Disorders Combining Physical and Psychological Factors

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Disorders Combining Physical and Psychological
Factors
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Mental Disorders Due to a General Medical
Condition

• The core concept of the diagnostic group is the
  occurrence of a mental disorder in association
  with a general medical condition that is judged
  to be its cause

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Necessary Clinical Information

• Evidence of a general medical disorder that could
  cause the mental disorder (e.g., tumor,
  infection)
• Recent changes in personality that are not
  characteristic for the individual (e.g.,
  irritable, labile, disinhibited, impulsive)
• Catatonic behavior

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• Catatonic Disorder Due to a General Medical
  Condition (p. 187)
• Personality Change Due to a General Medical
  Condition (p. 190)
• Delirium, Dementia, Amestic Disorder, Psychotic
  Disorder, Mood Disorder, Anxiety Disorder, Sexual
  Dysfunction, Sleep Disorder Due to a General
  Medical Condition
• Mental Disorder NOS Due to a General Medical
  Condition (p. 190)

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Key Diagnostic Points

• The symptoms of a Personality Change Due to a
  General Medical Condition are usually exaggerated
  character or personality traits that do not meet
  the criteria for any other diagnostic category.

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• Jane is a 27-year-old woman who experiences two
  or three brief periods of a minute or two each
  day when she feels detached from her surroundings
  and her own body. Sometimes she cannot remember
  what happens during these periods. Friends have
  observed these episodes and describe her as
  acting distant, as if in a dreamlike state. A
  neurological evaluation has demonstrated some
  abnormal EEG patterns, although the physician was
  unable to provoke one of her dissociative states
  during the examination.

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Diagnosis

• AXIS I

Personality change due to general medical
condition
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Somatoform Disorders Central features include

• Persistent or recurrent complaints of physical
  symptoms not supported by actual physical
  findings
• Persistent worry about having a physical illness
  that is not supported by actual physical findings
• Exaggerated concern about minor or imagined
  physical defects in an otherwise normal-appearing
  person

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Somatization

• The expression of psychological pain through
  physical symptoms or concerns

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Somatoform Disorders

• Somatization Disorder (p. 490)
• Undifferentiated Somatoform Disorder (p. 492)
• Conversion Disorder (p. 498)

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• Pain Disorder (p. 503)
• Hypochondriasis (p. 507)
• Body Dysmorphic Disorder (p. 510)
• Somatoform Disorder NOS (p. 511)

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Necessary Clinical Information

• Current and past nonpsychiatric medical illnesses
  and surgery
• Current and past worries about illness
• Current medications and abused substances
• Physical symptoms including pain and fatigue
• Degree of distress produced by the physical
  symptoms
• Psychiatric symptoms

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• History of stressors
• Impairment in daily functioning
• Stressors (e.g., death, divorce, separation, job
  loss)
• Psychological conflicts (e.g., dependence vs.
  independence)
• Psychological needs (e.g., dependency, intimacy,
  control)
• Typical reaction to external stressors

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Key Diagnostic Points

• The presence of pain is part of the criteria for
  the diagnosis of Somatization Disorder, Pain
  Disorder, Undifferentiated Somatoform Disorder,
  and Somatoform Disorder NOS.
• The loss of pain sensation is a more typical
  symptom of Conversion Disorder.
• Patients who have Body Dysmorphic Disorder do not
  appear to have any physical symptoms to the
  outside observer.

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Factitious Disorders

• The core concept of the diagnostic group is the
  individuals attempt, through deception, to feign
  physical or emotional illness in order to assume
  the role of a patient.

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• Factitious Disorder (p. 517)
• with Predominantly Psychological Signs and
  Symptoms
• with Predominantly Physical Signs and Symptoms
• with Combined Psychological and Physical Signs
  and Symptoms
• Factitious Disorder NOS

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Key Diagnostic Points

• The clients only motivation for feigning illness
  in Factitious Disorders is to assume a sick role.
  In contrast, in V65.2 Malingering (p. 739), the
  client intentionally produces false or grossly
  exaggerated physical or psychological symptoms
  motivated by external incentives (e.g., avoiding
  work, obtaining financial compensation).