ABNORMAL PSYCHOLOGY

• Somatoform disorders are now

referred to as somatic symptom and
related disorders.
• In DSM-IV, there was significant
overlap across the somatoform
disorders and a lack of clarity about
their boundaries.
• the DSM-5 classification reduces the
number of these disorders and
subcategories to avoid problematic
overlap. Diagnoses of
– somatization disorder,
– hypochondriasis,
– pain disorder, and
– undifferentiated somatoform disorder
• have been removed.
 An Overview of Somatoform Disorders

• Soma = Body
– Preoccupation with health or appearance
– Physical complaints
– No identifiable medical condition
 An Overview of Somatoform Disorders

• Somatoform Disorders
– Hypochondriasis
– Somatization disorder
– Conversion disorder
– Pain disorder
– Body dysmorphic disorder
SOMATIC SYMPTOM AND
RELATED DISORDERS
 Commonly shared . . .

Pathologically concerned with the functioning of their

bodies.

Prominence of somatic symptoms associated with

significant distress and impairment.

Commonly encountered in primary care and other medical

settings but are less commonly encountered in psychiatric
and other mental health settings.
SOMATIC SYMPTOM AND RELATED
DISORDERS

• A spectrum of disorders wherein

people experience significant physical
symptoms without any organic cause.
People with these disorders:

• do not consciously produce or control their

symptoms

• experience the symptoms

• Psychological factors are only resolved when

factors associated with it are resolved
(Hoeksema, 2011)
Difficulty in diagnosis
• Possibility of an actual medical , physical, or
organic disorder that is difficult to diagnose
Diagnosis is easier
• When psychological factors that contribute to the
symptoms are identified
• When a physical examination rules out the
possibility that symptoms are caused by organic
conditions
 DISTINGUISHING SOMATIC DISORDERS AND
RELATED DISORDERS OTHER DISORDERS1
SOMATIC PSYCHOSOMATIC MALINGERING FACTITIOUS
DISORDERS AND DISORDERS • Deliberately faking DISORDER
OTHER RELATED • Actual physical of physical • Deliberate faking of
DISORDERS illness present with symptoms to avoid physical illness to
psychological factors an unpleasant gain medical
• Subjective situation or in order
contributing to the attention and play
experience of to gain something
illness the sick role
physical symptoms
with no organic • Factitious Disorder
cause by proxy

1Hoeksema, 2011
SOMATIC SYMPTOM DISORDER

ILLNESS ANXIETY DISODER

CONVERSION DISORDER (FUNCTIONAL NEUROLOGICAL

SYMPTOM DISORDER)
PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL
CONDITIONS

FACTITIOUS DISORDER

OTHER SPECIFIED SOMATIC SYMPTOM AND RELATED DISORDER

UNSPECIFIED SOMATIC SYMPTOM AND RELATED DISORDER

• Diagnosis is based on:

– positive symptoms and signs (distressing

somatic symptoms plus abnormal thoughts,
feelings, and behaviors in response to these
symptoms) rather than the absence of a
medical explanation for somatic symptoms

– Presentation and interpretation of the

patient is accounted for Non-organic causes
A. One or more somatic symptoms that
are distressing or result in significant
disruption of daily life.
B. Excessive thoughts, feelings, or
behaviors related to the somatic
symptoms or associated health
concerns as manifested by at least one
of the following:
1. Disproportionate and persistent thoughts about
the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or
symptoms.
3. Excessive time and energy devoted to these
symptoms or health concerns.
C. Although any one somatic symptom may not be
continuously present, the state of being
symptomatic is persistent (typically more than 6
months).
• real and it hurts whether there are clear
physical reasons for pain or not (Aigner &
Bach, 1999; Asmundson & Carleton, 2009)
• share many features with the
anxiety and mood disorders,
particularly panic disorder

• genetic and biological vulnerability

(e.g., increased sensitivity to pain)
from illness
• 1% to 5% TO 16% for distressing symptoms

• Even across different phases of adulthood

• women, unmarried, and from lower

socioeconomic groups

• Chronic

• Culture specific
Biological

• Genetic (modest)
• Over response to stress, Hyposensitivity
• age of onset, personality characteristics,
• patterns of familial aggregation
Life Events

• early traumatic experiences (e.g., violence, abuse,

deprivation),

cultural/social norms that devalue and stigmatize psychological

suffering as compared with physical suffering
Psychosocial Causes

• Lack of reinforcement of non-Somatic

expressions of distress)
• Learning (e.g., attention obtained)
• Cultural/social norms that devalue and
stigmatize psychological suffering as
compared with physical suffering
 Treatment

• Psychodynamic
– Uncover unconscious conflict
– Limited efficacy data

• Educational & Supportive

– Ongoing and sensitive
– Detailed and repeated information
– Beneficial for mild cases
• physical symptoms are either not experienced
at the present time or are very mild, but
severe anxiety is focused on the possibility of
having or developing a serious disease.

• Despite reassurances by doctors that they are

well, they still go back to other doctors
thinking that something have been missed
Hypochondriasis

• Clinical Description
– Anxiety or fear of having a disease
– High comorbidity with anxiety/mood disorders
– Focus on bodily symptoms
• Normal
• Mild
• Vague
Hypochondriasis

• Clinical Description
– Little benefit from medical reassurance
– Strong disease conviction
• Misperceptions of symptoms
• Checking behaviors
• High trait anxiety
Hypochondriasis

• Statistics
– 1% to 5%
– 6.7% median rate of medical patients
– Female : Male = 1:1
– Onset at any age
• Peaks: adolescence, middle age, elderly
– Chronic course
Culture

• Culture-Specific Syndromes
– China—koro
– India—dhat
– Africa
– Pakistan
 A. One or more symptoms of altered voluntary motor
or sensory function.
B. Clinical findings provide evidence of incompatibility
between the symptom and recognized neurological or
medical conditions.
C. The symptom or deficit is not better explained by
another medical or mental disorder.
D. The symptom or deficit causes clinically significant
distress or impairment in social, occupational, or other
important areas of functioning or warrants medical
evaluation.

