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Chapter 7

PSYB32H3 Chapter 7: Somatic Symptom Disorders and Dissociative Disorders


Department
Psychology
Course Code
PSYB32H3
Professor
Konstantine Zakzanis
Chapter
7

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Chapter 7 Somatic Symptom Disorders and Dissociative
Disorders
In the recent years there happened to be some outbreaks of somatoform disorders in the United States that shed light
to this disorder, including the one that took place in Le Roy in the upper New York state, and the one that took place
just outside Le Roy.
Somatic symptom disorders, and dissociative disorder are related to anxiety disorders, in that in early version f the
DSM, all these disorders were subsumed under the heading of neuroses because anxiety was considered the
predominant underlying factor in each cause
Somatic symptom disorders suggest a physical defect or dysfunction, but for which no physiological basis
can be found
It reflects mind-body connection, and thus support the growing realization that the psychological and physical
functioning interact with each other
7.1 Somatic Symptom and Related Disorders
Somatic symptom disorders, psychological problems take a physical form.
Physical symptoms have no known physiological explanation and are not under voluntary control
The symptoms are though to be linked to psychological factors, presumably anxiety, and are assumed to be
psychologically caused
The somatoform disorders lack clinical utility, the somatoform category has been controversial ever since the release
of the DSM-IV; while there has been as radical argument that this disorder should be removed from DSM-V, with
the following list of concerns:
Terminology is often unacceptable to patients
The distinction between disease-based symptoms and those that are psychogenic may be more apparent than
real
There is great heterogeneity among the disorders, the only common link is physical illness that is not
attributable to an organic cause
The disorders are incompatible with other cultures (DSM-V is published by the American Psychiatric
Association)
There is ambiguity in the stated exclusion criteria
The subcategories fail to achieve accepted standards of reliability
The disorder lack clearly defined threshold in terms of the symptoms needed for a diagnosis
While the terminology is indeed quite confusing given that all disorders involve the presentation of physical
symptoms and/ or concern about the medical illness, in other words, they all share common featuressomatic
symptoms and cognitive distortions therefore, they were all being grouped under a common rubric called somatic
symptom disorder.
Body dysmorphic disorder (BDD)
The person is being preoccupied with an imagined or exaggerated defect in appearance, frequently in the face.
Occurs mostly among women
o While women tend also focus on the skin, hips, breasts, and legs,
o whereas men are more inclined to believe they are too short, that their penises are too small, or what
they have too much body hair
Typically begins in late adolescence
Frequently comorbid with depression and social phobia, eating disorders, thoughts of suicide, and substance
use and personality disorders
Usually chronic, people were less likely to achieve remission of their symptoms as a function of three factors
(1) having more severe symptoms at intake, (2) a longer lifetime duration of BDD, (3) being an adult when
assessed

