Somatoform Disorders
Mass Psychogenic Illness
Malingering & Factitious Disorders
Dissociative Disorders
Abnormal Psychology
Chapter 8
Sep 22-29, 2009
Classes #9-11
Somatoform Disorders
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Physical symptoms with an absence of
physical reasons for the symptoms
No physical damage results from the
disorder
These individuals believe that their
illnesses are real
Psychosomatic Disorders

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Tension headaches, cardiovascular
problems, etc. which cause physical
damage
State of mind appears to be causing the
illness
Somatoform Disorders
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Somatization Disorder (Briquet’s)
Pain Disorder
Hypochondriasis
Body Dysmorphic Disorder
Conversion Disorder
Somatization Disorder

Diagnostic Criteria
 To be diagnosed a person must have reported
at least the following:
 Gastrointestinal symptoms (2)
 Sexual symptoms (1)
 Neurological symptoms (1)
 Pain (4 locations)
 These symptoms cannot be explained by a
physical disorder
Somatization Disorder

Sex difference
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Onset
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F>M
Primarily a female disorder with about 1% suffering from
this disorder
Usually by age 30 but its seen from childhood on up
Familial tendencies
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5 to 10 times more common in female first-degree
relatives
Genetic links to antisocial personality and
alcoholism
A typical scenario…
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Typically, patients are dramatic and
emotional when recounting their symptoms
They are often described as exhibitionistic
and seductive and self-centered
In an attempt to manipulate others, they
may threaten or attempt suicide
These patients “doctor-shop”…

Often dissatisfied with their medical care,
they go from one physician to another…

What would be a recommended route for
these patients to choose insofar a
medical/mental health care is concerned???
They usually don’t go and further
than their General Practitioner…
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Bottom line:

Psychologists and psychiatrists rarely manage
the majority of patients with somatoform
disorders -- this difficult undertaking falls
predominantly on general practitioners
Somatization Disorder
Explanations
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Psychodynamic Explanation
Behavioral (Learning) Explanation
Physiological (Biological) Explanation
Cognitive Explanation
Psychodynamic Explanation
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They have an unconscious conflict, wish, or need
which is converted to a somatic symptom


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Pent-up emotional energy is converted to a physical
symptom
They may have identification with an important figure
who suffered from the symptom
They may have the need for punishment because of
an unacceptable impulse directed against a loved one
There may be an unconscious somatized plea for
attention and care from these individuals
Learning Explanation


A child with an injury quickly learns the
benefits of playing the sick role
Reinforced by increased parental attention
and avoidance of unpleasant responsibilities
Physiological Explanation

Genes
Cognitive Explanation


They do not accept doctors advice
Therefore treatment is difficult
Treatments

Really haven’t been successful because patient
usually won’t consider their problem as psychological

In rare cases when individual is receptive to
treatment, both psychoanalysis and cognitive
treatments have brought improvement

Drug treatments (anti-depressants and antianxiety meds) are often used to treat some of the
residual symptoms but are not effective in helping
with the somatization problems
Complications

There are several major complications to this
disorder…
Etiology

Unknown

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We know it tends to run in families but the
cause is unknown at this time
More research is needed for this one
Prognosis

Poor
 Its usually a lifelong disorder
 Complete relief of symptoms for any
extended period is rare
Pain Disorder

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The patient complains of pain without an
identifiable physical cause to explain the
symptoms the person is complaining about
Basically, the same as somatization disorder
except that pain is the only symptom
Body Dysmorphic Disorder
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Preoccupation with an imagined or minor
defect in one's physical appearance
It is distinguished from normal concerns
about appearance because it is timeconsuming, causes significant distress, and
impairs functioning
Depression, phobias, and OCD may
accompany this disorder
Sex difference: Females > Males
 Females: breasts, legs
 Males: genitals, height, and body hair
Symptoms

Major concerns involving especially the face or
head but may involve any body part and often
shifts from one to another

Examples: hair thinning, acne, wrinkles, scars, eyes,
mouth, breasts, buttocks, etc.
“Elise” from First Wives Club
Treatments

Cognitive-Behavioral
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Exposure is used to treat phobia-like symptoms
Therapy will focus on improving the distorted
body image that these people possess
Treatments

