CH. 8 Somatic Symptoms

Question 1

Factitious Disorder

Answer 1

factitious disorder (or MUNCHAUSEN SYNDROME) – A disorder in which a person feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person to gain attention.

• Often go to extremes to create the appearance of illness.
• Malingering – intentionally feigning illness to achieve some external gain, such as financial compensation or time off from work.
• Difficult to determine the prevalence of factitious disorder, since patients with the disorder hide the true nature of their problem.
• Nearly all these disorders are more common with women than men and begin in adolescence or early adulthood. common among people who:
  
  1. received extensive treatment for a medical problem as children.
  2. carry a grudge against the medical profession.
  3. have worked as a nurse, laboratory technician, or medical aide.
• Sufferers often have poor social support, few enduring social relationships, and little family life.
• Causes of fictitious disorder are not understood, Nor have clinicians been able to develop dependably effective treatments for this disorder.
• Munchausen syndrome by proxy – factitious disorder imposed on another. parents or – caretakers make up or produce physical illnesses in their children – again to gain attention or sympathy or reliance from the child.
  
  • Always a woman, a mother who is typically emotionally needy, with little social support, a medical background. They will deny their actions even in the face of clear evidence.

Question 2

Conversion Disorder

Answer 2

Conversion disorder – A disorder in which bodily symptoms affect voluntary motor and sensory functions, but the symptoms are inconsistent with known medical diseases. (Ex: Paralysis, Blindness).

• Conversion Disorder is different from Fictitious disorder in that those with Conversion Disorder are not consciously trying to induce the symptoms.
• hard, even for physicians, to distinguish from a genuine medical problem because it is always possible that a diagnosis of conversion disorder is a mistake and that the patient’s problem is actually an undetected neurological cause.

Signs that Conversion Disorder is at work:

1. the symptoms don’t sync with how the nervous system works
2. Conversion ‘paralysis’ victim’s limbs don’t atrophy like those with true paralysis.

• Victims tend to be generally suggestible, highly susceptible to hypnotic procedures. So perhaps Conversion is a sort of self-hypnosis.

Question 3

Somatic Symptom Disorder

Answer 3

Somatic symptom disorder – A disorder in which people become excessively distressed, concerned, and anxious about bodily symptoms they are experiencing, and their lives are disproportionately disrupted by the symptoms. There are two primary patterns:

• Somatization pattern (also called BRIQUET’s SYNDROME) – the individual experiences a large and varied number of bodily symptoms – many long-lasting physical ailments with little or no physical basis.
  
  • Often runs in the family, mostly among women
• Predominant pain pattern – the person’s primary bodily problem is the experience of pain.
  
  • The concerns and disruption produced by the pain are disproportionate to its severity and seriousness
  • Often it develops after an accident or during an illness that has caused genuine pain
  • Affects the poor more than the wealthy
• Mass hysteria or mass psychogenic illness – in which large numbers of people would share psychological or physical maladies that had no apparent cause.
  
  • Social media facilitates the widespread nature of this phenomenon including the face twitch of Leroy, NY..

Question 4

PSYCHODYNAMIC VIEW: Causes of Conversion and Somatic

Answer 4

HYSTERICAL DISORDERS – conversion and somatic symptom disorders were referred to as hysterical disorders. This label was meant to convey the prevailing belief that excessive and uncontrolled emotions underlie the bodily symptoms found in these disorders.

PSYCHODYNAMIC VIEW – Freud (1894) came to believe that hysterical disorders represented a conversion of underlying emotional conflicts into physical symptoms and concerns.

• ELECTRA COMPLEX – (according to Freud) All girls experience sexual feelings for their father and at the same time recognizes that they must compete with their mother for his affection. However, aware of her mother’s more powerful position and of cultural taboos, the child typically represses her sexual feelings and rejects these early desires for her father. Freud concluded that some women hide their sexual feelings by unconsciously converting them into physical symptoms and concerns.
  
