Abnormal Psychology

SOMATIC SYMPTOM DISORDER

·      Group of conditions that involve physical symptoms combined with abnormal thoughts, feelings and behavior in response to those symptoms.

·      “Soma” means “body”.

·      It involves patterns in which individual complain of bodily symptoms that suggest the presence of medical problems but where there is no obvious medical explanation – DSM V.

·      Clinical problems from blindness to paralyses.

·      Symptoms are not being faked by the patients.

·      The patient believes that something is actually wrong with them.

·      No organic basis is found.

Symptoms

·      Frequent back pains, headaches, abdominal cramping and pelvic pain.

·      Nausea, bloating, vomiting and food intolerance.

·      Gastrointestinal problems, pain in joints, legs and arms.

Causal Factors / Etiology

·      Increase in somatic sensations.

·      Low thresholds and tolerance for physical discomfort.

·      Social Learning Model – Escape from obligations, challenges and other duties because of the “sick role”.

·      Psychodynamic – Repression and Displacement – aggressive hostile wishes towards others are transferred into physical complaints.

·      Sign of excessive self concern

·      Expression of low self esteem

·      Sense of innate badness

·      Defense against guilt

·      Temperamental – Neuroticism – risk factor – comorbid with anxiety or depression

·      Environmental – less educated – low income level – recent stressful life events

Treatment

·      Resist psychiatric treatment

·      Group psychotherapy is good – social support and interaction – reduce anxiety

·      Individual insight oriented psychotherapy

·      Behavior Therapy

·      Cognitive Therapy

·      Hypnosis

MALINGERING AND FACTITIOUS DISORDER

·      Malingering :

o   Person intentionally produces or exaggerates physical symptoms.

o   Motivated by external incentives.

o   Eg : Avoiding assignments

·      Factitious Disorder :

o   Intentionally produce physiological or psychological symptoms.

o   Could be both ^.

o   There are no external incentives.

o   Goal of faking – obtain and maintain the attention or benefits that a sick person generally gets from those around them.

o   Could be family or medical personnel.

CONVERSION DISORDER

·      Also called Functional Neurological Symptom Disorder.

·      Was first grouped under “hysteria”.

·      Historically believed to be caused by sexual difficulties.

·      Freud termed it as conversion hysteria – symptoms caused due to repressed sexual energy (of course).

·      Still called conversion disorder but Freud’s interpretation was rejected ^

·      Unconscious conflict felt about sexual desires – converted – bodily disturbances.

·      Symptoms that affect sensory or voluntary functioning leads patients to think one has medical or neurological condition.

·      Patterns are not explained by medical condition.

·      Primary/Escape Gain :

o   Symptoms usually occur after emotional or interpersonal conflict or stressors.

o   Physical symptoms give patients an excuse and help them to escape a stressful event without having to take responsibility to do so.

o   Neutralizing intra-psychic conflict.

·      Secondary Gain :

o   Advantages that the symptoms give the patient over the primary gain.

o    “External” circumstances like attention from others/ financial gain.

Symptoms

·      Three categories :

o   Sensory – Involves sensory modalities – affected area is inconsistent with sensory pathways – visual, auditory and sensitivity to feelings.

o   Motor – paralysis – single limb mostly – loss of functioning like not able to write, aphonic, difficulty in swallowing, lump in the throat.  

o   Seizures – pseudo seizures – not EEG abnormalities – no loss of memory or confusion later.

Treatment

·      No well controlled study so far

·      Behavioral Approach :

o   Motor conversion symptoms are treated

o   Specific exercises

o   Reinforcements

o   Abnormal behavioral symptoms result in removal of reinforcements