Session-12 Somatoform Disorders Flashcards
What is Somatization?
Refers to psychological stress that manifests in the form of physical symptoms; a person’s physical symptoms are traceable to a mental or emotional cause rather than to a physical one.
(Somatization) What are the prominent somatic (bodily) symptoms, directly related to?
directly related to anxiety (deep-seeded, anxiety-producing cognitive schemas)
What is the most common clinical manifestation of anxiety disorders worldwide?
Somatization (somatoform disorders)- no basis really for distinguishing from anxiety disorders.
What was Freud’s original conceptualization of hysteria?
Somatization
note:
Freud’s original work is how the field got started, around 1890 or so, he began talking to people, he was an MD, a neurologist, but he started to get referrals in Vienna where he was living, a majority of the people coming to talk to him had somatoform presentations, basically at that time there were, many of the patients had paralysis, they could not move or feel parts of their body. And he started to notice a theme, he was seeing a theme in some of the young woman patients, many of the young woman patients had symptoms of paralysis below their, in the lower portions of their body. Now what you learn through the case of Anna O and others, he originally theorized that the reason why there was paralysis was not due to a medical issue, he thought the theme seemed to be that these woman had been traumatized, he thought they had been raped and that the paralysis was secondary to trauma. And that is called the seduction hypothesis; he thought these young woman had been the victims of incest in their families, they were abused and the paralysis was second to this abuse. How the field got started, our belief in trauma, and the bodily response to trauma. He hypothesized that these woman were seduced and violated incecuassly. As he began to talk about this, he had a bunch of followers and they started to talk about mental health issues, as they talk to him in this group, they tell him you cant just make this public because it will ruin the reputation of all these woman fathers and stuff. He was in higher power so his followers told him that he could not just state that all these woman are having these symptoms because they had been violated by their family. So he abandoned this hypothesis, he gave up that view and his revised view was this; that it was not the paralysis in these woman, in their lower portion was not a response to sexual abuse, it was due to a mental conflict, and the mental conflict is this; these young woman had a wish and wish for him meant the ID, the wish of these woman were to have sex, they had sexual desire as they were becoming woman (12/13/14), they had the wish for sexuality, and the fear connected to that was that this made them dirty. This made them bad, that made them hoars, so there is a triangle; the wish (sexualisty), fear (bad to have sexual desire), defense (somatization, paralyzing the vagina and often the legs). His original view of this was that if they cant feel stimulation they wont want it and if they want it they wont be able to walk to it.
Abandonement of seduction was replaced by the theory of conflit; this was sort of the first model of psychopathology. The wish of course was the ID, the fear is the Super Ego (values, religion, family), for Freud in the 1890s, woman should not be sexual at all, the Super Ego was making woman believe that if they had these wishes it made them naughty.
Theory of hysteria, hysterical; the first medical disease, the hysteria was the somatization symptoms due to sexual conflict about sexuality.
The reason why anxiety is a part of this, when there is a Wish and the Fear, this wish fear thing creates anxiety, that’s the anxiety that Freud thought about. Once there is anxiety it has to be defended against. We can say that somatoform disorders is the first set of disorders in the fear; the anxiety must be relieved some how, the way it is relieved is with a fear; wish, fear, release
Many feminist; one of the reasons why he was so criticized, they said it wasn’t really that they were having mental conflicts it was that they were sexually violated.
What point does Castillo make over and over again?
That there is significant (arbitrary) overlap between anxiety, somatoform, and mood disorders.
DSM-IV-TR: What are the “Somatoform Disorders”?
somatization disorder
undifferentiated somatoform disorder
conversion disorder
pain disorder
hypochondriasis
body dysmorphic disorder
somatoform disorder NOS
DSM-IV-TR: Somatization Disorder requires a history of ____ and have a duration of___?
history of recurrent multiple somatic complaints that begin before age 30 and have a duration of at least several years and are characterized by a combination of pain, gastrointestinal, sexual, and pseudoneurological symptoms
DSM-IV-TR: What is the highly specific criteria for Somatization Disorder?
Pain symptoms in 4 areas of the body
2 gastrointestinal disturbances other than pain: example, nausea, bloating, vomiting
1 sexual symptom other than pain: example, irregular menses, excessive menstrual bleeding, sexual indifference, erectile or ejaculatory dysfunction
1 pseudoneurological (dissociative) symptom (conversion symptoms) such as paralysis or seizure, impaired coordination or balance, difficulty swallowing, blindness.
DSM-IV-TR: What is Somatization Disorder often comorbid with?
With mood and anxiety disorders; for example, panic disorder, generalized anxiety disorder, and major depressive disorder
note: there is no known medical cause or symptoms and complaints are in excess of what is normally expected based on the medical condition and rarely occurs in men.
DSM-IV-TR: Somatization Disorder
What are Pseudo-neurological conditions?
They are illnesses that mimic a wide range of diseases of the nervous system, but are not caused by any organic disorder.
What are pseudo-neurological conditions in the classical form?
They are truly psychosomatic (caused or aggravated by mental conflict) and reflect the close links between the brain and the peripheral nervous system, and the interplay between mind and body.
Are pseudo-neurological symptoms fake?
They are not “put on” and affected individuals should not feel they are being branded as frauds.
Although difficult to distinguish from feigned (pretend) illness, in genuine cases, the symptoms are as real and disabling as those caused by organic disease.
What is the second group of pseudo-neurological conditions?
They are pseudo-syndromes; this is when the symptoms of one disorder produce effects which mimic those of another unrelated disease.