  • A more general and accepted interpretation is that sufferers of the disorders have unconscious conflicts carried forth from childhood that arouse anxiety that they convert into “more tolerable” physical symptoms.
• Psychodynamic theorists propose that two mechanisms are at work in these disorders:
  
  • Primary gain – People derive primary gain when their bodily symptoms keep their internal conflicts out of awareness. (Repression)
    
    • Ex: During an argument, for example, a man who has underlying fears about expressing anger may develop a conversion paralysis of the arm, thus preventing his feelings of rage from reaching consciousness.
  • Secondary gain – People derive secondary gain when their bodily symptoms further enable them to avoid unpleasant activities or to receive sympathy
    
    • Ex: A conversion paralysis allows a soldier to avoid combat duty. (Avoidance)

Question 5

COGNITIVE-BEHAVIORAL VIEW: Causes of Conversion and Somatic

Answer 5

COGNITIVE-BEHAVIORAL VIEW – Cognitive-behavioral theorists point to rewards and communication skills to help explain conversion and somatic symptom disorders.

• Regarding rewards, they propose that the physical symptoms of these disorders yield important benefits to sufferers. Perhaps the symptoms remove the individuals from an unpleasant relationship, or perhaps the symptoms bring attention from other people.
  
  • This focus on the role of rewards is similar to the psychodynamic notion of secondary gain. The key difference is that psychodynamic theorists view the gains as indeed secondary – that is, as gains that come only AFTER underlying conflicts produce the disorders.
  • Cognitive-behavioral theorists view them as the primary cause of the development of the disorders.
    
    • However, In many cases, the pain and upset that surround the disorders seem to outweigh any rewards the symptoms might bring.
• Regarding Communication Skills – Theorists hold that the emotions of people with the disorders are being converted into physical symptoms.
  
  • They suggest, however, that the purpose of the conversion is not to defend against anxiety but to communicate extreme feelings – anger, fear, depression, guilt, jealousy – in a “physical language” that is familiar and comfortable for the person
  • People who find it particularly hard to recognize or express their emotions are candidates for conversion and somatic symptom disorders.
  • So are those who “know” the language of physical symptoms through firsthand experience with a genuine physical ailment.
    
    • Because children are less able to express their emotions verbally, they are particularly likely to develop physical symptoms as a form of communication
• Also, people who are familiar with an illness will more readily adopt its physical symptoms.
  
  • In fact, studies find that many sufferers develop their bodily symptoms after they or their close relatives or friends have had similar medical problems.

Question 6

MULTICULTURAL VIEW: Causes of Conversion and Somatic

Answer 6

MULTICULTURAL VIEW –

Western bias – a bias that sees somatic reactions as an inferior way of dealing with emotions.

• In fact, the transformation of personal distress into somatic complaints is the norm in many non-Western cultures.
  
  • Studies have found very high rates of stress-caused bodily symptoms in non-Western medical settings throughout the world, including those in China, Japan, and Arab countries
  • Hispanic Americans display more somatic reactions in the face of stress than do other populations.

Question 7

How Are Conversion and Somatic Symptom Disorders Treated?

Answer 7

Many therapists focus on the causes of these disorders (the trauma or anxiety tied to the physical symptoms) and apply insight, exposure, and drug therapies.

• Psychodynamic therapists, for example, try to help those with somatic symptoms become conscious of and resolve their underlying fears, thus eliminating the need to convert anxiety into physical symptoms.
  
  • Exposure treatments. They expose clients to features of the horrific events that first triggered their physical symptoms, expecting that the clients will become less anxious over the course of repeated exposures
• Biological therapists most often use antidepressant drugs.
• Therapists who take a Reinforcement approach arrange for the removal of rewards for a client’s “sickness” symptoms and an increase of rewards for healthy behaviors.

Question 8

Illness Anxiety Disorder

Answer 8

Illness anxiety disorder – A disorder in which people are chronically anxious about and preoccupied with the notion that they have or are developing a serious medical illness, despite the absence of somatic symptoms and regardless of what anyone including doctors say.

• Men and women in equal numbers.
• 5% of all patients seen by primary care physicians may display the disorder.
• Illness anxiety disorder is like any other anxiety-related disorder.
  
  • Cognitive-behavioral theorists, for example, believe that illness anxiety is acquired through classical conditioning or modeling.
    
    1. that people with the disorder are so sensitive to and threatened by bodily cues that they come to misinterpret them.
  • People with illness anxiety disorder usually receive the kinds of treatments that are used to treat obsessive-compulsive disorder.

Question 9

Psychophysiological Disorders: Psychological Factors Affecting

Answer 9

Psychophysiological Disorders – in which biological, psychological, and sociocultural factors interact to cause or worsen a physical illness.

