[MUSIC PLAYING][Somatoform Disorders]

AMY WENZEL: A somatoform disorder is a mental healthproblem in which a person either hassignificant concerns about a medical problem, an illness,or pain that he or she is experiencing,or is actually reporting a great deal of medical problems, painand concern about that. [Amy Wenzel, PhD, ABPP] Actually,the terms somatoform disorder is no longer used in the DSM-5.

AMY WENZEL [continued]: It's been replaced by a category called somatic symptomdisorder.And one of the reasons is that these patientshave historically been viewed as difficult to treat.A number of them have actually beenviewed as having personality pathology, a personalitydisorder.In fact, a disorder that was conceptualized over100 years ago by Sigmund Freud was hysteria, the experiencing

AMY WENZEL [continued]: of fainting, or some of these very pronouncedphysiological manifestations of distress.And that term was seen as very judgmental.And so the field is really moving in a directionto use language that is respectfuland that adequately characterizesa manifestation of these disorders

AMY WENZEL [continued]: without that associated judgment.In fact, another good example of that would be hypochondriasis.That was a diagnosis that was included in the DSM-IV.Now in the DSM-5, it's called illness anxiety disorder.And really what that is is that it's a preoccupation or anxietyassociated with having an illness or some sortof medical problem-- usually, in my clinical experience also

AMY WENZEL [continued]: associated with the fear of death.Again, in terms of causes, I hesitate to use the word cause.Because really with most of these mental health problems,there's no one factor that causes any of them.And no blood test that a person can take in order to say,yes, this person has a gene.And therefore, it's the cause of the disorder.I will say with people of somatoform disorders,

AMY WENZEL [continued]: they tend to have a characteristicthat I call interoceptive sensitivity, meaning that theyare very acutely aware of even minor changesin their biological homeostasis.And then not only do they notice those changes,then they fixate on that.So they tend to also have a psychological characteristic

AMY WENZEL [continued]: of rumination or just fixation, being consumedwith some of these concerns.And when then they're consumed with these concerns,they tend to do what we call catastrophizing where theygo to the worst case scenario.I have a brain tumor.This means that I'm going to die.My heart is beating really fast.I'm going to have a heart attack and not

AMY WENZEL [continued]: going to be able to make it to a hospital.And it's tough because, behaviorally,a number of these patients, what you seeis that they see so many medical professionals in orderto rule out diagnoses or get explanationsfor the pain or the discomfort that they're experiencing.I can give an example of a 25-year-old young man who

AMY WENZEL [continued]: I've been seeing now for quite a while usingcognitive behavioral therapy.And he does seem to have more achesand pains than the usual male 25-year-old individual,but he has a gastrointestinal doctor.He has a neurologist.He has an orthopedic doctor for pain in his joints.He's also seen an endocrine specialist as well.

AMY WENZEL [continued]: I think he's literally seen six, seven,eight different specialists.And he's gotten cleared by every single one of these physicians.Yet he's still convinced that someof these sensations that he's experiencingare associated with catastrophes.So it is a very-- somatic symptomdisorders are challenging to treat,

AMY WENZEL [continued]: but fortunately we do have some very, very well-establishedresearchers who are taking on this problem.Steven Taylor at the University of British Columbia,Gordon Asmundson at the University of Regina,Jonathan Abramowitz at the University of North Carolina,Chapel Hill-- they are developing and are testingcognitive behavioral approaches to treating this anxiety

AMY WENZEL [continued]: that they call health anxiety.And the research is showing againthat it is making a difference.So while it's a challenging condition,it is able to be treated.And I will say, for people who aretrying to help somebody who has one of these somatic symptomdisorders, one of the things that people want to stay awayfrom is providing reassurance.

AMY WENZEL [continued]: Because that provision of reassurancethat they don't have an illness then prevents themfrom tolerating the ambiguity of these physiological sensations,as well as just the reality that most of us do experiencesome sort of illnesses and some sort of medical conditionsas we go on in life.And that is a part of life.So that acceptance of that uncertainty

AMY WENZEL [continued]: is key with these disorders.[MUSIC PLAYING]