Preoccupation With Appearance – Imagined Defect Imagined Defect  “Imagined” Ugliness “Imagined” Ugliness  Mirrors (Fixation or Avoidance) Mirrors (Fixation or Avoidance)  Ideas of Reference Ideas of Reference  Suicidal Ideation and Tendencies Suicidal Ideation and Tendencies  Clinical Description Clinical Description  Preoccupation With Appearance Preoccupation With Appearance – Imagined Defect Imagined Defect  “Imagined” Ugliness “Imagined” Ugliness  Mirrors (Fixation or Avoidance) Mirrors (Fixation or Avoidance)  Ideas of Reference Ideas of Reference  Suicidal Ideation and Tendencies Suicidal Ideation and Tendencies

25.  Common Locations of Defects Common Locations of Defects  Hair Hair  Nose Nose  Skin Skin  Eyes Eyes  Head / Face Head / Face  Lips Lips  Common Locations of Defects Common Locations of Defects  Hair Hair  Nose Nose  Skin Skin  Eyes Eyes  Head / Face Head / Face  Lips Lips

26.  Facts and Statistics Facts and Statistics  College Students College Students – 70% Report Some Disatisfaction 70% Report Some Disatisfaction – 28% Meet Diagnostic Criteria 28% Meet Diagnostic Criteria  Many Consult Plastic Surgeons Many Consult Plastic Surgeons  Males = Females Males = Females  Onset Late Adolescence Onset Late Adolescence  Facts and Statistics Facts and Statistics  College Students College Students – 70% Report Some Disatisfaction 70% Report Some Disatisfaction – 28% Meet Diagnostic Criteria 28% Meet Diagnostic Criteria  Many Consult Plastic Surgeons Many Consult Plastic Surgeons  Males = Females Males = Females  Onset Late Adolescence Onset Late Adolescence

27.  The Plastic Surgery Solution? The Plastic Surgery Solution?  Quite Popular but Expensive Quite Popular but Expensive  Most are Disappointed With Results Most are Disappointed With Results  The Plastic Surgery Solution? The Plastic Surgery Solution?  Quite Popular but Expensive Quite Popular but Expensive  Most are Disappointed With Results Most are Disappointed With Results BEFORE AFTER

28.  Causes and Treatment Causes and Treatment  Little is Known Little is Known  Co-Occurs With OCD Co-Occurs With OCD – Intrusive Thoughts and Checking Compulsions About Appearance Intrusive Thoughts and Checking Compulsions About Appearance  Exposure + Response Prevention Exposure + Response Prevention  Causes and Treatment Causes and Treatment  Little is Known Little is Known  Co-Occurs With OCD Co-Occurs With OCD – Intrusive Thoughts and Checking Compulsions About Appearance Intrusive Thoughts and Checking Compulsions About Appearance  Exposure + Response Prevention Exposure + Response Prevention