What are the symptoms and signs of pseudo-neurological conditions?
seizures
pain, especially headaches
weakness or paralysis
numbness or tingling
spasms, tics or tremors
abnormal posture
gait abnormalities
disturbances of vision
loss of taste and smell
loss of voice, stuttering is often, not always, a conversion problem
delirium
loss of memory
dizziness or vertigo
What are pseudo-neurological conditions though to arise from?
by a psychological mechanism called Conversion (previously known as hysteria)
note: When there is a wish for sex and the fear, the anxiety that erupts from that conflict gets converted, this is conversion. It gets converted from mind, meaning anxiety to body, the paralysis and you can say this conversion is the defense. When you convert mental conflict to bodily experience, this is conversion.
Somatization Disorder was historically known as?
Hysteria/ Briquet’s Syndrome
Poor, inconsistent historians: they cannot historically describe when things emerged for them, everything is vague and unclear and sometimes the information contradicts.
DSM-IV-TR: What is “undifferentiated somatoform disorder”?
Residual category for persistent somatoform-type illnesses that do not meet criteria for somatization disorder. One or more physical complaints that cannot be explained medically and the duration of the disturbance is at least 6 months.
DSM-IV-TR: Why is “undifferentiated somatoform disorder” important for cross-cultural assessment?
Important for cross-cultural assessment (culture-bound syndromes). For example, “neurasthenia” in China (depression rare, but emotional distress demonstrated in culturally-bound physical symptoms as an idiom of expression).
Cultural schemas differ re: pattern recognition of symptoms, meaning, and acceptance of particular constructs.
note: Cross culturally there are some people in areas that somatization is standard, it is an idiom of expression, idiom a way to express cultural anguish. A way of expressing mental constructs is through the body; meaning if it is culturally bound, an idiom of distress, the way of expressing mental distress is through the body, you would not assign this disorder to them; you would not be attending to their cultural context
Back of DSM-IV, idioms of distress
DSM-IV-TR criteria for “undifferentiated somatoform disorder”?
Residual category for persistent somatoform-type illnesses that do not meet criteria for Somatization disorder.
One or more physical complaints that cannot be explained medically and the duration of the disturbance is at least 6 months
Important for cross-cultural assessment (culture-bound syndromes)
For example, “neurasthenia” in China: depression is rare, but emotional distress demonstrated in culturally-bound physical symptoms as an idiom of expression
Cultural schemas differ with regard to recognition of symptoms, meaning assigned to symptoms, and acceptance of particular constructs to explain illness
DSM-IV-TR: What is “conversion disorder”?
One or more symptoms or deficits affecting voluntary motor or sensory function that suggests a neurological or other general medical condition;
Psuedoneurological (dissociative) symptoms such as amnesia, paralysis, impaired coordination or balanced, blindness, deafness, seizures without medical explanation, etc.
Symptoms are not intentionally produced and cannot be explained by a physical etiology.
DSM-IV-TR: What is criteria for “Conversion Disorder”?
Pseudoneurological dissociative symptoms that affect sensory or motor function and suggest a neurological or general medical condition, but are without medical basis
Symptoms defined as dissociative because the sensory or motor experience is considered to be split from awareness; also, individuals may be amnestic for episodes of more severe symptoms, such as seizures
Symptoms are considered to be the result of psychological problems and are often preceded by an identifiable stressor or trauma – symptoms become the focus of attention and allow the person to escape the stressful or traumatic experience
Symptoms include: impaired coordination or balance, paralysis or localized weakness, difficulty swallowing, urinary retention, blindness, deafness, double vision or seizures (not neurologically based)
note: Not neurologically based, a pseudo seizure, shows symptoms but not enough abnormality to be neurological.
Patient presents with symptoms consistent with seizure but etiology is unknown.
Some people think possession is really conversion; a defense against the anxiety; generally would be good and evil, wish is to be good and the fear is evil. Freud at some point, refined the theory of mental conflict, he argued that a lot of fears are actually wishes; a battle ground for the wish to be good and evil,
*esoteric conversion; like the old biblical of speaking in tongues, this is this but your able to voice different languages, so consciously you don’t posses knowledge of these languages,
Many people have conflicts with things outside of them and others have conflicts with things within them.
Prior to the diagnosis of “Conversion Disorder” what is necessary?
A full medical workup is essential to rule out medical explanations prior to the diagnosis of conversion disorder
People with conversion symptoms may also have coexisting bona fide medical or neurological conditions
Primary gain
Conversion symptoms function to keep some psychological conflict out of consciousness, thereby reducing anxiety
Secondary gain
Benefits (e.g., attention) are obtained and responsibilities (e.g., work, housekeeping) are evaded
However, in contrast to Factitious Disorder (sick role) or Malingering (secondary gain), in Conversion disorder, although there may be primary or secondary gain, symptoms are not deliberately produced to obtain those benefits
note: a typical conversion presentation; they go to multiple doctor visits, for scans, xrays and all these things and find nothing, now what its doing is primary gain; they are basically moving the highlight on their mental conflict to their bodily issue.
What are other features of a Conversion Disorder?
Other features
La belle indifference:
Apparent lack of concern about the symptoms or the implications of the symptoms
Present in some cases, although people may also be more overtly dramatic in their presentation
Possible reinforcement of the sick role over time
Associated disorders: dissociative disorders, major depressive disorder, histrionic PD, antisocial PD, borderline PD, dependent PD
Not diagnosed if conversion symptoms are part of Somatization disorder
DSM-IV-TR:
What is “Pain Disorder”?
Subjective experience of pain with no sufficient medical justification; psychological factors judged to play a role in the onset, severity exacerbation, or maintenance of the pain, and symptoms are not intentionally produced or feigned.
Subtypes: (1) with psychological factors, (2) with a general medical condition – code on Axis III, and (3) with both psychological factors and a general medical condition
Condition can be chronic, leading to a downward spiral of problems and psychological issues.