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As a result of the disorder, clients often engage in the following common behaviors,
They might either spend hours each day checking on their defect, looking at themselves in the mirrors; or
they would take steps to avoid being reminded of the defect by eliminating mirrors from their homes or
camouflaging the defect
There are also frequent consultation with plastic surgeons because some people with BDD are never satisfied
wit the results of cosmetic surgery
Hypochondriasis/ DSM-V: Illness anxiety disorder
Hypochondriasis is being dropped from DSM-V, while this symptomatology has been incorporated under the new
somatic symptom disorder, specially the illness anxiety disorder
Definition: Individuals were preoccupied with persistent fears of having a serious diseases, despite medical
reassurance to the contrary
Prevalence about 5% in the general population concluded by a paper in 2001
Typically begins in early adulthood, with a chronic course
Clients are therefore frequent consumers of medical services
Clients are likely to have mood or anxiety disorders
The theory behind the disorder is that they overreact to ordinary physical sensations and minor abnormalities, while
seeing them as evidence for their beliefs; they are making catastrophic interpretations of symptoms
Therefore people with high scores on a measure of hypochondriasis are more likely than others to attribute
physical sensations to an illness
Irregular heart beat, occasional coughing, stomach ache, are examples of the minor abnormalities, yet the
client would overreact to
For example, they would believe that a red blotch on the skin is a skin cancer
Health anxiety, defined as "health related furs and beliefs, based on interpretations, or perhaps more often,
misinterpretation of bodily signs and symptoms as being indicative of serious illness"
It is not limited to hypochondriasis, but also linked with anxiety and illness phobia
o There is a difference between the two: whereas hypochondriasis is a fear of having an illness, and
illness phobia is a fear of contracting an illness
Health anxiety is best being conceptualised on a continuum along a dimension rather than as an all-or-none
category
Illness Attitudes Scale (IAS) is used commonly to assess healthy anxiety
7.1.1 Conversion disorder/ DSM-V: Functional neurological symptom disorder
Definition: Physiologically normal people experience sensory or motor symptoms, although the body organs and
nervous systems are found to be fine
Develop in adolescence or early adulthood, typically after undergoing life stress
One episode might end abruptly, but sooner or later the disorder is likely to return, either in its original form
or with a symptoms of different nature and site
Prevalence <1%
More women than men are given the diagnosis
Frequently comorbid with other Axis I diagnosis
o Such as depression, substance abuse, anxiety and dissociative disorders, and with personality disorders,
notably borderline and historic personality disorder
Sufferers may experience paralysis of arms or legs; seizures and coordination disturbances; a sensation of
prickling, tingling, or creeping on the skin; insensitivity to pain; or the loss or impairment of sensations,
called anaesthesia's .
Vision may be seriously impaired; the person may become partially or completely blind or have tunnel vision.
Aphonia, loss of the voice and all but whispered speech, and anosmia, loss or impairment of the sense of
smell, are other conversion disorders
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The term conversion, was derived originally from Freud, who thought that the energy of a repressed instinct was
diverted into sensory-motor channels and blocked functioning. Therefore the anxiety and psychological conflict
were believed to be converted into physical symptoms
It is important to distinguish a conversion paralysis or sensory dysfunction with similar problems that have a true
neurological basis
Sometimes this task is early as when the paralysis does not make anatomical sense
Since the majority of paralyses, analgesia, and sensory failure do have biological causes, true neurological
problems may sometimes be misdiagnosed as conversion disorders
o One study found after nine years after diagnosis, an alarming number -- 60%-- of these individuals had
either died or developed symptoms of physical diseases
Fortunately, with technological advances in detecting illness and diseases, the rate of misdiagnoses appears
on the decline
Focus on Discovery 7.1 Malingering and Factitious Disorder
Malingering
Definition: an individual fakes an incapacity in order to avoid a responsibility, or to achieve some goal.
It is diagnosed when the conversion-like symptoms are determined to be under voluntary control, which is not
though to be the case in true conversion disorder
In an effort to discriminate conversion reactions from malingering, clinicians may attempt to determine
whether the symptoms have been consciously or unconsciously adopted
La belle indifference, characterized by a relative lack of concern or a blasé attitude toward the
symptoms
this is one aspect of behavior that can sometimes help distinguish the two disorder
Clients with conversion disorder sometime demonstrate this behavior, they also appear willing
and eager to talk endlessly and dramatically about their symptoms, but often without the
concern one might expect
The malingers are likely to be more guarded and cautious, perhaps because they consider
interview a challenge or threat to the success of the lie
However, this distinction is not fool proof, for only about one third of people with conversion
disorder show la belle indifference
Factitious disorder
Definition: people intentionally produce physical symptoms, or sometimes psychological ones,
in contrast to malingering, with factitious disorder the symptoms are less obviously linked to a recognizable
goal, the motivation for adopting the physical or psychological symptoms is much less clear\
The individual fore some unknown reason, wants to assume the role of client
Factitious disorder by proxy/ Munchausen syndrome by proxy
Definition: the disorder might also involve a parent creating physical illnesses in a child,
The motivation in this case appears to be the need to be regarded as an excellent parent and tireless in seeing
to the child's needs
7.1.2 Somatization Disorder/ DSM-V: Somatic Symptom Disorder
The somatization disorder has been dropped from the DSM-V, while patients who have been previously meet this
diagnosis will meet the criteria for somatic symptom disorder
Definition: people have maladaptive thoughts, feelings, and behaviors of people with this diagnosis. This disorder is
being characterized by recurrent, multiple somatic complains, with no apparent physical cause, for which medical
attention is sought
7.1.3 Etiology of Somatoform Disorder
7.1.3.1 Etiology
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