• These are broken into two broad categories:
  
  1. Traditional (ulcers, asthma, Insomnia, tension and migraine headaches,, hypertension, and coronary heart disease)
  2. New (Bacterial infections)
• Often results in serious physical damage.
• They are different from the fictitious, conversion, and illness anxiety disorders which are caused by psychological factors.

Question 10

Traditional Psychophysiological Disorders

Answer 10

The best known and most common of these disorders were ulcers, asthma, insomnia, chronic headaches, high blood pressure, and coronary heart disease.

• Ulcer – A lesion that forms in the wall of the stomach or of the duodenum.
• Asthma – A disease marked by narrowing of the trachea and bronchi, resulting in shortness of breath, wheezing, coughing, and choking sensation.
• Insomnia – Difficulty falling or staying asleep.
• Muscle contraction headache or Tension Headache – A headache caused by a narrowing of muscles surrounding the skull.
• Migraine headache – A very severe headache that occurs on one side of the head, often preceded by a warning sensation and sometimes accompanied by dizziness, nausea, or vomiting.
  
  • Research suggests that chronic headaches are caused by an interaction of stress factors, such as environmental pressures or general feelings of helplessness, anger, anxiety, or depression, and physiological factors, such as the abnormal activity of the neurotransmitter serotonin, vascular problems, or muscle weakness.
• Hypertension – Chronic high blood pressure.
• Coronary heart disease – Illness of the heart caused by a blockage in the coronary arteries.
  
  • The leading cause of death for both men and women, accounting for 17 million deaths around the world each year, 600,000 of them in the United States – around one-third of all deaths.

FACTORS THAT CONTRIBUTE TO PSYCHOPHYSIOLOGICAL DISORDERS

• BIOLOGICAL FACTORS – autonomic nervous system (ANS) – the network of nerve fibers that connect the central nervous system to the body’s organs. Defects in this system are believed to contribute to the development of psychophysiological disorders.
  
  • If one’s ANS is stimulated too easily, it may overreact to situations that most people find only mildly stressful, eventually damaging certain organs and causing a psychophysiological disorder.
• PSYCHOLOGICAL FACTORS – Certain needs, attitudes, emotions, or coping styles may cause people to overreact repeatedly to stressors, and so increase their chances of developing psychophysiological disorders.
  
  • Type A personality style – A personality pattern characterized by hostility, cynicism, drivenness, impatience, competitiveness, and ambition.
  • Type B personality style – A personality pattern in which a person is more relaxed, less aggressive, and less concerned about time
  • The link between the Type A personality style and coronary heart disease has been supported.
    
    • Type A characteristics of Hostility, competitiveness, and time urgency, may indeed be strongly related to heart disease
• SOCIOCULTURAL FACTORS – One of society’s most negative social conditions, for example, is poverty. In study after study, it has been found that impoverished people have more psychophysiological disorders, poorer health in general, and poorer health outcomes than wealthier people
  
  • Studies have found that the more discrimination people experience over a 1-year period, the greater their daily rise in blood pressure, and the more discrimination African Americans experience over the course of their lives, the more likely they are to have high blood pressure as they get older.
• The relatively positive health picture for Hispanic Americans in the face of clear economic disadvantage has been referred to in the clinical field as the “Hispanic Health Paradox.”
  
  • It may be that the strong emphasis on social relationships, family support, and religiousness that often characterize Hispanic American cultures increase health resilience among their members.”

Question 11

New Psychophysiological Disorders

Answer 11

Social Readjustment Rating Scale – assigns numerical values to the stresses that most people experience at some time in their lives.

• One shortcoming is that it does not take into consideration the particular life stress reactions of specific populations (e.g. college students vs. the elderly).

Psychoneuroimmunology – the area of study that ties stress and illness to the body’s immune system.

Immune system – The body’s network of activities and cells that identify and destroy antigens and cancer cells.

• Antigen – A foreign invader of the body, such as a bacterium or virus.
• Lymphocytes – White blood cells that circulate through the lymph system and bloodstream, helping the body identify and destroy antigens and cancer cells.
• The immune system is the body’s network of activities and cells that identify and destroy antigens – foreign invaders, such as bacteria, viruses, fungi, and parasites – and cancer cells. Among the most important cells in this system are billions of lymphocytes, white blood cells that circulate through the lymph system and the bloodstream. When stimulated by antigens, lymphocytes spring into action to help the body overcome the invaders.
  
