Chapter 9: Disorders featuring Somatic Symptoms (Abnormal Psych)

Multicultural theorists have criticized Western clinicians' theories of somatic symptom disorder. They have suggested that: A. the failure to explain the cause of the physical symptoms does not invalidate the reality of those symptoms. B. it is normal in other cultures to transform emotional distress into physical symptoms. C. other cultures are more comfortable not being able to explain the cause of all physical illnesses. D. These disorders are not seen in less industrialized parts of the world, suggesting that they reflect the stress inherent in modern society.

B. it is normal in other cultures to transform emotional distress into physical symptoms.

Specialized white blood cells such as T-cells, B-cells, and natural killer T-cells are known as: A. cytokines. B. lymphocytes. C. antigens. D. endorphins.

B. lymphocytes.

The gain people derive when their somatic symptoms elicit kindness from others is known as: A. primary gain. B. secondary gain.

B. secondary gain.

Jan does not report any pain or physical symptoms. However, she is convinced that she has a serious health problem and that she may be dying. Jan has been referred to a therapist who diagnoses Jan with: A. conversion disorder. B. somatic symptom disorder. C. illness anxiety disorder. D. somatization pattern.

C. illness anxiety disorder.

Tia has been to many doctors because of the pain she is experiencing in her joints. Tia is constantly worried and anxious about this pain, and she is convinced that this means her joints are deteriorating. While Tia's doctor has found some signs of arthritis, she believes Tia's pain is exaggerated and suspects: A. conversion disorder. B. hypochondriasis. C. somatic symptom disorder. D. factitious disorder.E. histrionic disorder.

C. somatic symptom disorder.

New Psychopathological Disorders: Antigen: lymphocytes: B-cells

produces antibodies, protein molecules that recognize and bind to antigens, mark them for destruction,and prevent them from causing infection

New Psychopathological Disorders: Antigen: lymphocytes: natural killer cells

seeks out and destroys body cells that have already been infected with viruses , thus helping to stop the spread of viral infections.

Traditional Psychophysiological Disorders:

- Before the 1970s, clinicians believed that only a number of illnesses were psychophysiological. The best known and most common of these disorders were: ulcers, asthma, insomnia, chronic headaches, high blood pressure, and coronary heart disease. - Recent research has shown that many other physical illnesses- including bacterial and viral infections- may also be caused by an interaction of psychosocial and physical factors.

Psychophysiological Disorders: Psychological factors affecting other medical conditions:

- Psychophysiological disorders: disorders in which biological, psychological, and sociocultural factors interact to cause or worsen physical illness. Also known as psychological factors affecting other medical conditions or psychosomatic disorders. - It is important to recognize that significant medical symptoms and conditions are involved in psychophysiological disorders and that the disorders often result in serious physical damage.

Somatic Symptom Disorder: Somatization Pattern: types of symptoms: pain, gastrointestinal, sexual, neuro

- first described by Pierre Briquet in 1859, is also known as Briquet's syndrome. - A sufferer's ailments often include pain symptoms (such as headaches or chest pain), gastrointestinal symptoms (such as nusea or diarrhea), sexual symptoms (such as erectile or menstrual difficulties), and neurological-type symtpoms (such as double vision or paralysis).

People with this disorder go to extremes to create the appearance of illness: what may they use to do this?

-Many people give themselves medication secretly. Some inject drugs to cause bleeding, infections,or other problems. -Others use laxatives to produce chronic diarrhea. High fevers are especially easy to create. -Many people with this disorder often research their supposed ailments and are knowledgeable about medicine. Many eagerly undergo painful testing or treatment or surgery.

Factitious disorder seems to be particularly common among people who

1) received extensive treatment for a medical problem as children, 2) carry a grudge against the medical profession, or 3) have worked as a nurse, laboratory technician, or medical aide. - More common in women than men.

Two patterns of somatic symptom disorder have received particular attention: Somatization Pattern and predominant pain pattern

1) sometimes called a Somatization Pattern, the individual experiences a large and varied number of bodily symptoms, 2) called a predominant pain pattern, the person's primary bodily problem is the experience of pain.

