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Chapter 5: Somatic Symptom, Dissociative, and Factitious Disorders pg
167-194
Somatic Symptom and Related Disorders
- Excessive thoughts, feelings, and behaviours related to somatic symptoms
- Ppl experience real physical symptoms, but their physical pain cannot be fully explained
by an established medical condition
Somatic Symptom Disorder
- Pierre Briquet; French physician
o Wrote paper describing psychiatric patients with many somatic complaints that
seemed to lack a physical cause
- The presence of one or more somatic symptoms plus abnormal/excessive thoughts,
feelings, and behaviours regarding the symptoms – including pseudoneurological
complaints
o No specific physical symptoms are needed
o Psychogenic seizures can occur – RARE
o Most common are motor symptoms or deficits
▪ Impaired coordination or balance, paralysis or weakness, tremor, gait
abnormality, and abnormal limb posturing
o Unusual symptom: globus
▪ Aphonia, sensations of choking, difficulty swallowing, shortness of breath,
or feelings of suffocation
o Less common: Sensory abnormalities; glove anesthesia
Conversion Disorder (Functional Neurological Symptom Disorder)
- Symptoms of altered motor or sensory function
o Can be dramatic; sudden paralysis or blindness
o Some physical symptoms can be attributed to a diagnosable medical condition
Real Science Real Life: Nancy — a Case of Conversion Disorder
- Has seizures, with some control of her body mov’t
o Only occurred after a conflict w/ kids or siblings 9
- Married bc pregnant; now in a marriage w/ no communication or affection bc kids moved
out
- Husband is attentive when she has her seizures
o Medication given for seizures which Nancy says helps is a placebo
Illness Anxiety Disorder
- Having a high level of worry about health and easily become alarmed about the
possibility of having an illness → hypochondriac
- Similar to OCD
o Constantly seek reassurance and monitor their own physical status
- High rate of comorbid anxiety and depressive disorders
Factitious Disorder
- Important difference; physical or psychological signs or symptoms of illness are
intentionally produced in what appears to be desire to assume a sick role
- Ppl are aware they are producing the symptoms and making themselves ill but they are
not aware of why
- 2 types:
o Factitious disorder imposed on self
▪ Engaging and deceptive practises to produce signs of illness
▪ Faking, manipulation, falsifying results, etc.
o Factitious disorder imposed on another
▪ Usually the parent produces physical symptoms in a child
• Can also occur in nursing homes
▪ A form of child abuse
Functional Impairment
- Difficulty maintaining employment, increased likelihood of physical disability,
occupational impairment, and overuse of health services
- Chronic disorders
Ethics and Responsibility
- In cases of factitious disorder imposed on another, psychologists have a responsibility to
act in the best interest of the child
Epidemiology
- There’s no known epidemiological data on the prevalence of factitious disorders in the
general population
Sex, Race, and Ethnicity
- They’re rare disorders so little evidence exists
- Factitious disorder is more likely to occur in women for both types
Developmental Factors
- Diagnostic criteria is same for children and adolescents
- Somatoform disorder is a rare before to adulthood
- Factitious disorder imposed on self is most common in children and adolescents
Etiology
- Psychosocial factors
o Propose that these disorders result from intrapsychic conflict, personality, and
defence mechanisms
▪ Negative feelings converting into physical symptoms
o Empirical data supports hypothesis that children/adults who complain of physical
aches/pain have more negative emotions and poor self-awareness of the emotions
▪ Less able to regulate their emotions
o Environmental issues
▪ Familial violence/conflict, sexual abuse, stress, etc.
o Psychodynamic models explain factitious disorder as
▪ An attempt to gain mastery or control that was formerly elusive
▪ A form of masochism (where pleasure occurs as a result of physical or
psychological pain inflicted by oneself or another person)
▪ The result of a deprived childhood, in which a child did not receive
attention or care
▪ An attempt to master trauma that was experienced as a result of physical
or sexual abuse, with the physician unknowingly assuming the symbolic
role of the abuser
o Cognitive theories propose hat somatoform disorders develop from inaccurate
beliefs about
▪ The prevalence and contagiousness of illnesses
▪ The meaning of bodily symptoms
▪ The course and treatment of illnesses
- Integrative Model
o Crucial factor being whether a physician’s response reassures you or if you
continue to worry
Is Childhood Sexual abuse associated with DSM-iv Somatoform Disorders?
- Somatoform disorders (DSM-IV) have been linked to physical and sexual abuse early in
life
- Family environments characterized by high conflict, hostility, and rejection may lead to a
dysregulation of the neuroendocrine system that mediates stressful responses in the body
Treatment
- 1st challenge is the reluctance of people with somatic symptom disorders to reveal their
worries to a professional
o Many ppl don’t believe they have a psychological disorder
- Basic education is the main treatment option
o Teaching patients to cope with their symptoms by emphasizing how current
psychological and social factors affect their symptoms without forcing people to
accept a psychological basis for their disorder
- CBT
o Engaging relaxation training, diverting attention away from the physical
symptoms, and correction of automatic thoughts
Dissociative Disorders
- They generally involve a disruption in the usually integrated functions of consciousness,
memory, identity, emotion, perception, body representation, motor control, and behaviour
- 5 types:
o Depersonalization
▪ Feeling of detachment from one's body; experiencing the self as strange or
unreal
o Derealization
▪ Feeling of unfamiliarity or unreality about one's physical or interpersonal
environment (ex. feeling as if you’re in a dream)
o Amnesia
▪ The inability to remember personal info or significant periods of time
▪ More than simply forgetting a name, where you put your keys, etc
o Identity confusion
▪ Being unclear or conflicted about one's personal identity
o Identity alteration
▪ Overt behaviours indicating that one has assumed an alternate identity
Dissociative Amnesia
- The inability to recall important information, usually of a personal nature
- Causes: head injuries, epilepsy, alcoholic “blackouts,” low blood sugar
- Types:
o Localized – failure to recall events that occur during a certain period of time
o General – total inability to recall any aspect of one’s life
o Selective – person forgets some elements of one’s life
Dissociative Identity Disorder
