Somatoform Disorders “Somatoform disorders are characterized by the presence of physical symptoms or concerns that are not due to a medical disorder” (Hansell & Damour, 2008, p. 224). Individuals who suffer from somatoform disorders experience symptoms of physical disease or defect when there is nothing wrong with their bodies medically. Factitious disorders are similar to somatoform disorder in that individual’s fake bodily symptoms to give others the perception that he or she is sick (Hansell & Damour, 2008). Somatoform disorder symptoms date back to 1600 B. C.
E where it was known as hysteria. Freud described hysteria as a disorder that involved physical symptoms that were the result of repressed anxiety that provoked the impulses of physical symptoms (Hansell & Damour, 2008). In 1980 the DSM-IV-TR moved away from the term “hysteria” and associated the symptoms as specific somatoform disorders (Hansell & Damour, 2008). According to the DSM-IV-TR, there are five subcategories of somatoform disorders: Psychogenic pain disorder, undifferentiated disorder, conversion disorder, somatization disorder, and hypochondriasis (Meyer, Chapman, & Weaver, 2009).
Another category of somatoform disorder is atypical somatoform disorder, which is a catch-all category because individuals fit the general criteria for somatoform disorder, but do not meet the specific criteria for the five major categories (Meyer, Chapman, & Weaver, 2009). The goal of this paper is to analyze the case of Pam, a 38-year-old woman who suffers from the somatoform subcategory known as psychogenic pain disorder.
This paper will give an overview of Pam’s life, describing her background and potential predisposing factors of her disorder as well as analyze the biological, cognitive, emotional, and behavioral components of the psychogenic pain disorder. Client Description Current Description Pam a 38 year old woman visited the pain clinic reporting that she had been suffering from recurrent hip pain since a car accident at the age of 17 (Meyer, Chapman, & Weaver, 2009). Pam’s gynecologist referred her to an orthopedic surgeon, whose evaluation could not find a conclusive explanation for her recurring hip pain.
Her hip pain was sporadic and would sometimes confine her to the bed for a day or two however she and her husband took a skiing vacation in which she had no pain at all. Pam also reported recurring headaches, which she described as “migraines, definitely” (Meyer, Chapman, & Weaver, 2009). Her headaches were on and off, like that of her hip pain and would be severe but later disappear altogether for several weeks (Meyer, Chapman, & Weaver, 2009). Pam was referred to a neurologist for evaluation, in which he found that her headaches did not correspond to the typical pattern of migraines.
The neurologist and gynecologist worked together and referred Pam to a pain clinic because they could not find an explanation for Pam’s headaches and hip pain. After watching a daytime television show describing premenstrual stress, Pam believed that this would explain her hip pain and headaches along with several new ailments (Meyer, Chapman, & Weaver, 2009). Her gynecologist reported that the possibility of premenstrual stress had already been considered and did not account for Pam’s problems therefore psychogenic factors needed to be evaluated (Meyer, Chapman, & Weaver, 2009). Clients Background
Pam was the second youngest of four children. As a child she did not receive much attention from her parents. Pam’s parents gave their attention to the youngest child who was pampered, and to her oldest brother whose academic achievements overshadowed the younger children. Pam’s parents believed that males should be competitive and outgoing, whereas their daughters were to succeed with a focus on music and academics (Meyer, Chapman, & Weaver, 2009). Because of Pam’s parent’s views, she adopted a feminine view of herself and confined herself to music and academics (Meyer, Chapman, & Weaver, 2009).
Pam described her parents as unsociable and withdrawn, rarely showing affection to their children or each other (Meyer, Chapman, & Weaver, 2009). Pam and her siblings hid their emotions because they believed that any display of emotion made their parents uncomfortable. According to Pam, she received love and care from her parents only when she suffered from an illness (Meyer, Chapman, & Weaver, 2009). Pam’s father was devoted to his career and did not spend much time with his family. This raised concern for the children who worried about their father’s absence.
Pam’s mother made the children feel guilty and shame for complaining while their father worked hard to provide for their family. Pam suspected that her mother resented her father, although she never expressed this concern directly. Her mother would behave with superficial charm whenever her husband wanted to spend time with her suddenly becoming tired or complaining of having some kind of illness. Predisposing Factors According to Pam, her mother frequently visited the doctor and suffered from various gynecological problems that would keep her in bed for several days.
During these times, Pam’s father believed that her mother’s illness were a result of stress. He would demand that the children behave and not cause their mother to become upset. Pam’s father would show his wife love and attention while caring for her, but as soon as she was better he would throw himself back into his work. When Pam’s mother wanted attention, she suddenly would become ill to gain her family’s attention only for things to return to normal when she felt better. Pam adopted her mother’s way of suppressing her frustrations for fear she would be made to feel guilty of voicing how she felt.
Pam’s long-term high school boyfriend would pressure her for sex, and she wanted him to stop pressuring her or break it off, but she did not want the confrontation. Pam began to complain of pain in her hip after she and her boyfriend were involved in a car accident. The doctors found no signs of injury, but Pam continued to complain of hip pain which interfered with her dating and other activities. Pam got married to a man named John and had three children. Her husband was a hard-working man and spent little time with his family.
Pam was left to care for the home and their children and need a way to escape. She believed her experiences with pain would help her to get a break. Components of the Disorder Biological Biological components of psychogenetic pain disorder are depression and anxiety, as a result of incapacitation due to conversion somatization or pain symptoms (Hansell & Damour, 2008). Cognitive Cognitive components of psychogenetic pain disorder are psychological factors that play an important role in the onset, severity, exacerbation, or maintenance of the pain (Hansell & Damour, 2008).
Certain situations that an individual wants to avoid may cause one to have an onset of pain. Behavioral Social learning and reinforcement play an important role in behaviors associated with somatoform disorders. When children have parents who have behaviors of somatoforms, the parent’s behavior reinforces those behaviors to the child. Behavior may include the repression of feelings that one may have as a defense mechanism to forget painful mental context (Hansell & Damour, 2008). Emotional
Emotional components of psychogenetic pain disorder include the need to feel loved and to seek attention. When an individual who suffers from psychogenetic pain disorder needs attention or need to feel loved, he or she develops this pain to seek the attention of those close to him or her. Conclusion Pam was predisposed to psychogenic pain disorder as a child. Pam watched as her mother suddenly would become ill when she wanted to avoid telling Pam’s father that she had resentment toward him or did not want to be bothered.
Her mother also became ill when she wanted to have the attention of her family. As a teen, Pam discovered that pain could allow her to avoid breaking up with her boyfriend or avoid the conversation of telling him to stop pressuring her for sex, which eventually resulted in the end of their relationship, and Pam’s pain subsiding. She took the behavior into her marriage complaining of hip pain and headaches when she wanted an escape from taking care of her home or children, or to avoid confronting any situation that she believed would make her feel guilty about voicing how she felt.
After her visit with the pain clinic and an evaluation resulting in her having to keep a journal of her symptoms and therapy, Pam was able to recognize the characteristic of her pain disorder. With therapy and support from her husband who was also discovered to have problems with expressing himself, Pam made a successful recovery from her psychogenetic pain disorder.