Somatoform and factitious disorders both occur in cases where psychological disorders are related to the experience or expression of physical symptoms. The important difference between them is that in somatoform disorders the physical symptoms are real, whereas in factitious disorders they are not.
One case in which psychological problems create real physical impairments is in the somatoform disorder known assomatization disorder (a lso called Briquet’s syndrome or Brissaud-Marie syndrome). Somatization disorder is a psychological disorder in which a person experiences numerous long-lasting but seemingly unrelated physical ailments that haveno identifiable physical cause. A person with somatization disorder might complain of joint aches, vomiting, nausea, muscle weakness, as well as sexual dysfunction. The symptoms that result from a somatoform disorder are real and cause distress to the individual, but they are due entirely to psychological factors. The somatoform disorder is more likely to occur when the person is under stress, and it may disappear naturally over time. Somatoform disorder is more common in women than in men, and usually first appears in adolescents or those in their early 20s.
Another type of somatoform disorder is conversion disorder, a psychological disorder in which patients experience specific neurological symptoms such as numbness, blindness, or paralysis, but whereno neurological explanation is observed or possible(Agaki & House, 2001). 1 The difference between conversion and somatoform disorders is in terms of the location of the physical complaint. In somatoform disorder the malaise is general, whereas in conversion disorder there are one or several specific neurological symptoms.
Conversion disorder gets its name from the idea that the existing psychological disorder is “converted” into the physical symptoms. It was the observation of conversion disorder (then known as “hysteria”) that first led Sigmund Freud to become interested in the psychological aspects of illness in his work with Jean-Martin Charcot. Conversion disorder is not common (a prevalence of less than 1%), but it may in many cases be undiagnosed. Conversion disorder occurs twice or more frequently in women than in men.
There are two somatoform disorders that involve preoccupations. We have seen an example of one of them, bodydysmorphic disorder, in the Defining Psychological Disorders opener. Body dysmorphic disorder (BDD) is a psychological disorder accompanied by an imagined or exaggerated defect in body parts or body odor. There are no sex differences in prevalence, but men are most often obsessed with their body build, their genitals, and hair loss, whereas women are more often obsessed with their breasts and body shape. BDD usually begins in adolescence.
Hypochondriasis (hypochondria) is another psychological disorder that is focused on preoccupation, accompanied by excessive worry about having a serious illness. The patient often misinterprets normal body symptoms such as coughing, perspiring, headaches, or a rapid heartbeat as signs of serious illness, and the patient’s concerns remain even after he or she has been medically evaluated and assured that the health concerns are unfounded. Many people with hypochondriasis focus on a particular symptom such as stomach problems or heart palpitations.
Two other psychological disorders relate to the experience of physical problems that are not real. Patients with factitious disorder fake physical symptoms in large part because they enjoy the attention and treatment that they receive in the hospital. They may lie about symptoms, alter diagnostic tests such as urine samples to mimic disease, or even injure themselves to bring on more symptoms. In the more severe form of factitious disorder known as Münchausen syndrome, the patient has a lifelong pattern of a series of successive hospitalizations for faked symptoms.
Factitious disorder is distinguished from another related disorder known asmalingering, which also involves fabricating the symptoms of mental or physical disorders, but where the motivation for doing so is to gain financial reward; to avoid school, work, or military service; to obtain drugs; or to avoid prosecution.
The somatoform disorders are a lmost always comorbid with other psychological disorders, including anxiety and depression and dissociative states (Smith et al., 2005). 2 People with BDD, for instance, are often unable to leave their house, are severely depressed or anxious, and may also suffer from other personality disorders.
Somatoform and factitious disorders are problematic not only for the patient, but they also have societal costs. People with these disorders frequently follow through with potentially dangerous medical tests and are a t risk for drug addiction from the drugs they are given and for injury from the complications of the operations they submit to (Bass, Peveler, & House, 2001; Looper & Kirmayer, 2002). 3 In addition, people with these disorders may take up hospital space that is needed for people who are really ill. To help combat these c osts, emergency room and hospital workers use a variety of tests for detecting these disorders.