  • One group of lymphocytes, called helper T-cells, identifies antigens and then multiplies and triggers the production of other kinds of immune cells.
  • Another group, natural killer T-cells, seeks out and destroys body cells that have already been infected by viruses, thus helping to stop the spread of a viral infection.
  • A third group of lymphocytes, B-cells, produces antibodies, protein molecules that recognize and bind to antigens, mark them for destruction, and prevent them from causing infection.
  • Stress can interfere with the activity of lymphocytes and other parts of the immune system, slowing them down and thus increasing a person’s susceptibility to viral and bacterial infections

Several factors influence whether stress will result in a slowdown of the system:

• BIOCHEMICAL ACTIVITY – there are two biological stress pathways by which stressors produce arousal throughout the brain and body One is the sympathetic nervous system, which, among its many actions, triggers the release of the neurotransmitter norepinephrine.
  
  • If stress continues for too long, norepinephrine eventually travels to receptors on certain lymphocytes and gives them an inhibitory message to stop their activity, thus slowing down immune functioning
  • Recall also that the other biological stress pathway is the hypothalamic-pituitary-adrenal (HPA) pathway, which, among its various actions, triggers the release of cortisol and other stress hormones.
    
    • An extended-release of cortisol and other stress hormones can contribute to poorer immune system functioning. if stress continues for too long, the stress hormones travel to receptor sites located on certain lymphocytes and give an inhibitory message, again causing a slowdown of the activity of the lymphocytes.
    • Another action of norepinephrine and the various stress hormones is to trigger an increase in the production of cytokines, proteins that bind to receptors throughout the body. At moderate levels of stress, the cytokines help combat infection. But as stress continues and more norepinephrine and stress hormones are released, the growing production and spread of cytokines lead to chronic inflammation throughout the body, contributing at times to heart disease, stroke, and other illnesses.
• BEHAVIORAL CHANGES – Stress may set in motion a series of behavioral changes that indirectly affect the immune system. As a result, they may sleep badly, eat poorly, exercise less, or smoke or drink more
• PERSONALITY STYLE – people who generally respond to life stress with optimism, constructive coping, and resilience, experience better immune system functioning and are better prepared to fight off illness. people who are spiritual tend to be healthier than people without spiritual beliefs, and a few studies have linked spirituality to better immune system functioning
• SOCIAL SUPPORT – Finally, people who have few social supports and feel lonely tend to have poorer immune functioning. The high-loneliness group showed lower lymphocyte responses during a final exam period.

Question 12

Psychological Treatments for Physical Disorders

Answer 12

Behavioral medicine – A field that combines psychological and physical interventions to treat or prevent medical problems. The most common of these interventions are:

• Relaxation training – A treatment procedure that teaches clients to relax at will so they can calm themselves in stressful situations.
• Biofeedback – A technique in which a client is given information about physiological reactions as they occur and learns to control the reactions voluntarily
• Meditation – a technique of turning one’s concentration inward, achieving a slightly changed state of consciousness, and temporarily ignoring all stressors.
  
  • Mindfulness meditators pay attention to the feelings, thoughts, and sensations that are flowing through their mind during meditation, but they do so with detachment and objectivity and, most importantly, without judgment.
    
    • By just being mindful but not judgmental of their feelings and thoughts, including feelings of pain, they are less inclined to label them, fixate on them, or react negatively to them.
• Hypnosis – particularly helpful in the control of pain. hypnosis has been used successfully to help treat such problems as skin diseases, asthma, insomnia, high blood pressure, warts, and other forms of infection
• Cognitive interventions – teach new attitudes or cognitive responses toward their ailments.
  
  • Ex: An approach called SELF-INSTRUCTION TRAINING, or STRESS INOCULATION TRAINING, has helped patients cope with severe pain. In this training, therapists teach people to identify and eventually rid themselves of unpleasant thoughts that keep emerging during pain episodes (negative self-statements, such as “Oh no, I can’t take this pain”) and to replace them with coping self-statements instead (Ex: “When pain comes, just pause; keep focusing on what you have to do”).
• Support groups – even the writing down, of past and present emotions or upsets may help improve a person’s health, just as it may help one’s psychological functioning.
• Therapies to increase awareness and expression of emotions –
  
  • COGNITIVE APPROACHES – Relaxation and biofeedback training, for example, are equally helpful (and more helpful than placebos) in the treatment of high blood pressure, headaches, and asthma.
  • Psychological interventions are often most helpful when they are combined with other psychological interventions and with medical treatments.