Luzenne Sanchez Jones
Matrix on Somatic Disorders
Classifications of Somatic
Disorders
1. Somatic Symptom
Disorder
2. Illness Anxiety Disorder
PSYC 118X Clinical Psyc TTH 4:30-6:00
Clinical Description
-Used to be called Briquet’s
syndrome – Pierre Briquet (1859)
-Entire life revolves around
symptoms (symptoms are his/her
identity)
-Experience of severe pain in
which psychological factors
(anxiety and distress) play a major
role in maintaining or
exacerbating the pain whether
there is a clear physical reason for
the pain or not/ Reports of
multiple physical symptoms
without a medical basis
- Runs in families; probably
heritable basis
-Rare- most prevalent among
unmarried women in low
socioeconomic groups
-onset-usually in adolescence;
often persists into old age
-formerly known as
“hypochondriasis” in DSM-IV
-physical symptoms are either not
experienced at the present time
or are very mild, but severe
anxiety is focused on the
Etiology
-temperamental: negative
affectivity (neuroticism)
-environmental: few years of
education, low socioeconomic
status, stressful life events
-eventual social isolation
-continual development of new
symptoms
-immediate sympathy and
attention
-restrictive concept of health as
symptom free
- environmental: major life stress,
abuse, childhood illness
- increased anxiety
-faulty interpretation of physical
symptoms
-intensified focus on sensations
March 12, 2020
Duration
-although 1 somatic symptom
may not be continuously present,
the state of being symptomatic is
persistent (typically more than 6
months)
-illness preoccupation has been
present for at least 6 months
(may change over time)
Possible Treatments
-hard to treat
-Cognitive Behavioral Therapy (CBT) to
provide reassurance, reduce stress, and
minimize help-seeking behaviors
-therapy to broaden basis for relating to
others
-explanatory therapy
-gatekeeper physician
-psychotherapy to challenge illness
perceptions
-counselling and/or support groups to
provide reassurance
-exposure therapy
-explanatory therapy
 possibility of having or developing
a serious disease
-concern is primarily with the idea
of being sick instead of the
physical symptom itself (anxiety
and fear that one has a serious
disease)
-severe anxiety over physical
problems that are medically
undetectable
-affects women and men equally
-may emerge at any age
-evident in diverse cultures
3. Psychological Factors -the presence of a diagnosed
Affecting Medical medical condition such as asthma,
Condition diabetes, or severe pain clearly
caused by a known medical
condition such as cancer that is
adversely affected (increased in
frequency or severity) by one or
more psychological or behavioral
factors which have a direct
influence on the course or
perhaps the treatment of the
medical condition
4. Conversion Disorder -generally have to do with
physical malfunctioning, such as
paralysis, blindness, or difficulty
speaking (aphonia), without any
physical or organic pathology to
account for the malfunction
-severe physical dysfunctioning
(paralysis and blindness without
corresponding physical pathology
-it is possible that some
individuals who developed these
disorders have learned from
family members to focus their
anxiety on specific physical
conditions and illness
-stress
-no clear research data
-temperamental: maladaptive
personality traits
-environmental: childhood abuse
and neglect, stressful life events
-genetic and physiological:
presence of neurological disease
that causes similar symptoms
-social influences (symptoms
learned from observing real illness
- can occur across the lifespan
- Onset has been reported
throughout the life course.
-gatekeeper physician
- Treatment includes the person learning
about the effects of their thoughts and
behaviors on their medical condition. It
also includes psychotherapy to help the
person deal with their condition and to
follow treatment recommendations for
the medical condition.
-identify and attend to the traumatic or
stressful life event, if it is still present
(either in real life or in memory)
-reducing any reinforcing or supportive
consequences of the conversion symptoms
(secondary gain)-(ex. punishing mobility
and awarding immobility of patient)
-catharsis- therapeutic assistance in
reexperiencing or “reliving” the event
 -affected people are genuinely
unaware that they can function
normally
-may coincide with somatic
symptom disorder
-most prevalent in low
socioeconomic groups, women
and men under extreme stress
5. Factitious Disorder Imposed on Self
(Imposed on Self) -a set of conditions which fall
somewhere between malingering
and conversion disorder
-the symptoms are under
voluntary control, as with
malingering, but there is no
obvious reason for voluntarily
producing the symptoms except,
possibly, to assume the sick role
and receive increased attention
Imposed on Another
-when an individual deliberately
makes someone else sick (ex.
Mother purposely making child
sick for attention and pity)
-previously known as
Munchausen syndrome by proxy
or injury)
-life stresses or psychological
conflict
-reduced by incapacitating
symptoms
-marked biological vulnerability to
develop conversion disorder
when under stress
The exact cause of factitious
disorder is not known, but
researchers believe both
biological and psychological
factors play a role in the
development of this disorder.
Some theories suggest that a
history of abuse or neglect as a
child, or a history of frequent
illnesses in themselves or family
members that required
hospitalization, may be factors in
the development of the disorder.
Most patients with factitious
disorder have histories of abuse,
trauma, family dysfunction, social
isolation, early chronic medical
illness, or professional experience
in healthcare (training in nursing,
health aid work, etc.).
- chronic long-term condition
-hypnosis-added little or no effect to CBT
-same as for somatic symptom disorder
with emphasis on resolving life stress or
conflict and reducing help-seeking
behaviors
-Treatment of factitious disorder is often
difficult, and there are no standard
therapies. Because people with factitious
disorder want to be in the sick role, they're
often unwilling to seek or accept
treatment for the disorder. However, if
approached in a gentle, nonjudgmental
way, a person with factitious disorder may
agree to be treated by a mental health
professional.
- Treatment often focuses on managing
the condition, rather than trying to cure it.
Treatment generally includes:
 Having a primary care
doctor. Using one doctor or other
gatekeeper to oversee medical
care can help manage needed care
and the treatment plan and
reduce or eliminate visits to
numerous doctors, specialists and
surgeons.
 Psychotherapy. Talk therapy
(psychotherapy) and behavior
therapy may help control stress
and develop coping skills. If
possible, family therapy also may
 be suggested. Other mental health
disorders, such as depression, also
may be addressed.
 Medication. Medications may be
used to treat additional mental
health disorders, such as
depression or anxiety.
 Hospitalization. In severe cases, a
temporary stay in a psychiatric
hospital may be necessary for
safety and treatment.
Treatment may not be accepted or may
not be helpful, especially for people with
severe factitious disorder. In these cases,
the goal may be to avoid further invasive
or risky treatments. In cases where the
factitious disorder is imposed on others,
the doctor assesses for abuse and reports
the abuse to the appropriate authorities, if
indicated.

6. Other Specified Somatic  Brief Somatic Symptom -symptoms less than 6 months
Symptom and Related Disorder
Disorders
 Brief Illness Anxiety -symptoms less than 6 months
Disorder
 Illness Anxiety Disorder
without Excessive Health
Related Behaviors-
Criterion D for illness
anxiety disorder is not
met
 Pseudocyesis – a false
belief of being pregnant
that is associated with
objective signs and
reported symptoms of
pregnancy