Somatoform disorders

Somatization and Conversion

Pain and Hypochondriasis

Body Dysmorphic Disorder

Somatoform symptoms

Symptoms suggest a physical disorder Symptoms cannot adequately be

explained physiologically Symptoms are often (but not always)

described in dramatic ways Other disorders, such as anxiety

disorders, mood disorders, and personality disorders, often co-exist

Somatization Disorder (Briquet’s syndrome) Many physical complaints Beginning before age 30 Must include

– Four different pains– Two gastrointestinal symptoms– One sexual symptom– One pseudoneurological symptom

Symptoms are unfounded or exaggerated

Conversion Disorder

Physical symptoms suggesting neurological problems– Sensory impairment: Any modality– Paresthesias and paralysis (demonstrate)

Sudden onset, sudden termination, sudden reappearance

Mostly women; men in combat Often misdiagnosed: Overpathologized La belle indifference: 1/3 of cases

Pain Disorder

Main symptom is pain May be exacerbated by psychosocial

factors May be maintained by gain: Eugene

– Primary gain– Secondary gain

Hypochondriasis

No physical symptoms are necessary Preoccupied with the possibility that

normal sensations are symptoms of serious disease

Frequent visits to physicians Persists despite medical reassurance Over-report bodily sensations

Body Dysmorphic Disorder

Excessive concern with real or imagined defects in appearance, especially facial marks or features.

Frequent visits to plastic surgeons Culturally-influenced, but not culture-

bound May be a symptom of more pervasive

disorders: Obsessive-compulsive or delusional disorder, for example.

Do advertisements affect BDD?

“Your nose is central to the way you feel about your appearance and the way other people first perceive you.“If you are in the slightest way unhappy about it, and feel it detracts from your looks, you will probably always be unhappy about it.”

Can you see the difference?

“Once upon a time there was a young lady who had a small problem. She didn’t like her nose…”

What might be the influence of shows like The Swan (Fox), Extreme Makeover (ABC), I Want a Famous Face (MTV), or Dr. 90210 (E!)?

Are pretty and handsome synonymous with attractive?

More somatoform-like disorders

Malingering Factitious disorder

– Personal: Symptoms only when observed– By proxy (NOS)

Undifferentiated Somatoform Disorder Somatoform Disorder NOS

– Pseudocyesis (no everted umbilicus)– Hypochondriacal symptoms < 6 months

Etiology of somatoform disorders

Psychoanalytic theory– Controlling repressed sexual urges

• Displaced anxiety or secondary gain

– Sackeim: Deny knowledge but use information Behavior theory

– Malingering– Social learning and reinforcement– Secondary gain: Celia

More etiology

Biological factors– One sign (objective indicator) of anxiety is an

increased level of cortisol, a stress hormone. Cortisol levels are elevated in patients with somatization disorder.

– But there is no concordance in twin studies for any somatoform disorder.

– The right hemisphere may be implicated in conversion disorder, symptoms of which are more likely in the left half of the body. The right hemisphere is involved in emotional experience and expression.

Theodor & Mandelcorn’ vision test (1973): Tunnel vision

Grosz & Zimmerman (1970): Celia “I can’t see to read!”