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Somatoform Disorders

Somatoform Disorders. Hypochondriasis Origin of the word--hypochondria Characterized by Anxiety that one has a serious disease Preoccupied with bodily symptoms, misinterpreting them as indicative of disease Focus on long-term process of illness (contrast to PD)

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Somatoform Disorders

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  1. Somatoform Disorders • Hypochondriasis • Origin of the word--hypochondria • Characterized by • Anxiety that one has a serious disease • Preoccupied with bodily symptoms, misinterpreting them as indicative of disease • Focus on long-term process of illness (contrast to PD) • Preoccupation persists despite medical reassurance • Not delusionary intensity • Six months

  2. Somatoform Disorders • Hypochondriasis • Statistics • 1-14% • Not more prevalent in elderly • Culture • Koro • dhat

  3. Hypochondriasis • Etiology • Disorder of cognition or perception (cycle) • 1st begins with a trigger (information, event, illness) • 2nd, perceived threat • 3rd, apprehension • 4th, Increased focus on body and checking behavior • 5th, preoccupation w/ perceived change in bodily sensations • 6th, misinterpretation of sensations • 7th, perceived threat • Other factors • Stressful life events • incidence of illness during childhood • “sick role”

  4. Hypochondriasis • Treatment • CBT • Psychodynamic approach

  5. Somatization Disorder • Initially referred to as Briquet’s Syndrome • Criteria • History of many physical complaints before age 30 over several yrs • 4 pain symptoms • 2 GI symptoms • 1 sexual symptom • 1 pseudoneurological symptom • Either • Cannot be explained by general medical condition • There is a general medical condition, but complaints exceed what would be expected

  6. Somatization Disorder • Statistics • 4% • More frequently observed in females • Etiology • Similar pathogenesis to hypochondriasis • Strongly linked in family/genetic studies to ASPD • Behavioral Inhibition System • Sensitive to threat or danger • Avoid situations or signals suggesting threat or danger • Both diagnoses have a weak BIS • Both strive for short-term gain at the expense of long-term gain

  7. Somatization Disorder • Treatment • Gate-keeper • Rapport

  8. Conversion Disorder • 1 or more symptoms affecting voluntary motor or sensory function suggesting neurological condition • Psych factors judged to be associated w/ symptom b/c initiation or exacerbation of symptom is preceded by conflicts or other stressors • Symptom is not intentionally produced/feigned

  9. Conversion Disorder • Closely related disorders • Malingering • Factitious disorders • Statistics • 1-30% in neurological settings

  10. Conversion Disorder • Etiology • Freud • 1st process: individual experiences a traumatic event w/ unacceptable, unconscious conflict • 2nd process: person represses anxiety • 3rd process: as anxiety increases, unconscious converts it into physical symptom to avoid anxiety • Primary Gain • 4th process: individual receives increased attention and sympathy from love ones, and avoids responsibilities • Secondary Gain

  11. Body Dysmorphic Disorder • Preoccupation w/ imagined defect in appearance, if slight physical anomaly is present, one’s concern is markedly excessive • Preoccupation causes sign. distress or impairment

  12. Body Dysmorphic Disorder • Etiology • OCD relationship • Treatment • Pain Disorder • ?

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