Ch6som

Somatoform Features and Epidemiology

Somatoform Disorders: Causes and Prevention

Somatoform Disorders: Assessment and Treatment

Dissociative Disorders: Features and Epidemiology

Dissociative Disorders: Causes and Prevention

Dissociative Disorders: Assessment and Treatment

Part 1: Somatoform Disorders


SomatoformDisorders:Causes and Prevention





Emotions

Cognitions

Behaviors

Normal

Optimism regarding health.

No concerns about health.

Attending regular, preventive checkups with a physician.

Mild physical arousal and feeling of uncertainty about certain physical symptoms.

Some worry about health, perhaps after reading a certain magazine article.

Checking physical body a bit more or scheduling one unnecessary physician visit.







Emotions

Cognitions

Behaviors

NormalMild







Emotions

Cognitions

Behaviors

NormalMildModerate

Moderate physical arousal and greateruncertainty about one’s health.

Strong worry about aches, pains, possibledisease, or appearance. Fleeting thoughts about death or dying.

Scheduling more doctor visits but generally feeling relieved after each one.

Intense physical arousal misinterpreted as a signor symptom of some terrible physical disorder.

Intense worry about physical state or appearance. Intense fear that one has a serious disease. Common thoughts about death or dying.

Regular doctor-shopping and requests for extensive and repetitive medical tests with little or no relief. Checking body constantly for symptoms.







Emotions

Cognitions

Behaviors

NormalMildModerateSomatoform Disorder – Less Severe

Extreme physical arousal with great trouble concentrating on anything other than physical state or appearance.

Extreme worry about physical state or appearance.Extreme fear of having a serious potential disease. Frequent thoughts about death and dying.

Avoidance of many social and work activities.Scheduling regular surgeries, attending specializedclinics, or searching for exotic diseases.







Emotions

Cognitions

Behaviors

NormalMildModerateSomatoform Disorder – Less SevereSomatoform Disorder – More Severe







Somatization disorder Pattern of recurring, multiple, clinically significant somatic complaints.

Disorder Essential Features







Conversion disorder Presence of symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.








Pain disorder Pain is the predominant focus of clinical presentation and is of sufficient severity to warrant clinical attention.








Hypochondriasis Preoccupation with fears of having, or the idea that one has, a serious disease based on a misinterpretation of one or more bodily signs or symptoms.








Body dysmorphic disorder

Preoccupation with a defect in appearance.








Prevalence Rates of Major Somatoform Disorders

0.4%Somatization disorder

0.3%Conversion disorder

0.6%Pain disorder

4.8%Hypochondriasis

0.7%Body dysmorphic disorder







Amygdala

Hypothalamus

Prefrontal cortex Cingulate cortex

Somatosensory cortex







Illness behavior and reinforcement

Cognitive factors

Cultural factors







Misperception of symptoms

Feelings of uncontrollability

Over attention to minor bodily changes







Discuss various topics, not just symptoms.

Schedule regular visits not predicated on complaints.

Develop goals in conjunction with the client.

Discuss how symptoms limit a client’s functioning instead of what might be physically wrong.

Maintain empathy with a client but set limits on behavior.

Acknowledge that the symptoms are real and distressing to the client.

Accept the need to address somatic complaints.

Avoid attempts to convince the client of a psychological cause for symptoms.

Continue to gently refer to the role of tension and stress.







Antidepressant Medication







I am quick to sense the hunger contractions in my stomach.

Even something minor, like an insect bite or a splinter, really bothers me.

I have a low tolerance for pain.

I am often aware of various things happening within my body.

When I bruise myself, it stays noticeable for a long time.

I can sometimes feel the blood flowing in my body.

I can sometimes hear my pulse or my heartbeat throbbing in my ear.

Somatosensory Amplification Scale







Severe cognitive distortions

Trauma

Female gender

Low socioeconomic status

Substance use

Eating disorders and depression

Predictors of chronic somatoform disorders

Ch6som

Education

preventionsomatoform

treatmentsomatoform

physical state

physical body

certain physical symptoms

terrible physical disorder

severeextreme physical

severeintense physical