Illness Anxiety Disorder: CBT theorists believe that

1) the illness fears are acquired through classical conditioning or modeling, and 2) people with the disorder are so sensitive to and threatened by bodily cues that they come to misinterpret them.

Factitious Disorder Imposed on Self Checklist:

1. False creation of physical psychological symptoms, or deceptie production of injury or disease, even without external rewards for such ailments. 2. Presentation of oneself as ill, damaged, or hurt.

Somatic Symptom Disorder Checklist:

1. Person experiences at least one upsetting or repeatedly disruptive physical (somatic) symptom. 2. Person experiences an unreasonable number of thoughts, feelings, and behavior regarding the nature f implications of the physical symptoms, including one of the following: a. Repeated, excessive thoughts about their seriousness. b. Continual high anxiety about their nature or health implications. c. Disproportionate amounts of time and energy spent on the symptoms or their health implications. 3. Physical symptoms usually continue to some degree for more than 6 months.

Illness Anxiety Disorder Checklist:

1. Person is preoccupied with thoughts about having or getting a significant illness. In reality, person has no or, at most, mild somatic symptoms. 2. Person has easily triggered high anxiety about health. 3. Person displays unduly high number of health-related behaviors (keeps focusing on the body) or dysfunctional health-avoidance behaviors (avoids doctors) 4. Person's concerns continue to some degree for at least 6 months.

Psychological factors affecting other medical conditions Checklist:

1. The presence of a medical condition 2. Psychological factors negatively affect the medical condition by: a. Affecting the course of the medical condition b. Providing obstacles for the treatment of the medical condition. c. Posing new health risks. d. Triggering or worsening the medical condition.

Somatic Symptom Disorder: Somatization Pattern: Around ____% of all ppl in the US may experience a somatization pattern in any given year, women much more commonly than men. This pattern often runs in families; as many as _____% of the close female relatives of women with the pattern also develop it. It usually begins between adolescence and late adulthood.

4% and 20%

What factors contribute to psychophysiological disorders? Sociocultural factors and Multicultural Perspective: _______% of African Americans have high blood pressure compared with ____% of non-hispanic white americans → it may be the case that african americans have a physiological predisposition that increases their chance of developing high blood pressure. → or it may be that repeated experiences of racial discrimination constitute special stressors that raise blood pressure in african americans.

43% / 29%

Which of these is NOT a psychophysiological disorder? A. depression B. ulcers C. asthma D. insomnia E. hypertension F. These are all psychophysiological disorders

A. depression

Don is very competitive, ambitious, cynical, and hostile. He always has to win. According to Friedman and Rosenman, Don's behavior reflects the _______ personality style. A. Type A B. Type B C. Type C D. Type D E. phony Type B

A. Type A

Susan has lost the ability to see. Extensive testing has been unable to find anything wrong neurologically or with Susan's eyes. Her doctor is starting to suspect that Susan might have: A. conversion disorder. B. hypochondriasis. C. somatic symptom disorder. D. factitious disorder. E. histrionic disorder.

A. conversion disorder.

A number of factors may influence whether stress will result in a slowdown of the system: Personality Styles:

According to research, people who generally respond to life stress with optimism, constructive coping, and resilience experience better immune system functioning and are better prepared to fight off illnesses. Researchers have discovered that indivs. With a general sense of hopelessness, they die at above average rates from heart disease and critical illnesses.

