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differences
(a psychological conflict converted into a physical problem)
SOMATOFORM DISORDERS
Hysterical
Preoccupation
conversion disorder
somatization disorder
pain disorder
hypochondriasis
BDD
suffer changes in
physical functioning
misinterpret/overreact to
body symptom or
features
hysterical somatoform disorders
conversion disorder
somatization disorder
pain disorder
The physical ailments suggest a medical condition
but there is no evidence of physical pathology.
Not intentionally faking illness. In fact, distressed
and goes to physician about it.
Like dissociative disorders, viewed as ways to
escape stress.
conversion disorder
DIAGNOSTIC CRITERIA
•  1+ sensory or voluntary motor deficit
•  an associated stressor
examples of deficits
Visual (e.g. blindness or tunnel vision)
Auditory (e.g. deafness)
Tactile (e.g. selective numbness)
Motor (e.g. partial paralysis, probs speaking/mutism)
Other (e.g. dizziness, seizures)
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conversion disorder
• DEMOGRAPHICS
•  .005% prevalence (in past, very common in military & civilian life)
•  age of onset: adolescence to young adulthood
•  sex ratio: 2-10: 1
EXCEPTION: military combat (e.g. In WWI, it was the most
frequently diagnosed disorder among soldiers)
•  rural residents
•  less educated
•  medically unsophisticated
•  low socioeconomic status (SES)
conversion disorder
CAUSE
-rapid onset w/ trauma or stressor;
-symptoms obviously function as “excuse” to escape
when literal escape isn’t feasible or acceptable
-symptoms resolve ~ 2 weeks after stressor removed
TREATMENT
•  therapy for original trauma/stressor
•  exposure to stimuli that “produce” symptoms
•  do not reinforce deficits with attention/sympathy
•  physical exercises + pos reinforcement
•  SSRIs
somatization disorder
DIAGNOSTIC CRITERIA
before 30 yrs old, years of many long-lasting
physical complaints resulting in treatment
sought or sig impairment
•  4 pain
•  2 gastro-intestinal (e.g. vomiting, diarrhea, nausea, bloating)
•  1 sexual (e.g. menstrual irregularity, sex indifference or dysfunction)
(e.g. see conversion disorder)
•  1 neurological
(just symptoms, not worried about a specific disease)
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somatization disorder
DEMOGRAPHICS
•  prevalence 4%
•  sex ratio: 2-10:1
•  onset: adolescence
•  course: chronic
•  prognosis : poor, chronic
•  low SES, low edu, unmarried
somatization disorder
CAUSE
(genes for disinhibition runs in families;
males ASPD & females somatization disorder)
impulsiveness – short term gain (attn)
– long term probs (social isolation)
pleasure-seeking – provocative sexual behavior
TREATMENT
(hard to treat)
- 1 gateway physician
- CBT to promote appropriate behavior of social skills/relating
to others
- discourage relying symptoms to relate to others
- discourage help-seeking behaviors
pain disorder
DIAGNOSTIC CRITERIA
•  persistent/severe pain in 1+ sites
•  associated w/ a stressor
STATS
•  5-12% prevalence
•  onset: any
•  can start from condition w/ real pain but persists
TREATMENT
•  relaxation training
•  schedule daily activities & reinforcement for “no pain”
•  SSRIs
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preoccupation somatoform
disorders
hypochondriasis
body dysmorphic disorder
hypochondriasis
DIAGNOSTIC CRITERIA
•  6+ months
•  based on misinterpretation of symptoms, preoccupied
that has serious disease despite medical reassurance
otherwise
NOTE
- Preoccupied w/body functions (e.g. veins, HR) or minor
irregularities (e.g. cough, sore)
- not delusional; also, more anxiety than illness symptoms
STATS
•  prevalence 1-7%
•  sex ratio: 1:1
•  onset: early adulthood; trimodal (14,45,60+)
•  course: chronic but waxes & wanes
hypochondriasis
CAUSE
•  cognitive-behavioral view = disorder of cognition &
perception; misinterpret bodily sensations
•  attentional bias for illness-related information
•  knowledge & experience w/ illness (even from media)
• modeling illness in family, reinforcement by escaping
circumstances
TREATMENT
•  6 research studies show CBT every effective
•  educate client about this disorder
•  show client that selective attn to body area = selective
perception of symptoms
•  response & exposure prevention (no checking/reassurance)
•  SSRIs
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body dysmorphic disorder
DIAGNOSTIC CRITERIA
•  complete preoccupation w/ imagined defect or
excessive concern over a minor defect
NOTE
•  compulsive checking behavior (e.g. checking in mirror,
hiding/repairing)
•  avoidance of everyday activities to avoid others
•  significant emotional pain
STATS
•  1-5% prevalence
•  sex ratio: 1:1
•  onset: adolescence to 20’s
•  50% have no job
•  comorbid w/ depression
body dysmorphic disorder
CAUSE
•  genes for being high on trait of neuroticism
•  as child, reinforced for appearance rather than behavior
•  teased/criticized for appearance
•  OCD is sometimes comorbid
TREATMENT
•  SSRIs
•  exposure & response prevention helps 80% of patients
•  cognitive therapy (ID & change perception of body)
ADDITIONAL DIAGNOSIS
If firmly held, get “Delusional Disorder, Somatic Type”
purposely faking
these are NOT somatoform disorders
Why do it?
malingering
to gain an incentive or
avoid jail or work
factitious
disorder
to play the sick role;
for attn & sympathy
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purposely faking
MALINGERING (external incentive)
•  avoid military duty
•  avoid incarceration
•  avoid work
•  gain insurance money
•  gain personal injury lawsuit award
purposely faking
FACTITIOUS DISORDER
Wants attention & sympathy
associated features:
•  childhood exposure to extensive med treatment
•  childhood abuse or disruption
•  grudge against medical profession
•  worked in medical profession
•  dependent personality
•  no social supports
MUNCHAUSEN SYNDROME
Historically, considered extreme & long-term factitious
disorder
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