Somatoform DisordersSomatoform Disorders

HypochondriasisHypochondriasis Origin of the word--hypochondriaOrigin of the word--hypochondria

Characterized byCharacterized by Anxiety that one has a serious diseaseAnxiety that one has a serious disease Preoccupied with bodily symptoms, misinterpreting Preoccupied with bodily symptoms, misinterpreting

them as indicative of diseasethem as indicative of disease Focus on long-term process of illness (contrast to PD)Focus on long-term process of illness (contrast to PD) Preoccupation persists despite medical reassurancePreoccupation persists despite medical reassurance Not delusionary intensityNot delusionary intensity Six monthsSix months

Somatoform DisordersSomatoform Disorders

HypochondriasisHypochondriasis StatisticsStatistics

1-14%1-14% Not more prevalent in elderlyNot more prevalent in elderly

CultureCulture KoroKoro dhatdhat

HypochondriasisHypochondriasis EtiologyEtiology

Disorder of cognition or perception (cycle) Disorder of cognition or perception (cycle) 11stst begins with a trigger (information, event, illness) begins with a trigger (information, event, illness) 22ndnd, perceived threat, perceived threat 33rdrd, apprehension, apprehension 44thth, Increased focus on body and checking behavior, Increased focus on body and checking behavior 55thth, preoccupation w/ perceived change in bodily sensations, preoccupation w/ perceived change in bodily sensations 66thth, misinterpretation of sensations, misinterpretation of sensations 77thth, perceived threat, perceived threat

Other factorsOther factors Stressful life eventsStressful life events incidence of illness during childhoodincidence of illness during childhood ““sick role”sick role”

HypochondriasisHypochondriasis

TreatmentTreatment CBTCBT Psychodynamic approachPsychodynamic approach

Somatization DisorderSomatization Disorder Initially referred to as Briquet’s SyndromeInitially referred to as Briquet’s Syndrome

CriteriaCriteria History of many physical complaints before age 30 over History of many physical complaints before age 30 over

several yrsseveral yrs 4 pain symptoms4 pain symptoms 2 GI symptoms2 GI symptoms 1 sexual symptom1 sexual symptom 1 pseudoneurological symptom1 pseudoneurological symptom EitherEither

Cannot be explained by general medical conditionCannot be explained by general medical condition There is a general medical condition, but complaints There is a general medical condition, but complaints

exceed what would be expectedexceed what would be expected

Somatization DisorderSomatization Disorder StatisticsStatistics

4%4% More frequently observed in femalesMore frequently observed in females

EtiologyEtiology Similar pathogenesis to hypochondriasisSimilar pathogenesis to hypochondriasis Strongly linked in family/genetic studies to Strongly linked in family/genetic studies to

ASPDASPD Behavioral Inhibition SystemBehavioral Inhibition System

Sensitive to threat or dangerSensitive to threat or danger Avoid situations or signals suggesting threat or dangerAvoid situations or signals suggesting threat or danger Both diagnoses have a weak BISBoth diagnoses have a weak BIS

Both strive for short-term gain at the expense of long-Both strive for short-term gain at the expense of long-term gainterm gain

Somatization DisorderSomatization Disorder

TreatmentTreatment Gate-keeperGate-keeper Rapport Rapport

Conversion DisorderConversion Disorder

1 or more symptoms affecting voluntary motor 1 or more symptoms affecting voluntary motor or sensory function suggesting neurological or sensory function suggesting neurological conditioncondition

Psych factors judged to be associated w/ Psych factors judged to be associated w/ symptom b/c initiation or exacerbation of symptom b/c initiation or exacerbation of symptom is preceded by conflicts or other symptom is preceded by conflicts or other stressorsstressors

Symptom is not intentionally produced/feignedSymptom is not intentionally produced/feigned

Conversion DisorderConversion Disorder

Closely related disordersClosely related disorders MalingeringMalingering Factitious disordersFactitious disorders

StatisticsStatistics 1-30% in neurological settings1-30% in neurological settings

Conversion DisorderConversion Disorder

EtiologyEtiology FreudFreud

11stst process: individual experiences a traumatic process: individual experiences a traumatic event w/ unacceptable, unconscious conflictevent w/ unacceptable, unconscious conflict

22ndnd process: person represses anxiety process: person represses anxiety 33rdrd process: as anxiety increases, unconscious process: as anxiety increases, unconscious

converts it into physical symptom to avoid converts it into physical symptom to avoid anxietyanxiety

Primary GainPrimary Gain 44thth process: individual receives increased process: individual receives increased

attention and sympathy from love ones, and attention and sympathy from love ones, and avoids responsibilitiesavoids responsibilities

Secondary GainSecondary Gain

Body Dysmorphic Body Dysmorphic DisorderDisorder

Preoccupation w/ imagined defect in Preoccupation w/ imagined defect in appearance, if slight physical anomaly appearance, if slight physical anomaly is present, one’s concern is markedly is present, one’s concern is markedly excessiveexcessive

Preoccupation causes sign. distress or Preoccupation causes sign. distress or impairmentimpairment

Body Dysmorphic Body Dysmorphic DisorderDisorder

EtiologyEtiology OCD relationshipOCD relationship

TreatmentTreatment

Pain DisorderPain Disorder ??