The Case of Alix

October 31st, 2011

The Case of Alix

“Persons with somatoform disorders, like those with the factitious disorder, manifest complaints and symptoms of apparent physical illness for which there are not demonstrable organic findings to support a physical diagnosis” (Meyer, Chapman & Weaver, 2009 pg. 76).  Somatoform disorders have five major subcategories of somatization disorder, undifferentiated somatoform disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis (Meyer, Chapman & Weaver, 2009).  Women more frequently suffer from this disorder than men, and one case in point is the case of Alix, also known as the Empress Alexandra Fedorovna.  Born Alix Victoria Helena Louise Beatrice. Alix was the Princess of Hesse-Darmstadt and led a fairytale life, until the death of her sister, and mother when she was six.  From that point forward Alix’s sunny disposition dramatically changed to cold and distant.

In 1894 Alix would marry Nicholas II of Russia. In 1896, upon Nicholas’ crowning, she became the Express Alexandra Fedorovna and so began the beginning of the well-known Romonov family.  There was immense pressure for Alexandra to produce a son to be heir to the throne.  Four daughters were born before their son Alexis was born, only to be plagued by hemophilia.  The slightest bump or fall caused Alexis great pain and on a couple of occasions almost killed him.  When these events occurred Alexandra would not leave his side.  “After the crisis, she would collapse, lying on a bed or couch for weeks, moving only in a wheelchair” (Meyer, Chapman & Weaver, 2009, p.79).  She began developing episodes of hyperventilation, anxiety and fatigue together with physical symptoms of headaches and nausea.  She also continued to suffer from sciatica which she has experienced since childhood (Meyer, Chapman & Weaver, 2009).  In 1917, in the midst of a political revolution, Nicholas II, Alexandra, and their children were exiled to Siberia, and in 1918 they were brutally executed (Meyer, Chapman & Weaver, 2009).

Factors Involved
According to the DSM-IV-TR, there must be a history of physical complaints before a disorder can be diagnosed. These symptoms must take place over the course of seven years and must have presented before the age of 30. In Alix’s case, her condition would qualify for a diagnosis of undifferentiated Somatoform disorder. Alix experienced many physical symptoms that could be explained through any medical condition; her symptoms were unrelenting throughout her life. Alix’s mother’s death caused her psychological distress and her illness was influenced by her environment which enclosed these traumatic experiences. Alix also grieved for her young son Alexis, who suffered from a hemorrhage because of the hemophilia.  Hemophilia is rare condition in which the inflicted suffers from a blood-clotting deficiency.

Alix felt very guilty because she believed she caused his condition (Meyer, Chapman & Weaver, 2009). Alix also experienced intermittent sciatica, a severe pain in her back and legs that she had been experiencing since childhood.  Alix also experienced episodes in which she would hyperventilate, anxiety episodes, and periodic episodes of fatigue. She also occasionally experienced headaches and nausea. Alix believed that most of her symptoms were due to an enlarged heart and weak blood vessels that she may have inherited. She endured a significant amount of stress after the engagement, and marriage because of Alix’s German heritage the Russian people rejected her and there was intense pressure on her to bear a son. These irrational expectations on behalf of the Russians were pursued by a discontent ahead of acknowledging Alexis’ hemophilia. Thus her entire life would be exemplified by Alexis’s illness that was significant to both physical and emotional energy (Meyer, Chapman & Weaver, 2009).


An intervention for somatoform disorder is using cognitive-behavioral therapy. The reason cognitive-behavioral therapy is a great intervention of this disorder is because there are not medical findings of a person having any medical illnesses when they are complaining of the pain that is within their body. It is explained (Landlaw, 2006), that somatoform can be analyzed in the process of both responding and operant conditioning.  Since the pain that is “caused” by the disorder, and this is caused by the person responding to the painful experiences, cognitive-behavioral therapy appears to be the best route for treatment.  This is the best route because once the history and assessment is completed with the patient finding the correct treatment can then be chosen.  Individual or group therapy seems to be the best choice of therapy for persons with this disorder. This is one of the best interventions because it will begin to show the patient why he or she is feeling the body pain and in what ways he or she may react to painful experiences without causing themselves pain.  The patient, in a way, is causing his or her pain by responding to life in that way that causes this disorder.

Although cognitive-behavioral approaches to the treatment of somatoform disorders are known to be the most effective treatment, other approaches have proven to be successful as well.  Another intervention that has had success in treating this disorder is the family therapy approach (Schade, Torres, & Beyebach, 2011).  Family members can have a significant impact in an individual’s life both negatively and positively.  In non-western cultures, there is more value in the family system rather than the individual (Edwards, Stern, Clarke, Ivbijaro, & Kasney, 2010).  With this in mind, family therapy treatments can potentially be very successful in treating cases of somatoform disorder similar to that of Alix. For those individual’s suffering from the disorder, it is important to include the family members not only to help the individual themselves, but to help the family system as a whole (Edwards et al., 2010).  In recent studies it has been made known that individuals with a somatoform disorder “report higher levels of family conflict and lower levels of family cohesion” (Edwards et al., 2010, pg. 215, para. 5).  This family conflict is believed to be the reason for the “attention seeking behavior” in the patient (Edwards et al., 2010).  In using family therapy, all members of the family are involved in the sessions.

In the therapy sessions, the therapists will help the family members to better understand the link between the psychological processes and the physical processes of the disorder (Edwards et al., 2010).  This understanding can help reduce the tension and conflict within the family; therefore, helping to reduce the behaviors and physical symptoms of the individual (Edwards et al., 2010)

Within the Case of Alix, she has shown that she has a somatoform disorder. Alix has developed this disorder over a period of time, hence being able to use the DSM-IV-TR as a reference in regard to diagnosing. With the death of her sister, mother, pressure to bear a son, this has caused her to have several symptoms. These symptoms include sciatica, anxiety/fatigue episodes, and stress. Both physical and emotional symptoms. There are not only biological factors involved but also psychological and social factors as well. The cognitive-behavioral approach and family systems approach would be appropriate in the field of clinical psychology, due to the success rates and nature of each approach that is used.




Edwards, T. M., Stern, A., Clarke, D. D., Ivbijaro, G., & Kasney, L. (2010). The treatment of patients with medically unexplained symptoms in primary care: a review of the literature. Mental Health in Family Medicine, 7(4), 209-221. Retrieved from EBSCOhost.

Landlaw, K., Tazaki, M. February 18, 2006.  Behavioural mechanisms and cognitive-behavioural interventions of somatoform disorders. Website:

Meyer, R.G., Chapman, L.K., & Weaver, C.M. (2009). Case studies in abnormal behavior (8th      ed.). Boston, MA: Pearson Education/Allyn & Bacon

Schade, N., Torres, P., & Beyebach, M. (2011). Cost-efficiency of a brief family intervention for somatoform patients in primary care. Families, Systems, & Health, 29(3), 197-205. doi:10.1037/a0024563




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