Which is the primary gain associated with developing physical symptoms in response to stress?

3rd edition as of August 2022

Module Overview

In Module 8, we will discuss matters related to somatic symptom disorders to include the clinical presentation, epidemiology, comorbidity, etiology, and treatment options for somatic symptom disorder, illness anxiety disorder, functional neurological symptom (conversion) disorder , and factitious disorder.  We also will discuss psychological factors affecting other medication conditions in relation to their clinical presentation, diagnostic criteria, common types of psychophysiological disorders, and treatment. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of therapies (Module 3).

Module Outline

• 8.1. Clinical Presentation
• 8.2. Epidemiology
• 8.3. Comorbidity
• 8.4. Etiology
• 8.5. Treatment
• 8.6. Psychological Factors Affecting Other Medical Conditions

Module Learning Outcomes

• Describe how somatic symptom disorders present.
• Describe the epidemiology of somatic symptom disorders.
• Describe comorbidity in relation to somatic symptom disorders.
• Describe the etiology of somatic symptom disorders.
• Describe treatment options for somatic symptom disorders.
• Describe psychological factors affecting other medical conditions in terms of their clinical presentation, diagnostic criteria, common types of psychophysiological disorders, and treatment.

8.1. Clinical Presentation

Section Learning Objectives

• Describe somatic symptom and related disorders.
• Describe how somatic symptom disorder presents.
• Describe how illness anxiety disorder presents.
• Describe how functional neurological symptom (conversion) disorder presents.
• Describe how factitious disorder presents.

Psychological disorders that feature somatic symptoms are often challenging to diagnose due to the internalizing nature of the disorder, meaning there is no real way for a clinician to measure the somatic symptom. Furthermore, the somatic symptoms could take on many forms. For example, the individual may be faking the physical symptoms, imagining the symptoms, exaggerating the symptoms, or they could be real and triggered by external factors such as stress or other psychological disorders. The symptoms also may be part of a real medical illness or disorder, and therefore, the symptoms should be treated medicinally.

All the disorders within this chapter share a common feature: there is a presence of somatic symptoms and/or illness anxiety associated with significant distress or impairment. Oftentimes, individuals with a somatic disorder will present to their primary care physician with their physical complaints. Occasionally, they will be referred to clinical psychologists after an extensive medical evaluation concludes that a medical diagnosis cannot explain their current symptoms. As you will see, despite their similarities, there are key features that distinguish the disorders in this class from one another.

8.1.1. Somatic Symptom Disorder

Individuals with somatic symptom disorder often present with multiple somatic symptoms at one time. These symptoms are significant enough to impact their daily functioning, such as preventing them from attending school, work, or family obligations. The symptoms can be localized (i.e., in one spot) or diffused (i.e., entire body), and can be specific or nonspecific (e.g., fatigue). Individuals with somatic symptom disorder often report excessive thoughts, feelings, or behaviors surrounding their somatic symptoms (APA, 2022). For example, individuals with somatic symptom disorder may spend an excessive amount of time or energy evaluating their symptoms, as well as the potential seriousness of their symptoms. A lack of medical explanation is not needed for a diagnosis of somatic symptom disorder, as it is assumed that the individual’s suffering is authentic. Somatic symptom disorder is often diagnosed when another medical condition is present, as these two diagnoses are not mutually exclusive.

Somatic symptom disorder patients generally present with significant worry about their illness. Their interpretation of symptoms is often viewed as threatening, harmful, or troublesome (APA, 2022). Because of their negative appraisals, they fear that their medical status is more serious than it typically is, and high levels of distress are often reported. Oftentimes these patients will “shop” at different physician offices to confirm the seriousness of their symptoms.

8.1.2. Illness Anxiety Disorder

Illness anxiety disorder, previously known as hypochondriasis, involves an excessive preoccupation with having or acquiring a serious medical illness. The key distinction between illness anxiety disorder and somatic symptom disorder is that an individual with illness anxiety disorder does not typically present with any somatic symptoms. Occasionally an individual will present with a somatic symptom; however, the intensity of the symptom is mild and does not drive the anxiety. Acquiring a serious illness drives concerns and they will even avoid visiting a sick relative or friend for fear of jeopardizing their own health.

