Overly preoccupied with their health or body appearance. But lack any identified medical condition, assumed linked to psychological factors such as anxiety.

A. Hypochondriasis

1) Clinical Description -fears of having a serious illness, misinterpret normal range of physical sensations as symptoms. Physicians are unsuccessful in dissuading. Comorbidity with panic disorder. Checkers, trait anxiety, focus on long-term process of illness, wider range of sxs, consult more

2) Statistics and Course-4-9% of medical patients, no gender diffs, later onset than illness phobia, must rule out physical cause

3) Causes-misinterpretation of somatic sensatons as signes of physical illness, disordered cognitions, perceptions, and emotional factors. Somatic sensitivity may be genetic or learned overreaction to stress, view negative events as uncontrollable and unpredictable, modeling or family disease during childhood, and /or secondary gain for ilness behavior.

4) Treatment - target anxiety and illness preoccupations with cognitive therapy, behavioral appraoches, drug therapy, support groups

B. Somatization Disorder

1) Clinical Description -Before age 30 recurrent multiple somatic complaints for which medical attention is sought but no clear medical basis: headaches, fatigue, allergies, abdominal pain, chest pain. Multiple organ systems, multiple physicians.Unnecessary surgery, addiction to prescription meds, depression, & suicidal attempts commonly seen. Impaired function. Differs from conversion in number of complaints.

2) Statistics and Course-0.7% prevalence rates, undifferentiated somatization = 4.4% of population, adolescent onset, umarried women, low SES, chronic, impaired social and occupational functioning, runs in families, comorbidity with anxiety, mood and substance abuse disorders.

3) Causes-similar to hypochrondriasis -family modeling, linked to antisocial PD, may share a neurobiological based disinhibition syndrome, failure to control behavioral activation syndrome-impulsivity, thrill-seeking, excitability----short-term gratification and sympathy/attention. But show dependency and little aggression--socialization shapes a bio vulnerability?

4) Treatment - reduce stress & dependency, decrease rewarding consequenes (attention, disability)

C. Conversion Disorder

1) Clinical Description - sxs suggest physical malfunction or neurological impairment, but no medical evidence to support this, e.g., paralysis of limbs, seizures, disturbing sensations, insensitivity to pain, blindness, La belle indifference --apathy toward sxs, precipitated by stress, little insight into normal functioning, 25% are later found to have an actual disorder

Distinguish From:

a) Malingering - sxs under voluntary control, acquires an obvious environmental goal

b) Factitious Disorders- "Munchhausen syndrome", multiple hospitalizations and operations, conversion-like symptoms that are under voluntary control through physiological tampering, no obvious desire to gain attention or reward.

 

2) Statistics and Course-1-30% prevalence rate, seen more in women, except in war, onset adolescence, sxs common in rural fundamentalist religious groups

 

3) Causes -Freudian theory- converting repressed psychological conflict into a physical symptom, repression increases axiety, secondary gain, formerly Hysteria. New theory - trauma-->develop sxs purposely but split off motivation from consciousness, maintained by negative reinforcement

 

4) Treatment - address traumatic event, catharsis, & reduce secondary gain

 

D. Pain Disorder - complaint of pain w/out any known organic pathology, associated with stress or conflict - difficulties w/ category associated with the fact that pain is influenced by psychological factors. Thus, pain disorder may be seen in patients with a medical condition or without a clear medical diagnosis.

E. Body Dismorphic Disorder - person obsessed by an imagined or exaggerated physical appearance. Ususally facial features. Ideas of reference, avoidance, disrupts functioning. Prevalence unclear, mild cases may be common. Equal in males and females, onset late adolescents. Consult with plastic surgeons, not psychologists. Influenced by cultural standards. May be a form of displacement, linked to social phobia or OCD. Serotonin reuptake inhibitors diminish sxs. Psychologists may consult with plastic surgeons to screen for persons with BDD.

Symptoms of unreality are most prevalent, alteration in memory or identity/ personality, dissociation = separation of one part of identity from another. All related to exposure to extreme psychosocial stressors (disaster, rape, sexual and physical abuse), onset is sudden.

A. Depersonalization Disorder -experience severe and frightening feelings of unreality and detachedness to the extent that functioning is impaired. Also seen in other disorders, panic and actute stress disorder.

B. Dissociative Amnesia -loss of memory for important stressful events, depersonalization, amnesia can be localized, global, selective, or continuous (rare). Generalized amnesia - can't remember anything, including their identity. More commonly see localized amnesia, or a failure to recall a specific event during a specific period... sometimes see amnesia for their emotional reaction rather than to the events.

C. Dissociative Fugue -person travels to a new location and assumes a new identity, forget their previous identity. Rapid onset and offset, often without recall for events during fugue. Usually begins in adulthood.

D. Dissociative Trance Disorder - sxs resemble other dissociative states, but changes are attributed to possession of a spirit. More common in women, associated with stress/trauma. Only considered abnormal if undesirable and pathological.

E. Dissociative Identity Disorder -

1) Clinical Description: adopt new identities within their body and mind.

2) Statistics & course: more common in females, childhood onset, chronic course, co-morbidity: substance abuse, depression, somatization disorder, borderline PD, panic, and eating disorders. Severe abuse.

F. Causes of DID and other dissociativ disorders - 97% experienced severe child abuse, 2/3 experienced incest. May be more suggestible or hypnotizable, so dissociation becomes their defense against trauma..autohypnotic model. Biological factors may contribute- epilepsy pts =dissociative sxs.

G. Treatment of Dissociative Disorders- Dissociative amnesia or fugue often spontaneously remit. Therapy may focus on coping with traumatic events and uncovering info about experiences during amnesia/fuge states. For DID, reintegration of one's personality is emphasized. Poor prognosis. Modern approaches utilize procedures used in treating. PTSD, e.g., reliving early trauma to increase pts sense of control, put trauma in past, hypnosis to access memories, coping skills, antidepressants.