Somatoform Disorders

1. Somatoform Disorders * when physical illness is largely psychological in origin

2. Genuine physical ailments caused in part by factors such as emotional distress. Ulcers, asthma, high blood pressure Axis III (psychological, Axis I) Physical ailments that cannot be fully explained by organic condition and are largely due to psychological factors Not faking Psychosomatic vs. Somatoform

3. Somatoform Disorders • 3 types: somatization, coversion, hypochondriasis • Marked by a pattern of recurring, multiple and significant bodily (somatic) symptoms that extend over several years • These symptoms (pain, vomiting, paralysis, etc) are not under voluntary control & have no known physical causes • Often misdiagnosed so no firm data about the prevalence of these disorders

4. Historically called hysteria About 2.7% of population- more common in women Begins before age 30 & is characterized by multiple symptoms that have no physical causes Cardiovascular, gastrointestinal, pulmonary, neurological, urinary tract Person usually has a long history of medical treatment This disorder is often co-morbid (exist with) depression & anxiety disorders Could be a means of coping with a stressful situation Mix of symptoms alerts doctor to unlikelihood of illness Somatization Disorder

5. Significant loss of physical function (with no organic basis) Common symptoms: loss of vision, loss of hearing, paralysis, laryngitis Mass Hysteria- condition experienced by a group of people who through suggestion or observation develop the same symptoms Conversion Disorder

6. Hypochondria • Excessive preoccupation with their health and constant worry about developing a physical illness • Skeptical & disbelieving of doctors who tell them there is nothing wrong with them • Often co-morbid with depressive & anxiety disorders (particularly OCD) Hypochondriacs

8. Etiology (causes) • Personality Factors • Histrionic personality disorder • Neuroticism • Cognitive Factors • Tend to draw catastrophic conclusions about minor bodily complaints • The Sick Role • Enjoy the attention they get from being sick • May get indirect rewards from being sick (positive reinforcement) • Avoid facing real life problems with the attention from these “problems”

9. Anxiety Disorders * Marked by feelings of excessive apprehension

10. Generalized Anxiety Disorder (GAD) • High level of anxiety not specific to any threat • Constant worry • Worry is out of proportion to actual event • Some Symptoms: trembling, dizziness, sweating, heart palpitations, difficultly concentration, irritable

11. Phobias • Most common anxiety disorder • Irrational fear of a specific thing that presents no realistic danger • Even imagining the fear can bring great anxiety • Most common phobia is Social Phobia- fear of performing in social situations, fear of humiliating or embarrassing themselves Maury

13. Sampling of Phobias: A’s Ablutophobia- Fear of washing or bathing.Acarophobia- Fear of itching or of the insects that cause itching.Acerophobia- Fear of sourness.Achluophobia- Fear of darkness.Acousticophobia- Fear of noise.Acrophobia- Fear of heights.Aerophobia- Fear of drafts, air swallowing, or airbourne noxious substances.Aeroacrophobia- Fear of open high places.Aeronausiphobia- Fear of vomiting secondary to airsickness.Agateophobia- Fear of insanity.Agliophobia- Fear of pain.Agoraphobia- Fear of open spaces or of being in crowded, public places like markets. Fear of leaving a safe place.Agraphobia- Fear of sexual abuse.Agrizoophobia- Fear of wild animals.Agyrophobia- Fear of streets or crossing the street.Aichmophobia- Fear of needles or pointed objects.Ailurophobia- Fear of cats.Albuminurophobia- Fear of kidney disease.Alektorophobia- Fear of chickens.Algophobia- Fear of pain.Alliumphobia- Fear of garlic.Allodoxaphobia- Fear of opinions.Altophobia- Fear of heights.Amathophobia- Fear of dust.Amaxophobia- Fear of riding in a car.Ambulophobia- Fear of walking.Amnesiphobia- Fear of amnesia.Amychophobia- Fear of scratches or being scratched.Anablephobia- Fear of looking up.Ancraophobia- Fear of wind. (Anemophobia)Androphobia- Fear of men.

14. Other Common Phobias • Agoraphobia- fear of going out in public places because escape might be difficult (more common in women) • Acrophobia- fear of heights • Claustrophobia- fear of small enclosed spaces • Hydrophobia- fear of water • Animals & Insects

15. Panic Disorder • Recurrent attacks of overwhelming anxiety that occur suddenly and unexpectedly • Panic attack- (must have 4 of the following symptoms) racing heart, sweating, trembling, feelings of choking or that you have difficulty breathing, chest pain, nausea, dizzy Panic Disorders

16. Obsessive Compulsive Disorder (OCD) • Uncontrollable & unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) to reduce the thoughts • Common rituals: counting, cleaning, & checking Personal Story of OCD OCD girl

18. Etiology • Biological Factors • Concordance rates- percentage of twin pairs and other pairs of relatives who exhibit the disorder • Identical twins 35%; fraternal twins 15% • Neurochemical activity- inbalance of GABA & serotonin may play a role • OCD involves problems in communication between the front part of the brain and deeper structures (basil ganglia)

19. Etiology (cont.) • Conditioning & Learning • Phobias may be acquired through classical conditioning & maintained through operant conditioning • Once the fear is acquired the person will show an avoidance response (-R) • Fears can also be created by observational learning • Seligman: Preparedness by evolutionary history to acquire certain fears

20. Etiology (cont.) • Cognitive Factors • “The doctor examined little Emma’s growth” (subjective) • Anxious subjects were more likely to perceive the growth as a tumor • Certain styles of thinking make some people more vulnerable to certain anxiety disorders • Stress Factors- correlation btw amount of stress and anxiety disorders • Personality type neuroticism

21. Anxiety Treatments

22. Anti-anxiety Medications • Benxodiazepines (tranquilizers, valium, xanax) • CNS depressors (downers)- reduce activity in brain and body • Effects occur immediately but they only last a few hours • Potential for abuse, dependence, & overdose

23. Exposure Therapy • Used to treat phobias • Type of behavior therapy • Gradually exposing the person to actual anxiety producing situations or objects • Systematic Desensitization is a type of exposure therapy • The purpose is to reduce the maladaptive behavior

24. Systematic Desensitization • Goal is to weaken the association btw the CS and CR • Involves 3 steps: • Therapist helps the client build an anxiety hierarchy (list or triggers) • Teaching the client deep relaxation techniques • Client tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus

26. Aversion Therapy • Using classical conditioning to create a negative response to a stimulus that has elicited problematic behavior • Alcoholics given an emetic drug with their favorite drinks to induce vomiting • Therapist hopes to create a conditioned aversion (learned-taste aversion) • Sexual deviance, drug and alcohol abuses, stuttering & overeating

28. Social Skills Training • Improve interpersonal skills by emphasizing modeling, behavioral rehearsal, & shaping • Modeling- client watches socially skilled friends • Behavioral Rehearsal- practice social techniques in role playing exercises • Shaping- client gradually given more complicated social situations to handle