Individuals with illness anxiety disorder generally are cleared medically; however, some individuals are diagnosed with a medical illness. In this case, their anxiety surrounding the severity of their disorder is excessive or disproportionate to their actual medical diagnosis. While an individual’s concern for an illness may be due to a physical sign or sensation, most individual’s concerns are derived not from a physical complaint, but their actual anxiety related to a suspected medical disorder. This excessive worry often expands to general anxiety regarding one’s health and disease. Unfortunately, this anxiety does not decrease even after reassurance from a medical provider or negative test results, even when provided by multiple physicians and diagnostic tests.

As one can imagine, the preoccupation and anxiety associated with attaining a medical illness severely impacts daily functioning. The individual will often spend copious amounts of time scanning and analyzing their body for “clues” of potential ailments. Additionally, an excessive amount of time is often spent on internet searches related to symptoms and rare illnesses. Illness becomes a central feature of the person’s identity and self-image. Although extreme, some cases of invalidism have been reported due to illness anxiety disorder (APA, 2022).

Making Sense of the Disorders

In relation to somatic symptom and related disorders, note the following:

• For somatic symptom disorder …… the patient presents with multiple somatic symptoms at one time that are significant enough to impact their daily functioning
• For illness anxiety disorder … the patient does not typically present with any somatic symptoms but if they do, the symptoms are just mild in intensity

8.1.3. Functional Neurological Symptom Disorder (Conversion Disorder)

Functional neurological symptom (conversion) disorder occurs when an individual presents with one or more symptoms of altered voluntary motor or sensory function (APA, 2022). Common motor symptoms include weakness or paralysis, abnormal movements (e.g., tremors), and gait abnormalities (i.e., limping). Sensory symptoms include altered, reduced, or absent skin sensation, vision, or hearing. Less commonly seen are epileptic seizures and episodes of unresponsiveness resembling fainting or coma (Marshall et al., 2013). The disorder was called “conversion disorder” in prior versions of the DSM and in the psychiatric literature. As noted, “The term “conversion” originated in psychoanalytic theory, which proposes that unconscious psychic conflict is “converted” into physical symptoms” (APA, 2022).

The most challenging aspect of functional neurological symptom disorder is the complex relationship with a medical evaluation. While a diagnosis of conversion disorder requires that the symptoms not be explained by a neurological disease, just because a medical provider fails to provide evidence that it is not a specific medical disorder is not sufficient. Therefore, there must be evidence of an incompatibility of the medical disorder and the symptoms. For example, an individual experiencing a seizure would require a normal simultaneous electroencephalogram (EEG), indicating that there is not epileptic activity during what was previously thought of as an epileptic seizure.

8.1.4. Factitious Disorder

Factitious disorder differs from the three previously discussed somatic disorders in that there is deliberate falsification of medical or psychological symptoms imposed on oneself or on another, with the overall intention of deception. While a medical condition may be present, the severity of impairment related to the medical condition is more excessive due to the individual’s need to deceive those around them. Even more alarming is that this disorder is not only observed in the individual leading the deception— it can also be present in another individual, often a child or an individual with a compromised mental status who is not aware of the deception behind their illness.

Some examples of factitious disorder behaviors include, but are not limited to, altering a urine or blood test, falsifying medical records, ingesting a substance that would indicate abnormal laboratory results, physically injuring oneself, and inducing illness by injecting or ingesting a harmful substance. Although most individuals with factitious disorder seek treatment from health care professionals, some choose to mislead community members either in person or online about the illness or injury (APA, 2022). While it is unclear why an individual would want to fake their own (or someone else’s) physical illness, there is some evidence suggesting that factors such as depression, lack of parental support during childhood, or an excessive need for social support may contribute to this disorder (McDermott, Leamon, Feldman, & Scott, 2012; Ozden & Canat, 1999; Feldman & Feldman, 1995).

Individuals with factitious disorder are at risk for experiencing psychological distress or functional impairment causing harm to themselves and others such as family, friends, heath care professionals, and faith leaders. The DSM-5-TR states, “Whereas some aspects of factitious disorders might represent criminal behavior, such criminal behavior and mental illness are not mutually exclusive” (APA, 2022, pg. 368).

Key Takeaways

You should have learned the following in this section:

• Somatic symptom disorder is characterized by the presence of multiple somatic symptoms, whether localized or diffused and specific or nonspecific, at one time which impact daily functioning.
• Illness anxiety disorder is characterized by concern over having or acquiring a serious illness, and not the actual presence of somatic symptoms. Individuals spend a great deal of time scanning and analyzing their body for “clues” of potential ailments.
• Functional neurological symptom disorder is characterized by one or more symptoms of voluntary motor or sensory function.
• Factitious disorder is characterized by deliberate falsification of medical or psychological symptoms of oneself or another, with the overall intention of deception.

