two categories of somatoform disorders
hysterical and preoccupation disorders
hysterical disorders
characterized by actual changes in physical functioning; includes conversion, somatization, and pain disorder
preoccupation disorders
characterized by misinterpretation and overreaction to bodily symptoms or features; disorders include hypochondriasis and body dysmorphic disorder
conversion disorder
characterized by a significant alternation or loss of one or two areas of functioning that is actually an expression of a psychological conflict or need (hysteria); symptoms are not faked, they are involuntary responses not supported by medical evidence
conversion symptoms
neurological disease, parestecia (skin tingling), paralysis, seizures, blindness; loss of voice and smell, false pregnancy
conversion prevalence
less than 1%; twice as common in women than men; develops in late adolescents; onset is sudden and often due to severe psychological stress; often linked with anxiety, depression, and substance abuse
conversion disorder two diagnostic issues
often difficult to differentiate between true neurological disorders and conversion disorder (problems that technology cannot always detect abnormalities; neurological nonsense when symptoms directly contradict biology); need to differentiate conversion d
theories of conversion disorder: psychodynamic
conscious vs. unconscious processes; freud's three step process; psychological purpose of conversion symptoms
conscious vs. unconscious processes
if malingering has been ruled out and you believe the patient, you have to assume that there is some unconscious processes that are at work
freud's three step process
individual experiences a traumatic event or an unacceptable, unconscious conflict; because the conflict and the anxiety resulting form the conflict are unacceptable, the person represses the conflict into unconscious; the anxiety continues to increase and
two important psychological purposes of conversion disorder
primary gain and secondary gain
primary gain
the idea that the conversion disorder symptoms block the person's awareness of that internal conflict - focused on the physical symptoms so you no longer focus on the unconscious conflict
secondary gain
the conversion disorder symptoms excuses the person from responsibilities that helps them attract sympathy and attention
theories of conversion disorder: sociocultural
decreased substantially in prevalence in the last century because we have greater medical sophistication and increased psychological sophistication
support for sociocultural theory
includes evidence that conversion disorder is more common in people in lower socioeconomic classes who may not have higher medical and psychological sophistication; more common in uneducated people, rural areas, and undeveloped countries
theories for conversion disorder: behavioral
suggest that physical symptoms bring the sufferer rewards (attention/sympathy, getting out of things); same as psychodynamic secondary gain, however, it is a primary reason in the behavioral viewpoint; reinforcements tend to operantly condition people in
theories of conversion disorder: cognitive
proposes that symptoms are forms of communication, it is through these symptoms that people can express difficult emotions that they may not otherwise be able to express - purpose of the symptoms is to communicate some distressing emotion that they are no
treatment for conversion disorder
insight, suggestion, reinforcement, confrontation (all include some kind of "face-saving" mechanism in order for the patient to give up the physical symptom without the accusation that they were faking it the whole time)
insight
based on the idea that if is caused by a psychodynamic, unconscious conflict, the analysis will be psychodynamic therapy to help the patient work through the conflict in the conscious mind so there is no longer a need to convert the symptoms into a physic
suggestion
the therapist offers a lot of emotional support to the patient, tells them as persuasively as possible from someone with authority, with or without hypnosis
reinforcement
the therapist arranges for the removal of rewards for the client's sick behavior and increases rewards for healthy behavior
confrontation
the therapist attempts to force the patient out of the sick role by simply telling them that their symptoms have no medical basis (doesn't have a lot of support or evidence of success)
body dysmorphic disorder (BDD)
essential feature is a preoccupation with some imagined defect in appearance in a normal appearing person (conversion with a hysteria disorder)
BDD prevelance
difficult to determine, people are often secretive and do not believe that their problem is psychological; affects about 1% of population; slightly more common in women than men; age of onset is between early adolescence through twenties
distinction between BDD and anorexia
anorexic people are concerned with overall size and whole body, BDD people are more concerned about specific body parts
distinction between BDD and gender identity disorder
GID are born male but believe that they are actually a female with a female brain
associated features of BDD
frequent mirror checking, often worried that others are looking and making fun of their supposed defect, reassurance seeking, could care less about another real physical defect
associated psychiatric diagnosis often comorbid with BDD
depression; social phobia; avoidance personality disorder
course of BDD
the body part of concern might shift over time, however, it usually persists over several years and decades
impairment of BDD
social, occupational, marriage functioning; can cause suicidal ideation, attempts and completes suicide; relationship to plastic surgery
etiology of BDD: psychodynamic theories
arrives from unconscious displacement of sexual or emotional conflict, feeling inferior or guilty about something and this is projected onto the body part; choice of body part is symbolic; women with BDD are uncomfortable with their own sexual desires and
etiology of BDD: neurobiological changes
changes in the cadate nucleus; problems with serotonin
etiology of BDD: biopsychosocial approach
1. genetically based personality predisposition (scoring high on neuroticism) 2. emphasis on the sociocultural context (society places great value on attractiveness and beauty) 3. deficits or biases in information processing
treatment for BDD
medication and cognitive behavior treatment (ERP)
BDD medications
same antidepressant medications used for OCD and depression; early trials showed mild to moderate improvements and suggested that maybe medication isn't all that effective, however, inadequate doses were being used
BDD cognitive behavioral treatment (ERP)
50-80% of people improve with ERP; focus is on getting the person to identify and change the distorted perceptions of their body (expose them to an anxiety provoking situation and prevent them from the compulsions)