comerfund9e_lectureslides_ch08.pptx

Dis s Featuring Somatic Symptoms
Chapter 8
Fundamentals of Abnormal Psychology
RONALD J. COMER | JONATHAN S. COMER| ninth edition

Dis s Featuring Somatic Symptoms
DSM-5 categories identify somatic symptoms
Primarily caused by psychological factors
Symptoms trigger excessive anxiety or concern
Factitious dis
Conversion dis
Somatic symptom dis
Illness anxiety dis
Psychological factors affecting other medical conditions

Factitious Dis (part 1)
Imposed on self
False creation of physical or psychological symptoms, or deceptive production of injury or disease, even without external rewards
Presentation of oneself as ill, damaged, or hurt
Munchausen syndrome
Imposed on another
False creation of physical or psychological symptoms, or deceptive production of injury or disease, in another person, even without external rewards
Presentation of another person (victim) as ill, damaged, or hurt
Munchausen syndrome by proxy

Factitious Dis (part 2)
Links
Poor social support or relationships and little family life
Extensive medical treatment in childhood
Grudge against medical profession
Employment as nurse, lab technician, or aide

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Factitious Dis (part 3)
Causes and treatment
The precise causes of factitious dis are not understood
Clinicians have been unable to develop dependably effective treatments for this dis

The precise causes of factitious dis are not understood, although clinical reports have pointed to factors such as depression, unsupportive parental relationships during childhood, and an extreme need for social support.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 1)
Conversion dis
Neurological-like symptoms inconsistent with known neurological or medical disease
Usually beginning in late childhood and young adulthood; often appears suddenly during extreme stress
Not consciously wanted or purposely produced

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 2)
Conversion dis
Glove anesthesia
In this conversion symptom (left figure) the entire hand, extending from the fingertips to the wrist, becomes numb

Patients may be highly susceptible to hypnotic procedures.
Actual physical damage (right figure) to the ulnar nerve, in contrast, causes anesthesia in the ring finger and little finger and beyond the wrist partway up the arm; damage to the radial nerve causes loss of feeling only in parts of the ring, middle, and index fingers and the thumb and partway up the arm. (Information from Gray, 1959.)

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 3)
Somatization pattern
Long-lasting physical ailment with no physical basis; dramatic and exaggerated
Treatment sought from doctor to doctor
Prevalence: 4 percent
Abuse and genetic links

Predominant pain pattern
Pain source known or unknown
May develop after an accident or illness that initially caused genuine pain

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 4)
These groups of dis s have much in common
Both may occur in response to severe stress
Both have traditionally been viewed as forms of escape from stress
A number of individuals suffer from both types of dis s
Theorists and clinicians often explain and treat the two groups of dis s in similar ways

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

MindTech
Can social media spread “mass hysteria”?
Bartholemew
Argues that social media are a major factor in the current increase in mass hysteria
Suggests future outbreaks may be more numerous, wide-ranging, and severe

Do you think this phenomenon is related to social media?
Why? Why not?

Conversion Dis and Somatic Symptom Dis (part 5)
Somatic symptom dis
At least one upsetting or repeatedly disruptive physical (somatic) symptom
An unreasonable number of thoughts, feelings, and behaviors
Physical symptoms usually continue to some degree for more than 6 months

Person experiences an unreasonable number of thoughts, feelings, and behaviors regarding the symptoms
Repeated, excessive thoughts about their seriousness
Continual high anxiety about their nature or health implications
Disproportionate amounts of time and energy spent on the symptoms or their health implications

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 6)
What causes conversion and somatic symptom dis s?
Previously called hysterical dis s
Widely considered unique and in need of special explanation
No explanation has received much research support, and the dis s are still poorly understood

Conversion Dis and Somatic Symptom Dis (part 7)
The psychodynamic view (Freud)
First psychodynamic theory of these two dis s
Underlying emotional conflicts converted into physical symptoms and concerns
Two defense mechanisms
Primary gain
Secondary gain

Electra complex goes awry

Freud argued that a hysterical dis may result when parents overreact to their daughter’s early displays of affection for her father, by repeatedly punishing her, for example. The child may go on to exhibit sexual repression in adulthood and convert sexual feelings into physical ailments.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 8)
Contemporary psychodynamic theories
Disagree with Freud on many points
Agree that patients carry unconscious conflicts from childhood, causing anxiety
Anxiety turns into physical pain

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 9)
Cognitive-behavioral view
Physical symptoms of dis are rewarded and maintained through reinforcement
Symptoms
Create distance from unpleasant relationships
Bring attention; source of communication influenced by modeling of knowledge of medical problems
Secondary gains
This view has not been widely tested and is not supported by research

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dis s That Have Somatic Symptoms

Dis Voluntary Control of Symptoms? Symptoms Linked to Psychosocial Factor? An Apparent
Goal?

