Cognitive Behavioral Therapy

CBT is a promising approach for treating BDD. Early case reports indicated a successful outcome with exposure therapy (Marks and Mishan 1988 Schmidt and Harrington 1995), audiovisual self-confrontation (Klages and Hartwich 1982), systematic desen-sitization (Munjack 1978), and cognitive plus behavioral techniques (Cromarty and Marks 1995 Gomez-Perez et al. 1994 Newell and Schrubb 1994). Studies using exposure (e.g., exposing the perceived defect in social situations and preventing avoidance...

Treatment

The treatment of patients with conversion disorder is best carried out in collaboration with an internist, primary care physician, or neurologist. In most cases, neither medical nor psychiatric treatment alone suffices. A joint approach is often best, which includes adequate medical intervention directed at diagnosing the cause of the patient's symptoms. After ruling out medical problems or managing any that are present, psychiatric consultation is indicated. The first step in treating...

References

Allodi FA Accident neurosis whatever happened to male hysteria Canadian Psychiatric Association Journal 19 291-296, 1974 American Psychiatric Association Diagnostic and Statistical Manual Mental Disorders. Washington, DC, American Psychiatric Association, 1952 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 2nd Edition. Washington, DC, American Psychiatric Association, 1968 American Psychiatric Association Diagnostic and Statistical Manual of Mental...

General Approach

Physicians often encounter difficulties in diagnosing and managing patients who are somatically preoccupied. A major issue is that these patients focus on somatic concerns and tend to deny psychological and social issues (Pilowsky 1978, 1987). The proclivity of somatization disorder to mimic medical conditions is another difficulty faced by the physician. The general treatment of somatization disorder is based on data indicating that the disorder is chronic and that needless medical...

Prevalence

BDD appears relatively common in clinical settings. In a study in a dermatology setting, 12 of patients screened positive for BDD (Phillips et al. 2000b). In cosmetic surgery settings, rates of 6 , 7 , and 15 have been reported (Ishigooka et al. 1998 Sarwer et al. 1998a, 1998b). Reported rates of BDD are 8 -37 in patients with obsessive-compulsive disorder (OCD) (Brawman-Mintzer et al. 1995 Hollander et al. 1993 Phillips et al. 1998b Piggott et al. 1994 Simeon et al. 1995 Wilhelm et al. 1997),...

Comorbidity

Conversion disorder commonly occurs in association with other psychiatric and medical disorders (Bowman 1993). Psychiatric disorders commonly seen in patients with conversion disorder are major depression, somatization disorder (Briquet's syndrome), anxiety disorders, alcohol abuse, dissociative disorders, depersonalization disorder, and personality disorders. The most common lifetime psychiatric diagnosis in patients with acute conversion symptoms is major depression (about 85 ) (Roy 1980 see...

Sensory Symptoms or Deficits

Conversion disorder can present with alterations of almost any sensory modality. The distribution of the disturbance is inconsistent with anatomical sensory innervation and sometimes is inconsistent over time. In the visual system, blindness, changes (e.g., double vision, blurred vision) or constriction of the visual fields, tunnel or gun barrel vision (e.g., peripheral blindness with preservation of central vision), and visual hallucinations have been described (Grosz and Zimmerman 1965...

Initial Aspects of Treatment Establishment of Trust

The first objective is to develop a relationship of trust with the patient and to show an appreciation for the patient's problems. By demonstrating a thoughtful, impartial, and empathic nature through the joining process and reflective listening, the lines of communication are facilitated, and sufficient information can be gathered to make a practical assessment of the patient's problem. Trust is enhanced by validation of the patient's experience of symptoms and by avoiding the use of alarming...

Vicenzio Holder Perkins MD Thomas N Wise MD

Somatic symptoms may be conceptualized as warning individuals of potential dangers to their health and well-being, but these symptoms also have an interpersonal dimension that alerts the larger social environment to the need for relief from usual activities (Engel 1959). For example, mothers respond to what is perceived as somatic discomfort in their infants, which fosters a bond between the infant and parent that can evolve into a prototype as the infant matures. Using this developmental...

