sion disorder usually occurs between 10 and 35 years
of age. Pain disorder and hypochondriasis can occur
at any age (APA, 2000).
All the somatoform disorders are either chronic
or recurrent, lasting for decades for many people.
Clients with somatization disorder and conversion
disorder most likely seek help from mental health
professionals after they have exhausted efforts at
finding a diagnosed medical condition. Clients with
hypochondriasis, pain disorder, and body dysmorphic
disorder are unlikely to receive treatment in mental
health settings unless they have a comorbid condi-
tion. Clients with somatoform disorders tend to go
from one physician or clinic to another, or they may
see multiple providers at once in an effort to obtain
relief of symptoms. They tend to be pessimistic about
the medical establishment and often believe that
their disease could be diagnosed if providers were
more competent.RELATED DISORDERS
Somatoform disorders need to be distinguished from
other body-related mental disorders such as malin-
gering and factitious disorders in which people feign
or intentionally produce symptoms for some purpose
or gain. In malingering and factitious disorders, peo-
ple willfully control the symptoms. In somatoform dis-
orders, clients do not voluntarily control their physi-
cal symptoms.
Malingeringis the intentional production of
false or grossly exaggerated physical or psychological
symptoms; it is motivated by external incentives such
as avoiding work, evading criminal prosecution, ob-
taining financial compensation, or obtaining drugs.
People who malinger have no real physical symptoms
or grossly exaggerate relatively minor symptoms.
Their purpose is some external incentive or outcome
that they view as important and results directly
from the illness. People who malinger can stop the
physical symptoms as soon as they have gained what
they wanted.
Factitious disorderoccurs when a person in-
tentionally produces or feigns physical or psycholog-
ical symptoms solely to gain attention. People with
factitious disorder may even inflict injury to them-
selves to receive attention. The common term for
factitious disorder is Munchausen’s syndrome.A
variation of factitious disorder, Munchausen’s by
proxy,occurs when a person inflicts illness or injury
on someone else to gain the attention of emergency
medical personnel or to be a “hero” for saving the vic-
tim. An example would be a nurse who gives excess
intravenous potassium to a client and then “saves his
life” by performing CPR. Although factitious dis-
orders are uncommon, they occur most often in people
19 SOMATOFORMDISORDERS 463
who are in or familiar with medical professions such
as nurses, physicians, medical technicians, or hospi-
tal volunteers (Turner & Reid, 2002; Wilson, 2001).
People who injure clients or their children through
Munchausen’s by proxy generally are arrested and
prosecuted in the legal system.ETIOLOGY
Psychosocial Theories
Psychosocial theorists believe that people with so-
matoform disorders keep stress, anxiety, or frustra-
tion inside rather than expressing them outwardly.
This is called internalization.Clients express these
internalized feelings and stress through physical
symptoms (somatization). Both internalization and
somatization are unconscious defense mechanisms.
Clients are not consciously aware of the process, nor
do they voluntarily control it.
People with somatoform disorders do not readily
and directly express their feelings and emotions ver-
bally. They have tremendous difficulty dealing with
interpersonal conflict. When placed in situations
involving conflict or emotional stress, their physical
symptoms appear to worsen. The worsening of physi-
cal symptoms helps them to meet psychological needs
for security, attention, and affection through primary
and secondary gain (Guggenheim, 2000). PrimaryFactitious disorder