What causes conversion and somatic symptom disorder? The Cognitive-Behavioral View: Communication:

CBT propose that conversion and somatic symptom disorders are forms of self-expression, providing a means for people to reveal emotions that would otherwise be difficult for them to convey. - like their psychodynamic colleagues, these theorists hold that the emotions of people with the disorders are being converted into physical symptoms. They suggest, however, that the purpose of the conversion is not to defend against anxiety but to communicate extreme feelings-anger, fear, depression, guilt, jealousy- in a "physical language" that is familiar and comfortable with the person with the disorder

What causes conversion and somatic symptom disorder? The Cognitive-Behavioral View: Rewards

CBT propose that the physical symptoms of these disorders yield important benefits to sufferers. → perhaps the symptoms remove the individuals from an unpleasant relationship or perhaps the symptoms remove the individuals from an unpleasant relationship or perhaps the symptoms bring attention from other people. → in response to such rewards, the sufferers learn to display the bodily symptoms more prominently.

What causes conversion and somatic symptom disorder? The Cognitive-Behavioral View:

Cognitive-Behavioral theorists point to somatic vigilance, rewards, and communication skills to help explain conversion and somatic symptoms disorders.

Also known as Munchausen syndrome, this disorder involves intentionally faking an illness. A. conversion disorder B. hypochondriasis C. somatic symptom disorder D. factitious disorder E. fictitious disorder

D. factitious disorder

The idea that conversion and somatic symptom disorders might be the result of an excessive awareness of bodily sensations and discomfort is known as: A. anxiety sensitivity. B. somatization. C. secondary gain. D. somatic vigilance. E. physiological sensitivity.

D. somatic vigilance.

Which of these is NOT an example of behavioral medicine? A. relaxation training B. biofeedback C. hypnosis D. taking an antidepressant

D. taking an antidepressant

What factors contribute to psychophysiological disorders? Sociocultural factors and Multicultural Perspective: "hispanic health paradox"

Despite disadvantages Hispanic americans may face, the health of hispanic americans is, on average, at least as good, or better, than both non-hispanic white americans and african americans. → this is known as the "hispanic health paradox" → it may be that the strong emphasis on social relationships, family support, and religiousness that often characterize hispanic american cultures increases health resilience among their members. → or hispanic americans may have a physiological predisposition that improves their likelihood of having better health outcomes.

The symptoms of a conversion disorder: The physical effects

For example: When paralysis from the waist down, or paraplegia, is caused by damage to the spinal cord, a person's leg muscles may atrophy, or waste away, unless physical therapy is applied. → The muscles of people whose paralysis is the result of a conversion disorder; in contrast, do not usually atrophy. Perhaps those with a conversion disorder exercise their muscles without being aware that they are doing so. →Similarly, people with conversion blindness have fewer accidents than people who are organically blind, an indication that they have at least some vision even if they are unaware of it.

What causes conversion and somatic symptom disorder? The Psychodynamic View:

Freud's theory of psychoanalysis began with his efforts to explain hysterical symptoms. - After studying hypnosis in Paris, Freud became interested in the work of an older physician, Josef Breuer. Breuer has successfully used hypnosis to treat a woman he called Anna O, who suffered from hysterical deafness, disorganized speech, and paralysis. → Frued came to believe that hysterical disorders represented a conversion of underlying emotional conflicts into physical symptoms and concerns.

Various factors influence how effectively a person's immune system operates:

Insufficient sleep and poor diet slows down the system. So too does old age. Researchers have also come to appreciate that stress can interfere significantly with the activity of lymphocytes and other parts of the immune system, slowing those cells down and thus increasing a person's susceptibility to viral and bacterial infections.

New Psychopathological Disorders: Are physical illnesses related to stress? the Social Readjustment Rating Scale: comparing what is low on the scale and what is high on the scale, and calculating the final score

Lower on the scale is retirement (45 LCU) and still lower is a minor violation of the law (11 LCUs). This scale gave researchers a yardstick for measuring the total amount of stress a person faces over a period of time. - For example, if in the course of a year a woman started a new business (39 LCUs), sent her son off to college (29 LCU), moved to a new house (20 LCU), and had a close friend die (37 LCU), her stress score for the year would be 125 LCU which is a considerable amount of stress of a year. One shortcoming of this scale: it does not take into account the particular life stress reactions of specific populations.

