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Somatic symptoms chapter

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York University
PSYC 3140
Gerry Goldberg

CHAPTER 7 – SOMATIC SYMPTOM DISORDERS & DISSOCIATIVE DISORDERS • Similar outbreaks in the past have been referred to as examples of “psychogenic illness” or “mass hysteria” and are usually attributed to prolonged exposure to stress • Dissociative disorders – disorders in which the normal integration of consciousness, memory, and identity is suddenly and temporarily altered • Some means “body”; in somatoform disorders, psychological problems take a physical form • Pain disorder – a somatoform disorder in which the person complains of severe and prolonged pain that is not explainable by organic pathology; it tends to be stress-related or permits the client to avoid an aversive activity or to gain attention and sympathy (pain disorder and hypochondriasis are no longer distinct disorders in the DSM-5) SUMMARY OF SOMATOFORM DISORDERS: • 1. Pain Disorder – the onset and maintenance of pain, caused largely by psychological factors • 2. Body dysmorphic disorder – preoccupation with imagines or exaggerated effects in physical appearance • 3. Hypochondriasis – preoccupation with fears of having a serious illness • 4. Conversion disorder and somatization – sensory or motor symptoms without any physiological cause. Recurrent, multiple physical complaints that have no biological basis • Somatic Symptom Disorders – a newly described diagnosis in the DSM-5 to apply to disorders that have been removed from the latest version; a central theme is experiencing somatic symptoms that cause significant distress or impairment and that involved excessive thoughts, feelings, and behaviors in response to these symptoms o These disorders are grouped under a common rubric named “complex somatic symptom disorder” (CSSD), which was later modified to “somatic symptom disorder” • Body Dysmorphic Disorder (BDD) – a disorder characterised under OCD and related disorders in the DSM-5. It is marked by preoccupation with an imagined or exaggerated defect in appearance (ie: wrinkles in your skin) o BDD occurs mostly among women, typically begins in late adolescence, and is frequently comorbid with depression and social phobia, eating disorders, thoughts of suicide, and substance use and personality disorders; BDD is usually chronic o Some suggest that BDD is better classified as a social phobia, mood disorder, or even an eating disorder o Uma Thurman suffers from BDD • Hypochondriasis – a somatoform disorder in which the person, misinterpreting rather ordinary physical sensations, is preoccupied with fears of having a serious disease and is not dissuaded by medical opinion. individuals are preoccupied with persistent fears of having a serious disease o the disorder typically begins in early adulthood and has a chronic course; the theory is that they overreact to ordinary physical sensations and minor abnormalities (such as irregular heartbeat, occasion coughing or stomach ache) o Similarly, people with hypochondriasis make catastrophic interpretations of symptoms, such as believing that a red blotch on the skin is skin cancer • Illness Anxiety Disorder – refers to hypochondriasis and the tendency to worry obsessively about illness despite the apparent objective presence of a physical illness • Rachman states that cognitive factors are central to an understanding of health anxiety and at the root of these disorders are “catastrophic misinterpretations” CONVERSION DISORDER: • Conversion Disorder – a somatoform disorder in which sensory or muscular functions are impaired, usually suggesting neurological disease, even though the bodily organs themselves are sound ; also called “functional neurological symptom disorder” • Anaesthesias – a form of conversion disorder in which the person experiences a loss of sensation or an impairment of sensation • Hysteria – the term originally used to describe what are now known as conversion disorders • Conversion symptoms usually develop in adolescent or early adulthood, typically after undergoing life stress • Since the majority of paralyses, anaethesias, and sensory failures do have biological causes, true neurological problems may sometimes be misdiagnosed as conversion disorders MALINGERING & FACTITIOUS DISORDER • Malingering – an individual fakes an incapacity in order to avoid a responsibility; it is diagnosed when the conversion-like symptoms are determined to be under voluntary control, which is not thought to be the case in true conversion disorders • La belle indifference – the blasé attitude people with conversion disorder have toward their symptoms • Factitious disorder – a disorder in which the individual’s physical or psychological symptoms appear under voluntary control and are adopted merely to assume the role of a sick person; symptoms are less obviously linked to a recognizable goal )the motivation for adopting the physical or psychological symptoms is much less clear) SOMATIZATION DISORDER • Somatization disorder – a somatoform disorder in which the person continually seeks medical help for recurrent and multiple physical symptoms that have no discoverable physical cause • Social & Cultural factors in conversion disorder: conversion disorder
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