Abnormal Psychology Chapter 8 Feb 5-10, 2009 Classes #8-9

1. Somatoform DisordersMass Psychogenic IllnessMalingering & Factitious DisordersDissociative Disorders Abnormal Psychology Chapter 8 Feb 5-10, 2009 Classes #8-9

2. Somatoform Disorders • 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

3. Psychosomatic Disorders • Tension headaches, cardiovascular problems, etc. which cause physical damage • State of mind appears to be causing the illness

4. Somatoform Disorders • Somatization Disorder (Briquet’s) • Pain Disorder • Hypochondriasis • Body Dysmorphic Disorder • Conversion Disorder

5. 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

6. Somatization Disorder • Sex difference • F > M • Primarily a female disorder with about 1% suffering from this disorder • Onset • Usually by age 30 but its seen from childhood on up • Familial tendencies • 5 to 10 times more common in female first-degree relatives • Genetic links to antisocial personality and alcoholism

7. A typical scenario… • 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

8. 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???

9. They usually don’t go and further than their General Practitioner… • Bottom line: • Psychologists and psychiatrists rarely manage the majority of patients with somatoform disorders -- this difficult undertaking falls predominantly on general practitioners

10. Somatization Disorder Explanations • Psychodynamic Explanation • Behavioral (Learning) Explanation • Physiological (Biological) Explanation • Cognitive Explanation

11. Psychodynamic Explanation • They have an unconscious conflict, wish, or need which is converted to a somatic symptom • 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

12. 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

13. Physiological Explanation • Genes

14. Cognitive Explanation • They do not accept doctors advice • Therefore treatment is difficult

15. 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 anti-anxiety meds) are often used to treat some of the residual symptoms but are not effective in helping with the somatization problems

16. Complications • There are several major complications to this disorder…

17. Etiology • Unknown • We know it tends to run in families but the cause is unknown at this time • More research is needed for this one

18. Prognosis • Poor • Its usually a lifelong disorder • Complete relief of symptoms for any extended period is rare

19. Pain Disorder • 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

20. Body Dysmorphic Disorder • Preoccupation with an imagined or minor defect in one's physical appearance • It is distinguished from normal concerns about appearance because it is time-consuming, 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

21. 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.

22. “Elise” from First Wives Club

23. Treatments • Cognitive-Behavioral • Exposure is used to treat phobia-like symptoms • Therapy will focus on improving the distorted body image that these people possess

24. Treatments • Physiological • Preliminary evidence that selective serotonin reuptake inhibitors may be helpful but data on drug treatment is limited

25. Treatments • Family behavioral treatments can be useful • Support groups if available can also help

26. Prognosis • Poor • 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

27. Hypochondrasis • 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

28. Hypochondrasis • 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)

29. Hypochondrasis • Gender difference • More common in women than men (I couldn’t find any stats though) • Onset • Usually in 30’s • But seen in all age groups

30. Treatments • Much research suggests a cognitive-behavioral combo is best with therapist extremely gentle in his/her questioning the patient’s incorrect beliefs

31. Prognosis • Its not good (perhaps 5% recover) for the following reasons:

32. Major Differences between Somatization Disorder and Hypochondrasis • Focus of Complaint • Style of Complaint • Interaction with Clinician • Age • Physical Appearance • Personality Style

33. Conversion Disorder • Sensory/motor dysfunction in the absence of a physical basis… • Symptoms develop unconsciously and are limited to those that suggest a neurological disorder • 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

34. Conversion Disorder • 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

35. Conversion Disorder: Important Characteristics • Glove anesthesia

36. Conversion Disorder: Important Characteristics • Doctor Shop • They visit many physicians hoping to find one who will propose a physical treatment for their non-physical problems • La Belle Indifference • The tendency of these people to be relatively unconcerned about their physical problem

37. Explanations • Pure speculation at this point

38. Treatment • Hypnotherapy • The patient is hypnotized and potentially etiologic psychological issues are identified and examined • Narcoanalysis • Similar to hypnotherapy except the patient is also given a sedative to induce a state of semi-sleep • Relaxation training • Often combined with cognitive therapy

39. Prognosis • No treatment is considered very effective

40. Mass Psychogenic Illness • Also referred to as Mass Hysteria • Epidemic of a particular manifestation of a somatoform disorder

41. Mass Psychogenic Illness • Sex difference: F > M • Age Difference: Adolescents and children seem to be particularly at risk

42. Mass Psychogenic Illness • Physicians might consider a group sickness as being caused by mass psychogenic illness if: • 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

43. Mass Psychogenic Illness • Symptoms • 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 • Removing patients from the place where the illness started • Separate patients • Understand that the illness is real • Reassure patients that they will be okay

44. Complications • Do you see any complications here???

45. Are somatoform disorders real or faked? • Malingering • Factitious Disorders • Munchausen Syndrome • Munchausen Syndrome by Proxy

46. Malingering • 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

47. Factitious Disorders • Here, a person is faking symptoms to receive the attention and/or sympathy that comes with being sick… • Munchausen Syndrome • Munchausen Syndrome by Proxy

48. Munchausen Syndrome (Factitious Disorder By Proxy) • 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)

49. Munchausen Syndrome by Proxy • Signs and tests

50. Munchausen Syndrome by Proxy • Treatment • Offer parent help rather than accuse them • Psychiatric counseling will likely be recommended • Family therapy is often helpful if the husband is willing • Prognosis • This is often a difficult disorder to treat and often requires years of psychiatric support