Psychology Chapter 16: Somatoform Disorders

Characteristics of Somatoform Disorders

• Physical complaints lack demonstrable organic basis, and psychological factors play a role in initiating, exacerbating, and maintaining symptoms
• Symptoms or magnified health concerns are not under the client's conscious control

Types of Somatoform Disorders

• Somatic symptom disorder: multiple physical symptoms, combining pain, GI, sexual, and pseudoneurologic symptoms
• Conversion disorder (Functional neurological symptoms disorder): unexplained deficits in sensory or motor function associated with psychological factors, with an attitude of la belle indifference
• Pain disorder: pain unrelieved by analgesics, influenced by psychological factors
• Hypochondriasis (Illness anxiety disorder): preoccupation with the fear of having a serious disease or will get a serious disease

Onset and Clinical Course

• Somatization disorder, conversion disorder, and pain disorder are more common in women
• Hypochondriasis and body dysmorphic disorders occur equally in men and women
• Somatoform disorders are either chronic or recurrent, lasting for decades
• Onset of somatization and body dysmorphic disorder is around 25 years; conversion disorder, 10 to 35 years; pain disorder and hypochondriasis occur at any age

Etiology

• Psychosocial theories: anxiety, frustration, and feelings expressed through physical symptoms rather than verbally
• Nonconscious process control: individuals are not consciously aware of the process and do not voluntarily control it
• Limited verbal expression of emotions: people do not readily express their feelings and emotions verbally
• Difficulty with interpersonal conflict: physical symptoms tend to worsen in situations involving conflict or emotional stress
• Psychological needs and gains: physical symptoms worsen to fulfill psychological needs for security, attention, and affection through primary and secondary gain

Biology Theories

• Stimulus regulation in somatoform disorders: differences in regulating and interpreting stimuli
• Misinterpretation of normal sensations: clients attribute a pathological meaning to normal body sensations
• Amplification of minor discomfort: minor discomfort is amplified due to excessive concern and focus on the sensation
• Impact of acute stress on gastrointestinal symptoms: acute stress can trigger visceral hypersensitivity linked to GI symptoms

Cultural Considerations

• Cultural variances in somatic symptoms: types and frequencies of somatic symptoms and their interpretations differ across cultures
• Examples: dhat in India, Koro in Southeast Asia, Falling-out Episodes in the Southern U.S. and Caribbean, Hwa-Byung in Korea, Sangue Dormido in Portuguese Cape Verde Islanders, and Shenjing Shuairuo in China

Treatment

• Focus: managing symptoms and improving quality of life
• Health care provider's role: show empathy and sensitivity, foster trusting relationships, and discourage "doctor shopping"
• Medication: antidepressants, selective serotonin reuptake inhibitors, and nonsteroidal anti-inflammatory agents
• Therapeutic interventions: therapy groups, structured cognitive-behavioral group therapy, cognitive-behavioral therapy, and education

Prognosis

• Functional neurological symptom disorder can remit in a few weeks
• Recurrence in 20% to 25%
• Somatic symptom disorders tend to be chronic or recurrent