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C H A P T E R :8
Disorders Featuring
Somatic Symptoms
TO P I C OV E RV I E W
Factitious Disorde
Conversion Disorder and Somatic Symptom Disorde
Conversion Disorde
Somatic Symptom Disorde
What Causes Conversion and Somatic Symptom Disorders?
How Are Conversion and Somatic Symptom Disorders Treated?
Illness Anxiety Disorde
Psychophysiological Disorders: Psychological Factors
Affecting Medical Condition
Traditional Psychophysiological Disorders
New Psychophysiological Disorders
Psychological Treatments for Physical Disorders
Putting It Together: Expanding the Boundaries of
Abnormal Psychology
L E C T U R E O U T L I N E
I. DISORDERS FEATURING SOMATIC SYMPTOMS
A. Psychological factors may contribute to somatic, or bodily, illnesses in a variety of ways
B. The idea that stress and related psychosocial factors may contribute to physical illnesses
has ancient roots, yet it had few proponents before the twentieth century
C. Over the course of the twentieth century, however, numerous studies convinced medical
and clinical researchers that psychological factors, such as stress, wo
y, and perhaps even
unconscious needs, can contribute to bodily illness
D. DSM-5 lists a number of disorders in which bodily symptoms or concerns are the primary features
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II. FACTITIOUS DISORDER
A. Sometimes when physicians cannot find a medical cause for a patient’s symptoms, he o
she may suspect other factors are involved.
1. Patients may malinger, intentionally fake illness to achieve external gain (e.g., finan-
cial compensation, military deferment)
2. Patients may be manifesting a factitious disorder—intentionally producing or faking
symptoms simply out of a wish to be a patient [See Table 8-1, text p. 237]
B. Known popularly as Munchausen syndrome, people with factitious disorder often go to
extremes to create the appearance of illness
1. Many secretly give themselves medications to produce symptoms
2. Patients often research their supposed ailments and are impressively knowledgeable
about medicine
C. Clinical researchers have a hard time determining the prevalence of this disorder because
patients hide the true nature of their problems
1. Overall, the pattern appears to be more common in women than men and the disor-
der usually begins during early adulthood
2. Factitious disorder seems to be particularly common among people who (a) received ex-
tensive medical treatment as children, (b) ca
y a grudge against the medical profession,
or (c) have worked as a nurse, lab technician, or medical aide
D. The precise causes of factitious disorder are not understood, although clinical reports have
pointed to factors such as depression, unsupportive parental relationships, and an extreme
need for social support
E. Psychotherapists and medical practitioners often become angry at people with a factitious
disorder, feeling that they are wasting their time
1. People with the disorder, however, feel they have no control over their problems and
often experience great distress
2. In a related pattern, factitious disorder imposed on another, known popularly as Mun-
chausen syndrome by proxy, parents make up or produce physical illnesses in thei
children
III. CONVERSION DISORDER AND SOMATIC SYMPTOM DISORDER
A. When a bodily ailment has an excessive and disproportionate impact on the individual, no
apparent medical cause, or is inconsistent with known medical diseases, doctors may sus-
pect a conversion disorder or somatic symptom disorde
B. Conversion disorde
1. People with this disorder display physical symptoms that affect voluntary motor o
sensory functioning, but the symptoms are inconsistent with known medical dis-
eases [See Table 8-2, text p. 239]
a. In short, the individuals experience neurological-like symptoms—blindness,
paralysis, or loss of feeling—that have no neurological basis
2. Conversion disorder often is hard to distinguish from genuine medical problems
a. It is always possible that a diagnosis of conversion disorder is a mistake and the
patient’s problem has an undetected medical cause
. Physicians sometimes rely on oddities in the patient’s medical picture to help
distinguish the two
(a) For example, conversion symptoms may be at odds with the known func-
tioning of the nervous system, as in cases of glove anesthesia [See Figure 8-
1, text p. 240]
3. Unlike people with factitious disorder, those with conversion disorder don’t con-
sciously want or produce their symptoms
4. This pattern is called “conversion” disorder because clinical theorists used to believe
that individuals with the disorders are converting psychological needs into neuro-
logical symptoms
5. Conversion disorder usually begins between late childhood and young adulthood
a. It is diagnosed in women twice as often as in men
. It typically appears suddenly, at times of stress
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Disorders Featuring Somatic Symptoms 115
c. It is thought to be rare, occu
ing in, at most, 5 of every 1,000 persons
C. Somatic symptom disorde
1. People with somatic symptom disorder become excessively distressed, concerned,
and anxious about bodily symptoms that they are experiencing
2. Two patterns of somatic symptom disorder have received particular attention:
a. Somatization pattern
(a) People with a somatization pattern experience many long-lasting physi-
cal ailments that have little or no organic basis
(b) This disorder is also known as Briquet’s syndrome
(c) A sufferer’s ailments often include pain symptoms, gastrointestinal symp-
toms, sexual symptoms, and neurological symptoms
(d) Patients usually go from doctor to doctor in search of relief
(e) Patients with this pattern often describe their symptoms in dramatic and
exaggerated terms and most also feel anxious and depressed
(f) The pattern typically lasts for many years; symptoms may fluctuate ove
time but rarely disappear completely without therapy
(g) Between 0.2 percent and 2 percent of all women in the United States ex-
perience a somatization pattern in any given year (compared with less
than 0.2 percent of men)