Psychological Treatments for Physical Disorders: other treatments

Meditation Hypnosis Cognitive-Behavioral Interventions Support Groups and Emotional Expression Combination Approaches:

Factitious disorder is known popularly as what and why?

Munchausen Syndrome, a label derived from the exploits of Baron von Munchhausen, an 18th century cavalry officer who journeyed from tavern to tavern in Europe telling fantastical tales about his supposed military adventures.

In a related pattern, factitious disorder imposed on another, known as

Munchausen syndrome by proxy, parents, or caretakers make up or produce physical illness in their children, leading in some cases to repeated painful diagnostic tests, medication, and surgery.

What causes conversion and somatic symptom disorder? The Psychodynamic View: Phallic stage

Observing that most of his patients with hysterical disorders were women: Frued centered his explanation of such disorders on the needs of girls during their Phallic stage (ages 3-5).

A number of factors may influence whether stress will result in a slowdown of the system: Social Support:

People who have little social support and feel lonely tend to have poorer immune functioning in the face of stress than people who do not feel lonely. Other studies have found that social support and affiliation may actually help protect people from stress, poor immune system functioning, and subsequent illness, or help speed up recovery from illness or surgery,

How are conversion and somatic symptom disorders treated?

People with conversion and somatic symptom disorders usually seek psychotherapy only as a last resort. They believe that their problems are completely medical and at first reject all suggestions to the contrary. - When a physician tells them that their symptoms or concerns have a psychological dimension, they often go to another physician. - Eventually many patients with these disorders do consent to psychotherapy, psychotropic drug therapy, or both.

What causes conversion and somatic symptom disorder? The Multicultural View:

Studies found high rates of stress-caused bodily symptoms in non-Western medical settings throughout the world, including those in China, Japan, and Arab countries. - The lesson to be learned from such multicultural findings is not that somatic reactions to stress are superior to psychological ones or vice versa, but rather, that both bodily and psychological reactions to life events are often influenced by one's culture.

People with Illness Anxiety Disorder usually receive the kinds of treatments that are used to treat OCD.

Studies reveal that clients with the disorder often improve considerably when given the same antidepressant drugs that are helpful in cases of OCD.

What causes conversion and somatic symptom disorder? The Cognitive-Behavioral View: this focus on the role of rewards is similar to the psychodynamic notion of secondary gain.

The key difference is that psychodynamic theorists view the gains as indeed secondary- that is, as gains that come only after underlying conflicts produce the disorders. But CBT see this as the primary cause of the development of the disorders. → in many cases, the pain and upset that surround the disorders seem to outweigh any rewards the symptoms might bring.

Conversion Disorder and Somatic Symptom Disorder:

When a bodily ailment has an excessive and disproportionate impact on the person, has no apparent medical cause, or is inconsistent with known medical diseases, physicians may suspect a conversion disorder or somatic symptom disorder.

Factitious Disorder:

a disorder in which a person feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person. -A person may intentionally produce or feign physical symptoms from a wish to be a patient; that is, motivation for assuming the sick role may be the role itself.

Conversion Disorder

a disorder in which bodily symptoms affect voluntary motor and sensory functions, but the symptoms are inconsistent with known medical diseases. Also known as functional neurological symptom disorder. - Individuals with this disorder may have neurological-like symptoms- for example, paralysis, blindness, or loss of feeling- that have no neurological basis.

Illness Anxiety Disorder:

a disorder in which people are chronically anxious about and preoccupied with the notion that they have or are developing a serious medical illness, despite the absence of somatic symptoms.

Somatic Symptom Disorder:

a disorder in which people become excessively distressed, concerned, and anxious about bodily symptoms they are experiencing, and their lives are disproportionately disrupted by symptoms. - The symptoms last longer but are less dramatic than those found in conversion disorder. - In some cases, the somatic symptoms have no known cause; in others, the cause can be identified.

Psychological Treatments for Physical Disorders: Behavioral Medicine:

a field that combines psychological and physical interventions to treat and prevent medical problems.