Section 8.1 Review Questions

1. What are some commonly shared features of somatic disorders?
2. Which somatic disorder usually accompanies a medical diagnosis?
3. What are the key distinctions between illness anxiety disorder and somatic symptom disorder?
4. What are the key differences between factitious disorder and the other somatic disorders?

8.2. Epidemiology

Section Learning Objectives

• Describe the epidemiology of somatic disorders.

The prevalence rates for somatic disorders are often difficult to determine; however, overall estimates of somatic symptom disorder are around 4-6%. There is a trend that females report more somatic symptoms than males; thus, more females are diagnosed with somatic symptom disorder than males (APA, 2022).

Seeing as illness anxiety disorder is a newer diagnosis (replacing hypochondriasis), prevalence rates are largely based on the previous disorder. Previous findings suggest that illness anxiety disorder occurs in 1.3% to 10% of the general population and is equal among males and females.

Prevalence rates of factitious disorder are largely unknown, likely due to the use of deception in individuals diagnosed with the disorder. Additionally, health care professionals infrequently record the diagnosis, even in recognized cases (APA, 2022).

And like the other somatic symptom disorders, the prevalence of functional neurological symptom disorder is unknown, even though transient functional neurological symptoms are common. In the United States and northern Europe, research shows that the incidence of individual persistent functional neurological symptoms to be around 4-12 of every 100,000 annually (APA, 2022).

Key Takeaways

You should have learned the following in this section:

• Though prevalence rates for somatic symptom disorders are hard to determine, it is believed that between 1 and 10% of the population suffer from one of these disorders.
• Females are more like to be diagnosed with somatic symptom disorder and are as likely as males to be diagnosed with illness anxiety disorder.

Section 8.2 Review Questions

1. Create a table of the prevalence rates across the various somatic disorders. What are the differences between the disorders?
2. What gender differences are evident in the disorders, if any?

8.3. Comorbidity

Section Learning Objectives

• Describe the comorbidity of somatic disorders.

Given that half of psychiatric patients also have an additional medical disorder, 35% have an undiagnosed medical condition, and approximately 20% reported medical problems caused their mental condition, it should not come as a surprise that somatic disorders, in general, have high comorbidity with other psychological disorders (Felker, Yazel, & Short, 1996). More specifically, anxiety and depressive disorders are among the most commonly co-diagnosed disorders for somatic disorders. While there is not a lot of information regarding specific comorbidities among somatic symptom and related disorders, there is some evidence to suggest that those with illness anxiety disorder are at risk of developing OCD and personality disorders. Similarly, personality disorders are more common in individuals with functional neurological symptom disorder than the general public. Somatic symptom disorder is also comorbid with PTSD and OCD.  (APA, 2022). No comorbidity information is given for factitious disorder.

There is also high comorbidity between somatic disorders and other physical disorders classified as central sensitivity syndromes (CSSs), due to their common central sensitization symptoms, yet medically unexplained symptoms (McGeary, Harzell, McGeary, & Gatchel, 2016). Disorders included in this group are fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. Comorbidity rates are estimated at 60% for these functional syndromes and somatic pain disorder (Egloff et al., 2014).

Key Takeaways

You should have learned the following in this section:

• Anxiety and depression have a high comorbidity with somatic symptom and related disorders.
• Functional neurological symptom disorder and illness anxiety disorder frequently occur with personality disorders.
• PTSD and OCD are comorbid with somatic symptom disorder.
• Central sensitivity syndrome also has high comorbidity with somatic disorders.

Section 8.3 Review Questions

1. In general, what other disorders often occur with somatic disorders?
2. Which disorder do we not know anything about?

8.4. Etiology

Section Learning Objectives

• Describe the psychodynamic causes of somatic disorders.
• Describe the cognitive causes of somatic disorders.
• Describe the behavioral causes of somatic disorders.
• Describe the sociocultural causes of somatic disorders.