(h) The pattern often runs in families and begins between adolescence and
young adulthood
. Predominant pain pattern
(a) If the primary feature of somatic symptom disorder is pain, the individ-
ual is said to have a predominant pain pattern
(b) Although the precise prevalence has not been determined, this pattern ap-
pears to be fairly common
(c) The pattern often develops after an accident or illness that has caused gen-
uine pain
(d) The pattern may begin at any age, and more women than men seem to ex-
perience it
D. What causes conversion and somatic symptom disorder?
1. For many years, conversion and somatic symptom disorders were refe
ed to as hys-
terical disorders
a. This label was to convey the prevailing belief that excessive and uncontrolled
emotions underlie the bodily symptoms
2. Today’s leading explanations come from the psychodynamic, behavioral, cognitive,
and multicultural models
a. None has received much research support, and the disorders are still poorly un-
derstood
3. The psychodynamic view
a. Freud believed that hysterical disorders represented a conversion of underlying
emotional conflicts into physical symptoms
. Because most of his patients were women, Freud centered his explanation on the
psychosexual development of girls and focused on the phallic stage (ages 3–5)
(a) During this stage, Freud believed that girls develop a pattern of sexual de-
sires for their fathers (the Electra complex) while recognizing that they
must compete with their mothers for their fathers’ attention
(b) Because of the mother’s more powerful position, however, girls repress
these sexual feelings
(c) Freud believed that if parents ove
eacted to such feelings, the Electra
complex would remain unresolved and the child would reexperience sex-
ual anxiety through her life
(d) Freud concluded that some women unconsciously hide their sexual feel-
ings in adulthood by converting them into physical symptoms
c. Today’s psychodynamic theorists take issue with Freud’s explanation of the
Electra conflict
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116 CHAPTER 8
(a) They do continue to believe that sufferers of these disorders have uncon-
scious conflicts ca
ied from childhood
d. Psychodynamic theorists propose that two mechanisms are at work in hysteri-
cal dis orders:
(a) Primary gain—Bodily symptoms keep internal conflicts out of conscious
awareness
(b) Secondary gain—Bodily symptoms further enable people to avoid un-
pleasant activities or to receive sympathy from others
4. The behavioral view
a. Behavioral theorists propose that the physical symptoms of hysterical disorders
ing rewards to sufferers
(a) May remove individual from an unpleasant situation
(b) May
ing attention from other people
. In response to such rewards, sufferers learn to display symptoms more and
more prominently
c. This focus on rewards is similar to the psychodynamic idea of secondary gain,
ut behaviorists view them as the primary cause of the development of the
disorde
5. The cognitive view
a. Some cognitive theorists propose that conversion and somatic symptom disor-
ders are forms of communication, providing a means for people to express diffi-
cult emotions
(a) Like psychodynamic theorists, cognitive theorists hold that emotions are
eing converted into physical symptoms
(b) This conversion is not to defend against anxiety but to communicate ex-
treme feelings
6. The multicultural view
a. Some theorists believe that Western clinicians hold a bias that considers somatic
symptoms as an inferior way of dealing with emotions
(a) The transformation of personal distress into somatic complaints is the
norm in many non-Western cultures
(b) The lesson to be learned from multicultural findings is that both bodily and
psychological reactions to life events are often influenced by one's culture
E. How are conversion and somatic symptom disorders treated?
1. People with conversion and somatic symptom disorders usually seek psychotherapy
only as a last resort
a. They believe their problems are completely medical antidepressant medica-
tion, especially selective serotonin reuptake inhibitors (SSRIs)
2. Many therapists focus on the causes of the disorders and apply techniques including:
a. Insight—often psychodynamically oriented
. Exposure—client thinks about traumatic event(s) that triggered the physical
symptoms
c. Drug therapy—especially antianxiety and antidepressant medication
3. Other therapists try to address the physical symptoms of these disorders, applying
techniques such as:
a. Suggestion—usually an offering of emotional support that may include hypnosis
. Reinforcement—a behavioral attempt to change reward structures
c. Confrontation—an overt attempt to force patients out of the sick role
4. Researchers have not fully evaluated the effects of these particular approaches in
these disorders
IV. ILLNESS ANXIETY DISORDER
A. People with illness anxiety disorder, previously known as hypochondriasis, experience
chronic anxiety about their health and are concerned that they are developing a serious
medical illness, despite the absence of somatic symptoms [See Table 8-5, text p. 245]
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Disorders Featuring Somatic Symptoms 117
B. They repeatedly check their bodies for signs of illness and misinterpret bodily symptoms
as signs of a serious illness
1. Often their symptoms are merely normal bodily changes, such as occasional cough-
ing, sores, or sweating
C. Although some patients recognize that their concerns are excessive, many do not
D. Although this disorder can begin at any age, it starts most often in early adulthood, among
men and women in equal numbers
1. Between 1 percent and 5 percent of all people experience the disorde
E. For most patients