New Psychopathological Disorders: Antigen

a foreign invader of the body, such as a bacterium or virus (fungi, parasites, and cancer cells). - Among the most important cells in this system are billions of lymphocytes: white blood cells that circulate through the lymph system and bloodstream, helping the body identify and destroy antigens and cancer cells.

Traditional Psychophysiological Disorders: Ulcers

a lesion that forms in the wall of the stomach or of the duodenum, resulting in burning sensations, or pain in the stomach, occasional vomiting, and stomach bleeding. → more than 25 million people in the US have ulcers at some point during their lives, and ulcers cause an estimated 6,500 deaths each year. →ulcers often are caused by an interaction of stress factors, such as environmental pressure or intense feelings of anger or anxiety, and physiological factors , such as the bacteria H. pylori

Depression

a low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms.

Psychological Treatments for Physical Disorders: Biofeedback and Electromyograph (EMG):

a technique in which a client is given information about physiological reactions as they occur and learn to control the reactions voluntarily. Electromyograph (EMG): a device that provides feedback about the level of muscular tension in the body

Psychological Treatments for Physical Disorders: Relaxation Training:

a treatment procedure that teaches clients to relax at will so they can calm themselves in stressful situations.

What factors contribute to psychophysiological disorders? Psychological Factors:

according to many theorists, certain needs, attitudes, emotions, or coping styles amy cause people to overreact repeatedly to stressors, and so increase their chances of developing psychophysiological disorders. - Researchers found that men with a repressive coping style tend to have a particularly sharp rise in blood pressure and heart rate when they are stressed.

What factors contribute to psychophysiological disorders? Sociocultural factors and Multicultural Perspective:

adverse social conditions may set the stage for PPD. Such conditions produce ongoing stressors that trigger and interact with the biological and personality factors. -poor people typically experience higher rates of crime, job dissatisfaction, unemployment, overcrowding, and other negative stressors than wealthier people. In addition, they typically receive inferior medical care. - African Americans have higher rates of hypertension, diabetes, and asthma. They are also more likely to die of heart disease, stroke, HIV/AIDS, and COVID-19. - Economic factors may help account for this racial difference. (but could be due to other factors)

What factors contribute to psychophysiological disorders? Psychological Factors: Another personality style that may contribute to PPD is the Type A personality style:

an idea introduced more than a half-century ago by two cardiologists, Meyer Friedman and Ray Rosenman. → People with this style are said to be consistently angry, cynical, driven, impatient, competitive, and ambitious. → They interact with the world in a way that produces continual stress and often leads to coronary heart disease.

This pattern is called "conversion" because clinical theorists used to believe that individuals with the disorder

are converting psychological needs or conflicts into their neurological-like symptoms.

Traditional Psychophysiological Disorders: Migraine Headaches:

are extremely severe, often paralyzing, headaches that are located on one side of the head and are sometimes accompanied by dizziness, nausea, or vomiting. → Migraine headaches are thought by some medical theorists to develop in two phases: 1) blood vessels in the brain narrow so that the flow of the blood to parts of the brain is reduced, and 2) the same blood vessels later expand so that blood flows through them rapidly, stimulating many neuron endings and causing pain. → 30 million people in the US suffer from migraines each year.

Traditional Psychophysiological Disorders: headaches

are frequent intense aches of the head or neck that are not caused by another physical disorder. → There are 2 main types: Muscle contraction, or tension, headaches are marked by pain at the back or front of the head or the back of the neck. → these occur when the muscles surrounding the skull tighten, narrowing the blood vessels, → Over 45 million Americans suffer from headaches repeatedly. -> Researchers suggest that chronic headaches are caused by an interaction of stress factors, such as environmental pressures, or general feelings of helplessness, anger, anxiety, or depression, and physiological factors such as abnormal activity of the neurotransmitter serotonin, vascular problems, or muscle weakness.

How are conversion and somatic symptom disorders treated? Biological therapists: those who take the reinforcement route:

arrange for the removal of rewards for a client's "sickness" symptoms and an increase of rewards for healthy behaviors.