8.4.1. Psychodynamic

Psychodynamic theory suggests that somatic symptoms present as a response against unconscious emotional issues. Two factors initiate and maintain somatic symptoms: primary gain and secondary gain. Primary gains produce internal motivators, whereas secondary gains produce external motivators (Jones, Carmel & Ball, 2008). When you relate this to somatic disorders, the primary gain, according to psychodynamic theorists, provides protection from the anxiety or emotional symptoms and/or conflicts. This need for protection is expressed via a physical symptom such as pain, headache, etc. The secondary gain, the external experiences from the physical symptoms that maintain these physical symptoms, can range from attention and sympathy to missed work, obtaining financial assistance, or psychiatric disability, to name a few.

8.4.2. Cognitive

Cognitive theorists often believe that somatic disorders are a result of negative beliefs or exaggerated fears of physiological sensations. Individuals with somatic related disorders may have a heightened sensitivity to bodily sensations. This sensitivity, combined with their maladaptive thought patterns, may lead individuals to overanalyze and interpret their physiological symptoms in a negative light.

For example, an individual with a headache may catastrophize the symptoms and believe that their headache is the direct result of a brain tumor, as opposed to stress or other inoculate reasons. When their medical provider does not confirm this diagnosis, the individual may then catastrophize even further, believing they have an extremely rare disorder that requires an evaluation from a specialist.

8.4.3. Behavioral

Keeping true with the behavioral approach to psychological disorders, behaviorists propose that somatic disorders are developed and maintained by reinforcers. More specifically, individuals experiencing significant somatic symptoms are often rewarded by gaining attention from other people (Witthoft & Hiller, 2010). These rewards may also extend to more significant factors, such as receiving disability payments.

While the behavioral theory of somatic disorders appears to be like the psychodynamic theory of secondary gains, there is a clear distinction between the two – behaviorists view these gains as the primary reason for the development and maintenance of the disorder, whereas psychodynamic theorists view these gains as secondary, only after the underlying conflicts create the disorder.

8.4.4. Sociocultural

There are a couple of different ways that sociocultural factors contribute to somatic related disorders. First, there is the social factor of familial influence that likely plays a significant role in the attention to somatic symptoms. Individuals with somatic symptom disorder are more likely to have a family member or close friend who is overly attentive to their somatic symptoms or report high anxiety related to their health (Watt, O’Connor, Stewart, Moon, & Terry, 2008; Schulte, Petermann, & Noeker, 2010).

Culturally, Western countries express less of a focus on somatic complaints compared to those in the Eastern part of the world. This may be explained by the different evaluations of the relationship between mind and body. For example, Westerners tend to have a view that psychological symptoms sometimes influence somatic symptoms, whereas Easterners focus more heavily on the mind-body relationship and how psychological and somatic symptoms interact with one another.  These different cultural beliefs are routinely seen in research where Asian populations are more likely to report the physical symptoms related to stress than the cognitive or emotional problems that many in the United States report (Sue & Sue, 2016).

Key Takeaways

You should have learned the following in this section:

• Psychodynamic causes of somatic disorders include primary and secondary gains.
• Cognitive causes of somatic disorders include negative beliefs or exaggerated fears of physiological sensations.
• Behavioral causes of somatic disorders include reinforcers such as attention gained from others or receiving disability.
• Sociocultural causes of somatic disorders include familial influence and culture.

Section 8.4 Review Questions

1. How does catastrophizing contribute to the development and maintenance of somatic disorders?
2. How do somatic disorders develop according to behavioral theorists? Does this theory also explain how the symptoms are maintained? Explain.
3. What does the sociocultural model suggest regarding somatic disorders across cultures?

8.5. Treatment

Section Learning Objectives

• Describe treatment options for somatic disorders.

Treatment for these disorders is often difficult as individuals see their problems as completely medical, and therefore, do not think psychological intervention is necessary (Lahmann, Henningsen, & Noll-Hussong, 2010). Once an individual does not find relief from their symptoms after meeting with several different physicians, they often do willingly engage in psychotherapy, psychopharmacology, or both (Raj et al., 2014).

Among the most effective treatment approaches is the biopsychosocial model of treatment. This approach considers the various biological, psychological, and social factors that influence the illness and presenting symptoms (Gatchel et al., 2007).  This treatment is often achieved through a multidisciplinary approach where the symptoms are managed by many providers, usually including a physician, psychiatrist, and psychologist. The interdisciplinary approach involves a higher level of care as the multiple disciplines interact with one another and identify a treatment goal (Gatchel et al., 2007). This approach, although more difficult to find, particularly in more rural settings, is presumed to be more effective due to the integration of health care providers and their ability to work together to treat the patient uniformly.