Malingering Yes Maybe No

Factitious dis Yes Yes No*

Conversion dis No Yes Maybe

Somatic symptom dis s No Yes Maybe

Illness anxiety dis No Yes No

Psychophysiological dis No Yes No

Physical illness No Maybe No

Some cognitive-behavioral theorists propose that the dis s are forms of communication and that people express their emotions through their physical symptoms.
Treatments for these dis s include insight, exposure, and drug therapies and may include techniques such as education, reinforcement, or cognitive restructuring
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 10)
Multicultural view
Some Western clinicians do not advocate excessive focus on somatic symptom dis s included in DSM-5; others see this as bias
Formation of somatic complaints is the norm in many non-Western cultures

What does this tell us?

Bodily and psychological reactions to life events are often influenced by one’s culture.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conversion Dis and Somatic Symptom Dis (part 11)
How are conversion and somatic symptom dis s treated?
Focus on the cause of the dis
Insight
Exposure
Drug therapies
Focus on the symptoms
Education
Reinforcement
Cognitive restructuring

Individuals with preoccupation dis s typically receive the kinds of treatments applied to anxiety dis s, particularly OCD:
Antidepressant medication
Exposure and response prevention (ERP)
Cognitive-behavioral therapies
Treatments for these dis s often focus on the cause of the dis and apply the same kind of techniques used in cases of PTSD:
Insight: Often psychodynamically oriented
Exposure: Client thinks about the traumatic event(s) that triggered the physical symptoms
Drug therapy: Especially antidepressant medication

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Illness Anxiety Dis (part 1)
Preoccupation with thoughts or high anxiety about having or getting a significant illness
Absence of substantial somatic symptoms
Unduly high number of health-related behaviors or dysfunctional health-avoidance behaviors
Concerns continue to some degree for at least 6 months

In reality, the person has no or, at most, mild somatic symptoms.
Previously known as hypochondriasis.
Between 1 and 5 percent of all people experience the dis .
For most patients, symptoms rise and fall over the years.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Illness Anxiety Dis (part 2)
The dis can begin at any age, but starts most often in early adulthood
Affects men and women in equal numbers
Theoretical explanation and treatment are similar to those for anxiety dis s (OCD)
Drug and cognitive-behavioral approaches

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Psychological Factors Affecting Other Medical Conditions (part 1)
Early DSM labels
Included psychophysiological (psychosomatic) dis s
DSM-5 label
Includes psychological factors affecting other medical conditions
Characteristics of these dis s
Are different from factitious, conversion, and illness anxiety dis s
Involve significant medical symptoms and conditions
Often result in serious physical damage

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Psychological Factors Affecting Other Medical Conditions (part 2)
Psychophysiological dis s
Affected persons have a medical condition
Psychological factors negatively affect the medical condition
Affect the course of the medical condition
Provide obstacles to the treatment of medical condition
Pose new health risks
Trigger or worsen the medical condition

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Psychological Factors Affecting Other Medical Conditions (part 3)
Traditional psychophysiological dis s
Ulcers
Asthma
Insomnia
Chronic headaches
Migraine headaches
Hypertension

What do people do to relieve stress?