CONVERSION DISORDER
 • can be considered either in this diagnostic section
or as an anxiety disorder

CONVERSION DISORDER
Conversion Disorder
• Patients with this disorder lose functioning of a part
of their body due to neurological or a general medical
condition.
• paralysis, blindness, mutism, seizures, loss of hearing, severe
loss of coordination, and anesthesia in a limb
• Following an exposure to an extreme psychological
distressor
• Conversion – unconscious conflicts are “converted” to
physical symptoms
Conversion Disorder
• neurological symptoms that are found,
after appropriate neurological
assessment, to be incompatible with
neurological pathophysiology
 Conversion Disorder

• Statistics
– Rare
– Prevalence depends on setting
– Female > male
– Onset = adolescence
– Chronic, intermittent course
Conversion Disorder

• Special populations
– Soldiers
– Children
• Better prognosis?

– Cultural considerations
• Religious experiences
• Rituals
Causes

• Freudian psychodynamic view

– Trauma, conflict experience
– Repression
– “Conversion” to physical symptoms
• Primary gain
– Attention and support
• Secondary gain
Causes

• Behavioral
– Traumatic event must be escaped
– Avoidance is not an option
– Social acceptability of illness
– Negative reinforcement
Causes

• Family/Social/Cultural
– Low SES
– Limited disease knowledge
– Family history of illness
Treatment

• Similar to somatization disorder

– Attending to trauma
– Remove secondary gain
– Reduce supportive consequences
– Reward positive health behaviors
FACTITIOUS DISORDER IMPOSED ON SELF

• Persistent problems related to illness

perception and identity

• Have convictions about their medical

condition
FACTITIOUS DISORDER IMPOSED ON SELF

A. Falsification of physical or psychological

signs or symptoms, or induction of injury or
disease, associated with identified deception.
B. The individual presents himself or herself to
others as ill, impaired, or injured.
C. The deceptive behavior is evident even in
the absence of obvious external rewards.
D. The behavior is not better explained by
another mental disorder, such as delusional
disorder or another psychotic disorder.
 FACTITIOUS DISORDER IMPOSED ON ANOTHER
(Previously Factitious Disorder by Proxy)
A. Falsification of physical or psychological signs or
symptoms, or induction of injury or disease, in
another, associated with identified deception.
B. The individual presents another individual (victim
to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the
absence of obvious external rewards.
D. The behavior is not better explained by another
mental disorder, such as delusional disorder or
another psychotic disorder.
Other Specified Somatic Symptom
and Related Disorder
somatic
symptom and related
disorder that cause
clinically significant
distress or
impairment in social,
occupational, but do
not meet the
full criteria
Brief somatic symptom disorder: Duration
of symptoms is less than 6 months.
1. Brief illness anxiety disorder: Duration
of symptoms is less than 6 months.
2. Illness anxiety disorder without
excessive health-related behaviors:
Criterion D for illness anxiety disorder is
not met.
3. Pseudocyesis: A false belief of being
pregnant that is associated with objective
signs and reported symptoms of
pregnancy.
 somatic
symptom and related
disorder that cause clinically
UnSpecified
significant distress or
Somatic Symptom
and Related impairment in social,
Disorder occupational, decidedly
unusual situations but
insufficient information
SAMPLE CASE
• Ellen was a 35 yr old woman who consulted
many doctor for “high fever, vomiting,
diarrhea, inability to eat and rapid weihgt
loss”. After numerous negative lab tests, her
doctor told her “I cant go on with you; go to
espiritistas”.A cousin then took her to the
Spiritist center “for medicine”. The espiritista
was not also able to heLp her.
• Jessa was a popular 16 yr old who attends highschool.
During senior year, she became preoccupied with her
appearance and began to look constantly in the mirror or
windows. In her concern, she voiced it out to her friends,
but she stopped because they think she was going crazy.
She started wearing make up in attempt to hide a dent on
her nose. She started lowering her hair to obscure her face.
She wanted to have surgery on the nose and pleaded was
parents but became tearful when they did not allow her.
Sooner, she become isolated and does not want to go out
with her friends anymore. After turning 18, she moved out
of the house and when she got her first salary on the job,
she started doing minor surgery to change the shape of her
nose but would always feel dissatisfied.
Psychoanalytic Theory
•Symptoms are symbolic of concerns
or memories being repressed
•Representative of traumas
•La belle indifférence – indifference
or lack of concern of the patients
on the symptoms
 THEORIES
• Both run in the family, esp. female
relatives
• Parents who somatize tend to neglect
their children, causing children to learn
that the only way to receive attention
is to be ill
• Can be caused by trauma
 THEORIES
• COGNITIVE THEORY
• people with these disorders tend to
experience bodily sensations more
intensely than do other people, to
pay more attention than others to
physical symptoms, and to
catastrophize these symptoms
 Causes

• History of family illness or injury

• Links to antisocial personality disorder
– Socialization
– Gender roles
Treatment

• No “cures”
• Cognitive-behavioral interventions
– Initial reassurance
– Stress-reduction
– Reduce frequency of help-seeking behaviors
Treatment

• “Gatekeeper” physician
– Reduce visits to numerous specialists
References

• Barlow, D. & Durand, V. M. (2016). Abnormal

Psychology: An Integrative Approach. Cengage
Learning
• American Psychiatric Association (2013).
Diagnostic Statistical Manual of Mental
Disorders, Fifth Edition. DSM V. American
Psychiatric Publishing. USA