Abnormal Psychology

374 CHAPTER 8

Targeting Neurological Factors

Medications such as SSRI or St. John’s wort may be used to treat some anxiety-

related symptoms of somatoform disorders (see Table 8.18). As with anxiety

disorders, however, when the medication is stopped, the symptoms usually return.

There has not been much rigorous research on this form of treatment for somatoform

disorders; the studies that have been reported have rarely included appropriate

control groups, such as a placebo group or a wait-list control group to determine

whether the disorder spontaneously improves with time. Other type of treatments,

such as biofeedback, also target neurological factors (as shown in Table 8.18).

Were Anna O. to be treated by a mental health clinician today, she might

receive medication. Anxiety or depression may have contributed to her symptoms,

and if medication for these disorders did not alleviate her hallucinations, the clini-

cian might recommend an antipsychotic medication (Martorano, 1984). Note that

Anna O. was given medications frequently used at that time: morphine (typically

given for pain relief) and chloral hydrate (a narcotic used to induce sleep). She

became dependent on both of these substances, and after her “talking cure” with

Breuer ended, she needed inpatient treatment to end her dependence.

Disorder Medication Other Treatment Comment

Somatization Disorder SSRIa or St. John’s Wortb Biofeedback to decrease bodily

tension or ECT

Medication studies often do not include appropriate

placebo or wait-list control groups.

Conversion Disorder For pseudoseizures,

antianxiety medication

(diazepam)c

ECTd; biofeedbacke or TMSf for

conversion paralysis

There have been very few rigorous medication studies.

Hypochondriasis For obsessive and compulsive

symptoms, an SSRI,

particularly fl uoxetineg

A wide range of medications can lead to improvement,

including antipsychotics,h antidepressants, and

antianxiety drugs,i suggesting that the specifi c

medication is less important than the placebo effect

of taking a medication.j Without CBT, relapse is likely

when medication is stopped.

Body Dysmorphic

Disorder

For obsessive and compulsive

symptoms, an SSRIk

Without CBT, relapse is likely when medication

is stopped.l

aEscobar et al., 1996; bMüller et al., 2004; cAtaoglu et al., 2003; dGiovanoli, 1988; eFishbain et al., 1988; fSchonfeldt-Lecuona et al., 2003; gFallon, 2004; Fallon et al., 1993, 2003;

Magarinos et al., 2002; Mayou & Farmer, 2002; Phillips, 2001, Phillips, Albertini, & Rasmussen, 2002; hFawcett, 2002; Weintraum & Robinson, 2000; iKjernisted, Enns, & Lander,

2002; Oosterbaan et al., 2001; Stone, 1993; Wesner & Noyes, 1991; jFallon et al., 1996; kFallon, 2004; Jefferys & Castle, 2003; Magarinos et al., 2002; Mayou & Farmer, 2002;

Phillips, Albertini, & Rasmussen, 2002; Phillips & Hollander, 2008; Phillips & Najjar, 2003; lPhillips, 2000.

Table 8.18 • Targeting Neurological Factors for Somatoform Disorders

Targeting Psychological Factors: Cognitive-Behavior Therapy

Research suggests that the treatment of choice for most somatoform disorders is cog-

nitive-behavior therapy (CBT). As shown in Table 8.19, the foci of the cognitive and

behavioral methods used in treating each of the disorders vary because each disorder

has different symptoms. Cognitive methods focus on identifying and then modifying

irrational thoughts and shifting attention away from the body and bodily symptoms.

Behavioral methods focus on decreasing compulsive behaviors and avoidance.

Targeting Social Factors: Support and Family Education

Patients with a somatoform disorder can be helped, in part, merely by feeling that

someone understands the pain and distress they feel (Looper & Kirmayer, 2002).

For SD and conversion disorder, the therapist strives to understand the context of

the symptoms and of their emergence and the way the symptoms affect the patient’s

interactions with others (Holder-Perkins & Wise, 2001); with these two disorders,

treatment may focus on helping the patient communicate more assertively—which

can help to relieve the social stressors that contribute to the disorders.

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