Psychotropic Medications

There is no medication available specifically for the treatment of somatization disorder. Nevertheless, patients with somatization disorder often seek medications from various physicians to treat each symptom. This may result in their taking large amounts of unnecessary medications. For this reason, it is best for only one physician, usually the primary care physician, to prescribe and manage all medications. Psychotropic medications should be considered for comorbid psychiatric disorders,...

Obsessive Compulsive Disorder

BDD has many similarities to OCD, most notably prominent obsessions and repetitive behaviors. BDD has been considered to be an obsessive-compulsive spectrum disorder (Hollander 1993 McElroy et al. 1994), and it is probably more closely related to OCD than to the somatoform disorders with which it is classified. In a study that compared BDD and OCD, the disorders were similar in terms of sex ratio, illness severity, course of illness, and comorbidity (Phillips et al. 1998b). In addition, two...

History

The diagnosis of DSM-IV-TR conversion disorder, known as conversion reaction in DSM-I and hysterical neurosis, conversion type, in DSM-II, entered psychiatric nosology in DSM-III. DSM-III clearly distinguishes somatization disorder, based on polysymp-tomatic complaints with symptoms related to various organs, from conversion disorder, based on monosymptomatic complaints with symptoms limited to motor or sensory functioning. Somatization involves anxiety about symptoms, whereas conversion...

Pharmacotherapy

Unlike pharmacological approaches for treating hypochondria-sis that is secondary to another condition (e.g., depression, panic disorder), pharmacological approaches for treating primary hypo-chondriasis were considered generally unsuccessful until the 1990s, when reports emerged suggesting that serotonin reuptake inhibitors (SRIs) were particularly effective (see Table 2-2). Ms. Q, a 19-year-old college student, had experienced hypo-chondriacal symptoms since age 8, when her frequent bouts of...

Clinical Features

Using the statistical tools of factor analysis, Pilowsky (1967) identified three key components of hypochondriasis bodily preoccupation, disease phobia, and disease conviction. Depending on which feature is predominant in a particular patient, the disorder might appear strikingly different. For example, a patient with a high level of bodily preoccupation might check his or her body repeatedly or emphasize physical ailments when talking to others. A patient with a high level of disease phobia...

Alternative Treatments

Relaxation therapy is a core technique used in many comprehensive behavioral and stress management interventions. The goal of relaxation therapy is to reduce arousal in both the central nervous system and autonomic nervous system in order to sustain psychological and physical health this is done through abdominal breathing exercises, progressive muscle relaxation, or visual imagery (Jacobson 1938). Relaxation therapy, which aims to reduce muscle tension, seemingly contradicts the goal of...

Etiology

We have already discussed the limitations in the empirical evidence related to etiology. However, adventuresome clinicians have offered their own etiologic proposals, and these may have great utility in some cases. The behavioral literature suggests that FD is the result of past social learning and current positive and negative reinforcement (Barsky et al. 1992 Schwartz et al. 1994). Patients with FD may have experienced a critical illness as a child or had a relative who was seriously ill....

Cognitive Behavioral Treatment Strategies

Cognitive Aspects of Cognitive-Behavioral Therapy The principal aim of cognitive therapy is to unravel the core beliefs underlying the patient's hypochondriacal thoughts. Cognitive therapists help their patients understand that an organic medical disorder is not the only reasonable explanation for highly distressing physical symptoms and that distorted patterns of cognition have problematic emotional and behavioral conse quences. In cognitive therapy, patients learn to detect and dispute their...

Physiologic Model

Some researchers suggest that people who develop disorders such as hypochondriasis may have lower thresholds for responding physiologically to stressful life events and thus a heightened sensitivity to specific fear cues (Oberhummer et al. 1983). The sci entific literature also suggests that people who have a heightened physiological response to anxiety triggers may be more susceptible to anxiety disorders (Eysenck 1979). Gramling et al. (1996) conducted a psychophysiological study using cold...

Evolution of Diagnostic Criteria

The term hysteria has been used since Hippocrates. Hysteria is characterized by recurrent, multiple somatic complaints that are often described dramatically and are not explained by known clinical disorders. Hysteria was Freud's central concern during the early years of psychoanalysis, and ultimately resulted in the conceptualization of conversion as a defensive mechanism in patients with hysteria. The patients Freud treated for hysteria had loss of motor and sensory functions that were not...