What causes conversion and somatic symptom disorder? The Psychodynamic View: Electra complex

at that time he believed all girls develop a pattern of desires called the Electra complex: each girl experiences sexual feelings for her father and at the same time recognizes that she must compete with her mother for his affection. → however, aware of her mother's more powerful position and cultural taboos, the child typically represses her sexual feelings and rejects these early desires for her father.

What causes conversion and somatic symptom disorder? The Psychodynamic View: Freud believes that if a child's parents overreact to her sexual feelings -with strong punishment for example- the Electra conflict will

be unresolved and the child may reexperience sexual anxiety throughout her life. →whenever events trigger sexual feelings, she mat feel an unconscious need to hide them from both herself and others. → Freud concluded that some women hide their sexual feelings by unconsciously converting them into physical symptoms and concerns.

What factors contribute to psychophysiological disorders? Psychological Factors: People with a Type B personality style

by contrast, are thought to be more relaxed, less aggressive, and less concerned about time and thus are less likely to develop cardiovascular deterioration.

How are conversion and somatic symptom disorders treated? Biological therapists: Those who employ education:

explain the disorder to patients, while also offering emotional support and hope that the physical symptoms may soon disappear.

Traditional Psychophysiological Disorders: Asthma

causes the body's airways (the trachea and bronchi) to narrow periodically, making it hard for air to pass to and from the lungs. The resulting symptoms are shortness of breath, wheezing, coughing and a terrifying choking sensation. → almost 25 million people in the US currently suffer from asthma and most were children or young teenagers at the time of the first attack. → 70% of all cases appear to be caused by an interaction of stress factors, such as environmental pressures and anxiety, and physiological factors, such as allergies to specific substances, a slow acting sympathetic nervous system, or a weakened respiratory system.

The precise causes of factitious disorder are not understood, although clinical reports have pointed to factors such as

depression, unsupportive parental relationships during childhood, and extreme needs for attention and/or social support that are not otherwise available.

Traditional Psychophysiological Disorders: Insomnia

difficulty falling asleep or maintaining sleep, plagues one-third of the population each year. 10% of the population have insomnia that lasts months or years → Chronic insomniacs feel as though they are almost constantly awake. They often feel very sleepy during the day and may have difficulty functioning. Their problem may be caused by a combination of psychosocial factors such as: high levels of anxiety and depression, and physiological problems such as: an overactive system or certain medical ailments

Unlike people with factitious disorder, people with conversion disorder

do not consciously want to purposely produce their symptoms.

Traditional Psychophysiological Disorders: Hypertension:: around 10% of all cases are caused by physiological abnormalities alone; the rest result from a combination of psychological and physiological factors and are called

essential hypertension.

How are conversion and somatic symptom disorders treated? Biological therapists: Cognitive restructuring:

guide clients to think differently about the nature and causes of physical symptoms and illness.

A number of factors may influence whether stress will result in a slowdown of the system: Biochemical Activity: another action of norepinephrine and other stress hormones is to trigger an increase in the production of cytokines, proteins that bind to receptors throughout the body. → At moderate levels of stress, the cytokines....

help combat infections. But as stress continues and more norepinephrine and stress hormones are released the growing production and spread of cytokines, particularly so called proinflammatory cytokines, lead to chronic inflammation throughout the body, contributing to at times heart disease, stroke and other illnesses.

Illness Anxiety Disorder: Previously known as what and what is it

hypochondriasis -They repeatedly check their body for signs of illness and misinterpret various bodily events as signs of serious medical problems. Typically the events are merely normal bodily changes, such as coughing, sores, or sweating.

For years, conversion and somatic symptom disorders were referred to as

hysterical disorders - this label was meant to convey the prevailing belief that excessive and uncontrolled emotions underlie the bodily symptoms found in these disorders.

New Psychopathological Disorders: Antigen: lymphocytes: T-cells:

identifies antigens and then multiples and triggers the production of other kinds of immune cells.