8.5.1. Psychotherapy

      8.5.1.1. Psychodynamic. Interpersonal psychotherapy, a type of psychodynamic therapy, has been found to be efficacious in treating somatic disorders. Interpersonal psychotherapy focuses on the relationship between self-experience and the unconscious, and how these factors contribute to body dysfunction. This type of treatment has been shown to reduce anxiety, depression, and improve the overall quality of life immediately following treatment; however, effects appear to diminish over time (Abass et al., 2014; Steinert et al., 2015).

      8.5.1.2. CBT. Traditional cognitive-behavioral therapies (CBT) have been employed to address the cognitive attributions and maladaptive coping strategies that are responsible for the development and maintenance of the disorder. The most common misattribution for these disorders is catastrophic thinking, or the rumination about worst-case scenario outcomes. Additionally, goals of CBT treatment are the acceptance of the medical condition, addressing avoidance behaviors, and mediating expectations of treatment (Gatchel et al., 2014).

      8.5.1.3. Behavioral. Behavioral therapies have also been shown to effectively manage complex chronic somatic symptoms, particularly pain. The behavioral approach involves bringing attention to physiological symptoms, the individual’s attribution to those symptoms, and the subsequent anxiety produced by the negative attributions (Looper & Kirmayer, 2002).

8.5.2. Psychopharmacology

Psychopharmacological interventions are rarely used due to possible side effects and unknown efficacy. Given that these individuals already have a heightened reaction to their physiological symptoms, there is a high likelihood that the side effects of medication would produce more harm than help. With that said, psychopharmacological interventions may be helpful for those individuals who have comorbid psychological disorders such as depression or anxiety, which may negatively impact their ability to engage in psychotherapy (McGeary, Harzell, McGeary, & Gatchel, 2016).

Key Takeaways

You should have learned the following in this section:

• The biopsychosocial model of treatment is one of the most effective for somatic disorders as it considers the various biological, psychological, and social factors that influence the illness and presenting symptoms and includes a multidisciplinary approach.
• Psychotherapy options include interpersonal psychotherapy, CBT, and behavioral.
• Psychopharmacological interventions are rarely used for somatic disorders due to the side effects of the medication producing more harm than good. When used, they deal with comorbid disorders such as depression or anxiety.

Section 8.5 Review Questions

1. Discuss the difference between multidisciplinary and interdisciplinary approaches to treatment of somatic disorders.
2. What is the biopsychosocial model for treatment of somatic disorders? What are the three main components of this treatment?
3. Are there any treatments that are not effective in treating somatic disorders? If so, why?

8.6. Psychological Factors Affecting Other Medical Conditions

Section Learning Objectives

• Describe how psychological factors affecting other medical conditions presents.
• List and describe the most common types of psychophysiological disorders.
• Describe treatment options for psychological factors affecting other medical conditions.

Although previously known as psychosomatic disorders, the DSM-5-TR has identified physical illnesses that are caused or exacerbated by biopsychosocial factors as psychological factors affecting other medical conditions. This disorder is different than all the previously mentioned somatic related disorders as the primary focus of the disorder is not the mental disorder, but rather the physical disorder. Psychological or behavioral factors adversely affect the medical condition by, “…influencing its course or treatment, by constituting an additional well-established health risk factor, or by influencing the underlying pathophysiology to precipitate or exacerbate symptoms or to necessitate medical attention” (APA, 2022, pg. 365). It is believed that a lack of positive coping strategies, psychological distress, or maladaptive health behaviors exacerbate these physical symptoms (McGeary, Harzell, McGeary, & Gatchel, 2016).

8.6.1. Psychophysiological Disorders

The most common types of psychophysiological disorders are headaches (migraines and tension), gastrointestinal (ulcer and irritable bowel), insomnia, and cardiovascular-related disorders (coronary heart disease and hypertension). We will briefly review these disorders and discuss the associated psychological features believed to exacerbate symptoms.

      8.6.1.1. Headaches. Among the most common types of headaches are migraines and tension headaches (Williamson, 1981). Migraine headaches are often more severe and are explained by a throbbing pain localized to one side of the head, frequently accompanied by nausea, vomiting, sensitivity to light, and vertigo. It is believed that migraines are caused by the blood vessels in the brain narrowing, thus reducing the blood flow to various parts of the brain, followed by the same vessels later expanding, thus rapidly changing the blood flow. It is estimated that 23 million people in the U.S. alone suffer from migraines (Williamson, Barker, Veron-Guidry, 1994).