According to surveys, most of us go on the Internet, watch television, read, or listen to music. Tweeting is on the rise. (Information from BLS, 2016; MHA, 2008; NPD Group, 2008; Pew Research Center, 2016, 2011, 2010; Wagstaff, 2015; IWS, 2011.)
Ulcers
Lesions in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding
Experienced by more than 25 million people at some point in their lives
Causal psychosocial factors:
Environmental pressures, including intense feelings of anger or anxiety
Bacterial infection
Asthma
A narrowing of the body’s airways that makes breathing difficult
Affects up to 25 million people in the United States each year
Causal psychosocial factors:
Environmental pressures or anxiety
Allergies, a slow-acting sympathetic nervous system, or a weakened respiratory system
Insomnia
Difficulty falling asleep or maintaining sleep
Affects 10 percent of people in the United States each year
Causal psychosocial factors:
High levels of anxiety or depression
Overactive arousal system, certain medical ailments
Chronic headaches
Frequent intense aches of the head or neck that are not caused by another physical dis
Tension headaches affect 45 million Americans each year
Migraine headaches affect 23 million Americans each year
Causal psychosocial factors:
Environmental pressures; general feelings of helplessness, anger, anxiety, depression
Abnormal serotonin activity, vascular problems, muscle weakness
Hypertension
Chronic high blood pressure, usually producing few outward symptoms
Affects 75 million Americans each year
Causal psychosocial factors:
Constant stress, environmental danger, general feelings of anger or depression
10 percent caused by physiological factors alone
Obesity, smoking, poor kidney function, high proportion of collagen (rather than elastic) tissue in an individual’s blood vessels
Coronary heart disease
Caused by blockage in the coronary arteries
Encompasses several problems, including myocardial infarction (heart attack)
Nearly 18 million people in the United States have some form of coronary heart disease
The leading cause of death in men older than 35 years and women older than 40 years
Causal psychosocial factors:
Job stress, high levels of anger or depression
High level of cholesterol, obesity, hypertension, the effects of smoking, lack of exercise

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Psychological Factors Affecting Other Medical Conditions (part 4)
Several variables contribute to the development of psychophysiological dis s
Biological factors
Defects in the autonomic nervous system (ANS) may contribute to the development of psychophysiological dis s
Other more specific biological problems
Psychological factors
Needs, attitudes, emotions, personality, or coping styles may cause people to overreact repeatedly to stressors
Increases their chances of developing psychophysiological dis s

Psychological Factors Affecting Other Medical Conditions (part 5)
Sociocultural factors
Adverse social conditions that produce stress trigger and interact with biological and psychological factors
Poverty and dangerous environments
Discrimination
Health problems
Genetic predispositions

How much discrimination do racial minority teenagers face?
It depends on who’s being asked the question. In surveys of teenagers and young adults, African American respondents were more likely than non-Hispanic white American respondents to recognize that African American teens experience various forms of discrimination. (Information from Black Youth Project, 2016, 2011; OA, 2017.)
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Psychological Factors Affecting Other Medical Conditions (part 6)
Are physical illnesses related to stress?
Social Adjustment Rating Scale (1967)
Examined relationship between life stress and onset of illness
Linked stressors of various kinds to a wide range of physical conditions
Does not consider particular stress reactions within specific populations

Overall, the greater the amount of life stress, the greater the likelihood of illness.
Researchers have even found a relationship between traumatic stress and death.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Most Stressful Life Events
Adults: Social Readjustment Rating Scale*
Death of spouse
Divorce
Marital separation
Jail term
Death of close family member
Personal injury or illness
Marriage
Fired at work
Marital reconciliation
Retirement
Change in health of family member
Pregnancy
Students: Undergraduate Stress Questionnaire†
Death (family member or friend)
Had a lot of tests
It’s finals week
Applying to graduate school
Victim of a crime
Assignments in all classes due the same day
Breaking up with boy/girlfriend
Found out boy/girlfriend cheated on you
Lots of deadlines to meet
Property stolen
You have a hard upcoming week
Went into a test unprepared

*Full scale has 43 items.
†Full scale has 83 items.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Psychological Factors Affecting Other Medical Conditions (part 7)
New psychophysiological dis s
Many physical illnesses are linked to psychosocial stress
Psychoneuroimmunology: Examines how stressful events result in viral or bacterial infection
Stress can slow lymphocyte activity and interfere with the immune system’s ability to protect against illness during times of stress
Norepinephrine and cortisol activity, behavioral changes, personality style, and social support affect immune functioning

Clearly, biological, psychological, and sociocultural variables combine to produce psychophysiological dis s. In fact, the interaction of psychosocial and physical factors is now considered the rule in bodily function, not the exception.

…