Many clients also improve when treated with the CBT approach of exposure and response prevention. The therapists repeatedly point out bodily variations to the clients while, at the same time, preventing them from seeking their usual medical attention. → In addition, the CBT therapists guide the clients to

identify, challenge, and change their beliefs about illness that are helping to maintain their disorder.

A number of factors may influence whether stress will result in a slowdown of the system: Biochemical Activity: as in the case of norepinephrine,

if stress continues for too long, the stress hormones travel to receptor sites located on certain lymphocytes and give an inhibitory message again, causing a slow down of the activity of lymphocytes.

Somatic Symptom Disorder: Predominant Pain Pattern:

if the primary feature of somatic symptom disorder is pain, then the person is said to have a predominant pain pattern. - The concerns and disruptions produced by the pain are disproportionate to its severity and seriousness. - This pattern appears to be fairly common. - It may begin at any age, and women seem to be more likely than men to have it. - Often it develops after an accident or during an illness that has caused genuine pain.

Psychodynamic theorists propose that two mechanisms are at work in these disorders- Secondary gain:

in psychodynamic theory, the gain people derive when their somatic symptoms elicit kindness from others or provide an excuse to avoid unpleasant activities. → when, for example, a conversion paralysis allows a soldier to avoid combat duty or conversion blindness prevents the breakup of a relationship, secondary gain may be at work.

Psychodynamic theorists propose that two mechanisms are at work in these disorders- Primary gain:

in psychodynamic theory, the gain people derive when their somatic symptoms keep their internal conflicts out of awareness. → during an argument, for example, a man who has underlying fears about expressing anger may develop a conversion paralysis of the arm, thus preventing his feelings of rage from reaching consciousness.

Traditional Psychophysiological Disorders: Hypertension:

is a state of chronic high blood pressure. That is, the blood pumped through the body's arteries by the heart produces too much pressure against the artery walls. → Hypertension has few outward signs, but it interferes with the proper functioning of the entire cardiovascular system, greatly increasing the likelihood of stroke, heart disease, and kidney problems. → It is estimated that 77 million people in the US have hypertension, thousands die directly from it annually, and millions more perish because of illness caused by it.

Traditional Psychophysiological Disorders: Coronary Heart Disease:

is caused by a blocking of the coronary arteries, the blood vessels that surround the heart and are responsible for carrying oxygen to the heart muscle. The term actually refers to several problems, including blockage of the coronary arteries and myocardial infarction (a "heart attack").

conversion disorder usually begins between ..... and is thought to be rare, occuring......

late childhood and young adulthood; it is diagnosed at least twice as often in women as in men. → it is thought to be a rare problem, occurring in 1 to 5 of every 500 persons.

How are conversion and somatic symptom disorders treated? Biological therapists:

most often use antidepressant drugs to help reduce anxiety and depression in patients with these disorders. - Other therapies try to address the physical symptoms of these disorders rather than causes, using techniques such as education, reinforcement, and cognitive restructuring.

The symptoms of a conversion disorder: glove anesthesia

numbness begins sharply at the wrist and extends evenly right to the fingertips. Real neurological damage is rarely as abrupt or evenly spread out.

What factors contribute to psychophysiological disorders? Biological Factors:

one way the brain activates body organs is through the operation of the autonomic nervous system and the network of nerve fibers that connect the central nervous system to the body's organs. - Defects in this system are believed to contribute to the development of psychophysiological disorders - If one's ANS is stimulated too easily, it may overreact to situations that most people find only mildly stressful, eventually damaging certain organs and causing a psychophysiological disorder. - A person with a weak gastrointestinal system may be a prime candidate for an ulcer; whereas someone with a weak respiratory system may develop asthma readily. - People may display favored biological reactions that raise their chances of developing a PPD- some individuals perspire in response to stress, others develop stomachaches, and still others have a rise in blood pressure. - Researchers indicate that some people are particularly likely to have temporary rises in blood pressure when stressed. It may be that they are prone to develop hypertension.