Tension headaches are often described as a dull, constant ache localized to one part of the head or neck; however, it can co-occur in multiple places at one time. Unlike migraines, nausea, vomiting, and sensitivity to light do not often occur with tension headaches. Tension headaches, as well as migraines, are believed to be primarily caused by stress as they are in response to sustained muscle contraction that is often exhibited by those under extreme stress or emotion (Williamson, Barker, Veron-Guidry, 1994).  In efforts to reduce the frequency and intensity of both migraines and tension headaches, individuals have found relief in relaxation techniques, as well as the use of biofeedback training to help encourage the relaxation of muscles.

      8.6.1.2. Gastrointestinal. Among the two most common types of gastrointestinal psychophysiological disorders are ulcers and irritable bowel syndrome (IBS). Ulcers, or painful sores in the stomach lining, occur when mucus from digestive juices are reduced, allowing digestive acids to burn a hole into the stomach lining. Among the most common type of ulcers are peptic ulcers, which are caused by the bacteria H. pylori (Sung, Kuipers, El-Serag, 2009). While there is evidence to support the involvement of stress in the development of dyspeptic symptoms, the evidence linking stress and peptic ulcers is slowly growing. (Purdy, 2013). Researchers believe that while H. pylori must be present for a peptic ulcer to develop, increased stress levels may impact the amount of digestive acid present in the stomach lining, thus increasing the frequency and intensity of symptoms (Sung, Kuipers, El-Serag, 2009).

IBS is a chronic, functional disorder of the gastrointestinal tract. Common symptoms of IBS include abdominal pain and extreme bowel habits (diarrhea or constipation). It affects up to a quarter of the population and is responsible for nearly half of all referrals to gastroenterologists (Sandler, 1990).

Because IBS is a functional disorder, there are no known structural, chemical, or physiological abnormalities responsible for the symptoms. However, there is conclusive evidence that IBS symptoms are related to psychological distress, particularly in those with anxiety or depression. Although more research is needed to pinpoint the timing between the onset of IBS and psychological disorders, preliminary evidence suggests that psychological distress is present before IBS symptoms. Therefore, IBS may be best explained as a somatic expression of associated psychological problems (Sykes, Blanchard, Lackner, Keefer, & Krasner, 2003).

      8.6.1.3. Insomnia. Insomnia, the difficulty falling or staying asleep, occurs in more than one-third of the U.S. population, with approximately 10% of patients reporting chronic insomnia (Perlis & Gehrman, 2013). While exact pathways of chronic psychophysiological insomnia are unclear, there is evidence of some biopsychosocial factors that may predispose an individual to develop insomnia such as anxiety, depression, and overactive arousal systems (Trauer et al., 2015). Part of the difficulty with insomnia is the fact that these psychological symptoms can impact one’s ability to fall asleep; however, we also know that lack of adequate sleep also predisposes individuals to increased psychological distress. Due to this cyclic nature of psychological distress and insomnia, intervention for both sleep issues as well as psychological issues is vital to managing symptoms.

      8.6.1.4. Cardiovascular. Heart disease has been the leading cause of death in the United States for the past several decades. Costs related to disability, medical procedures, and societal burdens are estimated to be $444 billion a year (Purdy, 2013). With this large financial burden, there have been considerable efforts to identify risk and protective factors in predicting cardiovascular mortality.

Researchers have identified that depression is a predictor of early-onset coronary heart disease (Ketterer, Knysk, Khanal, & Hudson, 2006). More specifically, there is a five-fold increase of depression in those with coronary heart disease than the general population (Ketterer, Knysk, Khanal, & Hudson, 2006). Additionally, anxiety and anger have also been identified as an early predictor of cardiac events, suggesting psychological interventions aimed at reducing anxiety and establishing positive coping strategies for anger management may be effective in reducing future cardiac events (Ketterer, Knysk, Khanal, & Hudson, 2006).

