10.5 PUTTING IT...together

Expanding the Boundaries of Abnormal Psychology

Once considered outside the field of abnormal psychology, bodily ailments and physical illnesses are now seen as problems that fall squarely within its boundaries. Just as physical factors have long been recognized as playing a role in abnormal mental functioning, psychological conditions are now considered important contributors to abnormal physical functioning. In fact, many of today’s clinicians believe that psychological and sociocultural factors contribute to some degree to the onset and course of virtually all physical ailments.

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The number of studies devoted to this relationship has risen steadily during the past 40 years. What researchers once saw as a vague connection between stress and physical illness is now understood as a complex interaction of many variables. Such factors as life changes, a person’s particular psychological state, social support, biochemical activity, and slowing of the immune system are all recognized as contributors to disorders once considered purely physical.

Insights into the treatment of physical illnesses have been accumulating just as rapidly. Psychological approaches such as relaxation training and cognitive therapy are being applied to more and more physical ills, usually in combination with traditional medical treatments. Small wonder that many practitioners are convinced that such treatment combinations will eventually be the norm in treating the majority of physical ailments.

One of the most exciting aspects of these recent developments is the field’s growing emphasis on the interrelationship of the social environment, the brain, and the rest of the body. Researchers have observed repeatedly that mental disorders are often best understood and treated when sociocultural, psychological, and biological factors are all taken into consideration. They now know that this interaction also helps explain medical problems. We are reminded that the brain is part of the body and that both are part of a social context. For better and for worse, the three are intertwined.

CLINICAL CHOICES

Now that you’ve read about disorders featuring somatic symptoms, try the interactive case study for this chapter. See if you are able to identify Joanne’s symptoms and suggest a diagnosis based on her symptoms. What kind of treatment would be most effective for Joanne? Go to LaunchPad to access Clinical Choices.

BETWEEN THE LINES

Would You Want to Know?

78%

Percentage of U.S. adults who would want to have a test done to diagnose a disease even if there were no treatment or cure available

22%

Percentage of U.S. adults who would not want to know

(Information from: Siemens healthcare, 2013)
The Power of Distraction Researchers at a medical center in New Jersey had this 10-year-old girl and other young patients play with handheld Game Boys while waiting for their anesthesia to take effect before their surgery. Such game-playing was found to be more effective at relaxing the young patients than antianxiety drugs or holding hands with parents. Additional research suggests that patients who are more relaxed often have better surgical outcomes.

SUMMING UP

  • DISORDERS FOCUSING ON SOMATIC SYMPTOMS Several DSM-5 categories focus on somatic symptoms, including factitious disorder, conversion disorder, somatic symptom disorder, illness anxiety disorder, and psychological factors affecting medical condition. In these disorders, the somatic symptoms are primarily caused by psychosocial factors, or the symptoms trigger excessive anxiety or concern. p. 318

  • FACTITIOUS DISORDER People with factitious disorder feign or induce physical disorders, typically for the purpose of assuming the role of a sick person. The disorder is not well understood or treated. In a related pattern, factitious disorder imposed on another, a parent fabricates or induces a physical illness in his or her child. pp. 318–320

  • CONVERSION AND SOMATIC SYMPTOM DISORDERS Conversion disorder involves bodily symptoms that affect voluntary motor and sensory functions, but the symptoms are inconsistent with known medical diseases. Diagnosticians are sometimes able to distinguish conversion disorder from a “true” medical problem by observing oddities in the patient’s medical picture. In somatic symptom disorder, people become excessively distressed, concerned, and anxious about bodily symptoms that they are experiencing, and their lives are greatly and disproportionately disrupted by the symptoms.

    Freud developed the initial psychodynamic view of conversion and somatic symptom disorders, proposing that the disorders represent a conversion of underlying emotional conflicts into physical symptoms. According to behaviorists, the physical symptoms of these disorders bring rewards to the sufferer, and such reinforcement helps maintain the symptoms. Some cognitive theorists propose that the disorders are forms of communication and that people express their emotions through their physical symptoms. Treatments for these disorders include insight, exposure, and drug therapies and may include techniques such as suggestion, reinforcement, or confrontation. pp. 321–329

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  • ILLNESS ANXIETY DISORDER People with illness anxiety disorder are chronically anxious about and preoccupied with the notion that they have or are developing a serious medical illness, despite the absence of substantial somatic symptoms. Theorists explain this disorder much as they do anxiety disorders. Treatment includes drug, behavioral, and cognitive approaches originally developed for obsessive-compulsive disorder. pp. 330

  • PSYCHOPHYSIOLOGICAL DISORDERS Psychophysiological disorders are those in which biological, psychosocial, and sociocultural factors interact to cause or worsen a physical problem. Factors linked to these disorders are biological factors, such as defects in the autonomic nervous system or particular organs; psychological factors, such as particular needs, attitudes, or personality styles; and sociocultural factors, such as aversive social conditions and cultural pressures.

    For years, clinical researchers singled out a limited number of physical illnesses as psychophysiological. These traditional psychophysiological disorders include ulcers, asthma, insomnia, chronic headaches, hypertension, and coronary heart disease. Recently many other psychophysiological disorders have been identified. Indeed, scientists have linked many physical illnesses to stress and have developed a new area of study called psycho-neuroimmunology. pp. 330–339

  • PSYCHONEUROIMMUNOLOGY The body’s immune system consists of lymphocytes and other cells that fight off antigens—bacteria, viruses, and other foreign invaders—and cancer cells. Stress can slow lymphocyte activity, thereby interfering with the immune system’s ability to protect against illness during times of stress. Factors that seem to affect immune functioning include norepinephrine and corticosteroid activity, behavioral changes, personality style, and social support. pp. 339–342

  • PSYCHOLOGICAL TREATMENTS FOR PHYSICAL DISORDERS Behavioral medicine combines psychological and physical interventions to treat or prevent medical problems. Psychological approaches such as relaxation training, biofeedback training, meditation, hypnosis, cognitive techniques, support groups, and therapies that heighten the awareness and expression of emotions and needs are increasingly being included in the treatment of various medical problems. pp. 342–345

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