What causes conversion and somatic symptom disorder? The Psychodynamic View: Psychodynamic theorists propose that two mechanisms are at work in these disorders-

primary and secondary gain.

What causes conversion and somatic symptom disorder? The Cognitive-Behavioral View: Communication: According to this view, people who find it particularly hard to recognize or express their emotions are candidates for conversion and somatic symptom disorders...... as well as

so are those who "know" the language of physical symptoms firsthand through experience with a genuine physical ailment. → Because children are less able to express their emotions verbally, they are particularly likely to develop physical symptoms as a form of communication.

Traditional Psychophysiological Disorders: essential hypertension

some of the leading psychosocial causes of essential hypertension are constant stress, environmental danger, and general feelings of anger or depression. → Physiological factors include: obesity, smoking, poor kidney function, and an unusually high proportion of the gluey protein collagen in a person's blood vessels.

A number of factors may influence whether stress will result in a slowdown of the system: Behavioral changes:

some people under stress may become more anxious and depressed, perhaps even develop an anxiety or depression disorder. As a result, they may sleep poorly, eat badly, exercise less, or smoke or drink more. (behaviors known to slow down the immune system)

How are conversion and somatic symptom disorders treated? Biological therapists: It is also the case that antidepressant medications

sometimes help alleviate the physical symptoms of people with these disorders in addition to reduce their feelings of anxiety and depression.

What causes conversion and somatic symptom disorder? The Cognitive-Behavioral View: Somatic Vigilance:

suggest that some people are more attentive than others to their bodies, and this attentiveness causes them to focus more on their bodily discomforts, experience more arousal in response to them, and worry about them more. → This notion is similar to that of anxiety sensitivity, the personal inclination to focus on bodily sensations that is linked to panic disorder. → Researchers have found that people with higher levels of somatic vigilance experience pain and pain-related anxiety more often than people with lower levels.

New Psychopathological Disorders: Immune system:

the body's network of activities and cells that identify and destroy antigens and cancer cells.

Traditional Psychophysiological Disorders: Coronary Heart Disease: psychosocial factors and physiological factors

the majority of cases of this disease are related to an interaction of psychosocial factors, such as job stress or high levels of anger or depression, and physiological factors such as high cholesterol, obesity, hypertension, smoking, or lack of exercise.

New Psychopathological Disorders: Psychoneuroimmunology:

the study of the connections between stress, the body's immune system, and illness.

A number of factors may influence whether stress will result in a slowdown of the system: Biochemical Activity:

the sympathetic nervous system which triggers the release of the neurotransmitter norepinephrine, it turns out in addition to its role in producing arousal, an extended release of norepinephrine can influence the immune system adversely. - Research indicates that if stress continues for too long a period, norepinephrine eventually travels to receptors on certain lymphocytes and gives them an inhibitory message to stop their activity, thus slowing down immune functioning.

How are conversion and somatic symptom disorders treated? Psychodynamic therapists

try to help those with somatic symptoms become conscious of and resolve their underlying fears, thus eliminating the need to convert anxiety into physical symptoms.

How are conversion and somatic symptom disorders treated? CBT

use exposure treatments: they expose clients to features of the horrific events that first triggered their physical symptoms, expecting that the clients will become less anxious over the course of repeated exposures and more able to face those upsetting events directly rather than through physical channels.

New Psychopathological Disorders: Are physical illnesses related to stress? In 1987, two researchers, Thomas Holmes and Richard Rahe, developed the Social Readjustment Rating Scale,

which assigns numerical values to the stresses that most people experience at some times in their lives. - Answers given by a large sample of participants indicated that the most stressful event on the scale is the death of a spouse, which receives a score of 100 life change units (LCU).

A number of factors may influence whether stress will result in a slowdown of the system: Biochemical Activity: THe hypothalamic-pituitary-adrenal (HPA) axis

which triggers the release of cortisol and other stress hormones. In addition to producing bodily arousal, an extended release of cortisol and other stress hormones can contribute to poorer immune system functioning.