      8.6.1.5. Hypertension. Also called or chronically elevated blood pressure, is also found to be affected by psychological factors. More specifically, constant stress, anxiety, and depression have all been found to impact the likelihood of a cardiac event due to their impact on vasoconstriction (Purdy, 2013). Elevated inflammatory markers such as C-reactive protein, which is indicative of plaque instability, has been found in chronically depressed individuals, thus predisposing them to potential heart attacks (Ketterer, Knysk, Khanal, & Hudson, 2006).

8.6.2. Treatments for Psychological Factors Affecting Other Medical Conditions

As more information regarding contributing factors to psychophysiological disorders is discovered, more psychological treatment approaches have been developed and applied to these medical problems. The most common types of treatments include relaxation training, biofeedback, hypnosis, traditional CBT treatments, group therapy, as well as a combination of the previous treatments.

      8.6.2.1. Relaxation training. Relaxation training essentially teaches individuals how to relax their muscles on command. While relaxation is used in combination with other psychological interventions to reduce anxiety (as seen in PTSD and various anxiety disorders), it has also been shown to be effective in treating physical symptoms such as headaches, chronic pain, as well as pain related to specific causes (e.g., injection sites, side effects of medications; McKenna et al., 2015).

      8.6.2.2. Biofeedback. Biofeedback is a unique psychological treatment in which an individual is connected to a machine (usually a computer) that allows for continuous monitoring of involuntary physiological reactions. Measurements that can be obtained are heart rate, galvanic skin response, respiration, muscle tension, and body temperature, to name a few.

There are a few different ways in which biofeedback can be administered. The first is clinician-led. The clinician will actively guide the patient through a relaxation monologue, encouraging the patient to relax muscles associated near the pain region (or within the entire body). While going through the monologue, the clinician is provided with real-time feedback about the patient’s physiological response. Research studies have routinely supported the use of biofeedback, particularly for those with pain and headaches that have not been responsive to pharmacological interventions (McKenna et al., 2015).

Another option of biofeedback is through computer programs developed by psychologists. The most common, a program called Wild Devine (now Unyte) is an integrative relaxation program that encourages the use of breathing techniques while simultaneously measuring the patient’s physiological responses. This type of programming is especially helpful for younger patients as there are various “games” the child can play that requires the awareness and control of their thoughts, feelings, and emotions.

      8.6.2.3. Hypnosis. Hypnosis, which some argue is just an extreme sense of relaxation, has been effective in reducing pain and managing anxiety symptoms associated with medical procedures (Lang et al., 2000). Through extensive training, an individual can learn to engage in self-hypnosis or obtain recorded hypnosis monologues to assist with the management of physiological symptoms outside of hypnosis sessions. While additional research is still needed within the field of hypnosis, studies have indicated that hypnosis is effective in not only treating chronic pain, but also assists with a reduction in anxiety, improved sleep, and improved overall quality of life (Jensen et al., 2006).

      8.6.2.4. Group Therapy. Group therapy is another effective treatment option for individuals with psychological distress related to physical disorders. These groups not only aim to reduce the negative emotions associated with chronic illnesses, but they also provide support from other group members that are experiencing the same physical and psychological symptoms. These groups are typically CBT based and utilize cognitive and behavioral strategies in a group setting to encourage acceptance of disease while also addressing maladaptive coping strategies.

Key Takeaways

You should have learned the following in this section:

• Psychological factors affecting other medical conditions has as its primary focus the physical disorder, and not the mental disorder.
• The most common types of psychophysiological disorders include headaches to include migraines and tension, gastrointestinal to include ulcers and IBS, insomnia, coronary heart disease, and hypertension.
• Common treatments for these other medical conditions include relaxation training, biofeedback, hypnosis, traditional CBT treatments, and group therapy.

Section 8.6 Review Questions

1. What are the most common types of psychophysiological disorders?
2. Discuss the differences between the different types of headaches.
3. What is the difference between ulcers and irritable bowel syndrome?
4. What are the identified predictors to coronary heart disease and other cardiac events?
5. What are the most effective treatment options for psychophysiological disorders?

Module Recap

In Module 8, we discussed somatic disorders in terms of their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Somatic disorders included somatic symptom disorder, illness anxiety disorder, functional neurological symptom (conversion) disorder , and factitious disorder. We also discussed psychological factors affecting other medication conditions in relation to their clinical presentation, common types of psychophysiological disorders, and treatment.

3rd edition

Which is the primary gain for a client with conversion disorder?

What does somatic symptoms mean?

Which disease can be a psychosomatic disorder brought about by stress quizlet?

What are symptomatic disorders?