Physiological
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Preliminary evidence that selective
serotonin reuptake inhibitors may be
helpful but data on drug treatment is
limited
Treatments

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Family behavioral treatments can be useful
Support groups if available can also help
Prognosis

Poor
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Since these individuals are reluctant to
reveal their symptoms, it usually goes
unnoticed for years
Very difficult to treat as they usually insist
on a physical cause
More research is needed to determine any
effective treatment for this disorder
Hypochondrasis
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Unrealistic belief that a minor symptom reflects a
serious disease
Excessive anxiety about one or two symptoms
Examination and reassurance by a physician does
not relieve the concerns of the patient
They believe the doctor has missed the
real reason
Hypochondrasis
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Symptoms adversely affect social and
occupational functioning
Diagnosis is suggested by the history and
examination and confirmed if symptoms
persist for at least 6 months and cannot be
attributed to another psychiatric disorder
(such as depression)
Hypochondrasis
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Gender difference
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More common in women than men (I couldn’t
find any stats though)
Onset
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Usually in 30’s
But seen in all age groups
Treatments
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Much research suggests a cognitive-behavioral
combo is best with therapist extremely gentle in
his/her questioning the patient’s incorrect beliefs
Prognosis

Its not good (perhaps 5% recover) for the
following reasons:
Major Differences between Somatization
Disorder and Hypochondrasis
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Focus of Complaint
Style of Complaint
Interaction with Clinician
Age
Physical Appearance
Personality Style
Conversion Disorder
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Sensory/motor dysfunction in the absence of a physical
basis…
Symptoms develop unconsciously and are limited
to those that suggest a neurological disorder
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Examples: numbness of limbs, paralysis, speech
problems, blindness and hearing loss, difficulty
swallowing, sensation of a lump in your throat, difficulty
speaking, difficulty walking, etc.
Symptoms are not feigned (as in factitious disorder or
malingering)
Individual is often highly dramatic
Conversion Disorder
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History
 Was first studied by the Nancy School of Hypnosis
(Nancy, France) and Freud in examinations of
hysteria (1880’s)
Onset
 Tends to be adolescence to adulthood but may occur
at any age
Sex Difference
 Appears to be "somewhat" more common in women
 No stats
Prevalence
 1% - 3% of general population
 Tends to occur in less educated, lower socioeconomic
groups
Conversion Disorder:
Important Characteristics
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Glove
anesthesia
Conversion Disorder:
Important Characteristics
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Doctor Shop
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They visit many physicians hoping to find one
who will propose a physical treatment for their
non-physical problems
La Belle Indifference
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The tendency of these people to be relatively
unconcerned about their physical problem
Explanations
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Pure speculation at this point
Treatment
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Hypnotherapy
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Narcoanalysis
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The patient is hypnotized and potentially
etiologic psychological issues are
identified and examined
Similar to hypnotherapy except the
patient is also given a sedative to induce
a state of semi-sleep
Relaxation training
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Often combined with cognitive therapy
Prognosis
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No treatment is considered very effective
Mass Psychogenic Illness
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Also referred to as Mass Hysteria
 Epidemic of a particular manifestation of a
somatoform disorder
Mass Psychogenic Illness
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Sex difference: F > M
Age Difference: Adolescents and children
seem to be particularly at risk
Mass Psychogenic Illness
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Physicians might consider a group
sickness as being caused by mass
psychogenic illness if:
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Physical exams and tests are normal
Doctors can't find anything wrong with the
group's classroom or office (for example, some
kind of poison in the air)
Many people get sick
Mass Psychogenic Illness
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Symptoms
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Include the following: headache, dizziness, nausea,
cramps, coughing, fatigue, drowsiness, sore or burning
throat, diarrhea, rash, itching, trouble with vision,
anxiety, loss of consciousness, etc.
Treatment
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Removing patients from the place where the illness
started
Separate patients
Understand that the illness is real
Reassure patients that they will be okay
Complications
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Do you see any complications here???
Are somatoform disorders real or
faked?
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Malingering
Factitious Disorders
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Munchausen Syndrome
Munchausen Syndrome by Proxy
Malingering
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Faking physical illnesses to avoid
responsibility or for economic gain
Seek medical care or hospitalization under
false pretenses
Once they get what they want they usually
stop all complaining about their alleged
problems
Factitious Disorders
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Here, a person is faking symptoms to
receive the attention and/or sympathy that
comes with being sick…
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Munchausen Syndrome
Munchausen Syndrome by Proxy
Munchausen Syndrome
(Factitious Disorder By Proxy)
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Condition characterized by the feigning of the
symptoms of the disease in order to undergo
diagnostic tests, hospitalization, or medical or
surgical treatment
These people (almost always women) fake
serious symptoms in someone close to them
(usually a child) to gain attention and sympathy (
a form of child abuse)
Munchausen Syndrome by Proxy
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Signs and tests
Munchausen Syndrome by Proxy
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Treatment
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Offer parent help rather than accuse them
Psychiatric counseling will likely be recommended
Family therapy is often helpful if the husband is
willing
Prognosis
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This is often a difficult disorder to treat and often
requires years of psychiatric support
Dissociative Disorders
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Dissociative Amnesia
Dissociative Fugue
Depersonalization Disorder
Dissociative Identity Disorder
Dissociative Amnesia
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Formerly termed Psychogenic Amnesia. Name
of illness also changed in DSM IV
The sudden inability to remember important
personal information or events
Usually begins as a response to intolerable
psychological stress
Very rare (less than 1%)
Types of Dissociative Amnesia
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Localized amnesia
 The person fails to recall events that occurred during a
particular period of time
Selective amnesia
 The person can recall some but not all of the events
during a certain time frame
Generalized amnesia
 This lasts throughout a person’s entire life – very rare
Continuous amnesia
 The inability to recall events subsequent to a specific
time including the present
Systemized amnesia
 The loss of memory for certain categories of information
Dissociative Amnesia
Treatment
 Therapy can be useful to help with coping but is
not always needed
 Often, they become disoriented and may forget
who they are but usually the amnesia vanishes
as abruptly as it began
Dissociative Fugue
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Formerly termed Psychogenic Fugue
Name of illness also changed in DSM IV
An episode during which an individual
leaves his usual surroundings unexpectedly
and forgets essential details about himself
and his lives
It is very rare, with a prevalence rate of
about 0.2% in the general population
Symptoms
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Sudden and unplanned travel away from home
together with an inability to recall past events
about one's life
Cause
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Is usually triggered by traumatic and
stressful events, such as wartime battle,
abuse, rape, accidents, natural disasters,
and extreme violence, although fugue states
may not occur immediately
Treatment
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Psychoanalysis
Cognitive therapy ("creative therapies")
Hypnotherapy
Medications
Family therapy
Depersonalization
Disorder
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These individuals report feeling
detached from their mental
processes or body
Occurs in as many as 30% of
normal individuals at some time
Only constitutes a disorder if it
interferes with a person’s
functioning
Cause

As with other disorders in this category, an
acute stressor is often the precursor to
onset
Symptoms


This disorder is characterized by feelings of
unreality, that your body does not belong to
you, or that you are constantly in a
dreamlike state
Symptoms are most common between 25-44
Treatment


The disorder will typically dissipate on its
own after a period of time
Therapy can be helpful to strengthen coping
skills
Prognosis

Prognosis is very good
Dissociative Identity
Disorder

Commonly referred to as Multiple Personality
Disorder
 Very rare: Less than 1%.
 A person alternates between two or more
distinct personality systems
 Usually there is a main or basic personality
 Sex difference: F > M (9 to 1 ratio)
Symptoms

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The individual may change from one
personality to another in a matter of a few
minutes to several years (shorter time
frames are more common)
The personalities are often dramatically
different
Complications
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Sleep disorders
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Night terrors and/or sleep walking
Alcohol and drug abuse
OCD-like rituals
Eating disorders
Depression
High suicide rate
Probably the #1
“Hollywood Disorder”
Important Note
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Until 1970's extremely rare with few
reported cases (about 100) but since then
its prevalence has increased dramatically.
Why this dramatic increase???
Dissociative Identity
Disorder
Treatment
 Psychoanalysis -- try to give therapy to the
main personality who "knows" the others
Prognosis
 Not good