Somatoform Disorders

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Somatoform Disorders

• 2.20.2007

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Somatization Disorder

• A. A history of many physical complaints that
  occur over a period of several years and result
  in treatment being sought or significant
  impairment in functioning beginning before age 30
• B. Each of the following must have been met, with
  individual symptoms occurring at any time during
  the course of the disturbance
• 4 pain symptoms
• 2 gastrointestinal symptoms
• 1 sexual symptom
• 1 pseudoneurological symptom

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Somatization Disorder

• C. Either 1 or 2
• 1. After appropriate investigation, each of the
  symptoms in Criterion B cannot be fully explained
  by a known GMC or substance
• 2. When there is a related GMC, the physical
  complaints or resulting social or occupational
  impairment are in excess of what would be
  expected from the history, physical examination,
  or laboratory findings.
• D. The symptoms are not intentionally produced or
  feigned (as in Factitious Disorder or Malingering)

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Facts about Somatization Disorder

• Prevalence
• Gender
• Age of Onset
• Course
• Culture

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Undifferentiated Somatoform Disorder

• A. One or more physical complaints
• B. Either 1 or 2
• 1. After appropriate investigation, each of
  the symptoms in Criterion B cannot be fully
  explained by a known GMC or substance
• 2. When there is a related GMC, the physical
  complaints or resulting social or occupational
  impairment are in excess of what would be
  expected from the history, physical examination,
  or laboratory findings.

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Undifferentiated Somatoform Disorder

• C. The symptoms cause clinically significant
  distress or impairment in functioning
• D. The duration of the disturbance is at least 6
  months
• E. Not better accounted for by another mental
  disorder
• F. The symptom is not intentionally produced or
  feigned (as in Factitious Disorder or Malingering)

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Conversion Disorder

• One or more symptoms or deficits affecting
  voluntary motor or sensory function that suggest
  a neorological or other GMC
• Psychological factors are judged to be associated
  with the symptom or deficit because the
  initiation or exacerbation of the symptom or
  deficit is preceded by conflicts or other
  stressors
• The symptom or deficit is not intentionally
  feigned (as in Factitious Disorder or Malingering)

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Conversion Disorder

• D. The symptom or deficit cannot, after
  appropriate investigation, be fully explained by
  a general medical condition, or by the direct
  effects of a substance, or as a culturally
  sanctioned behavior or experience
• E. The symptom or deficit causes clinically
  significant distress or impairment in functioning
• F. The symptom or deficit is not limited to pain
  or sexual dysfunction, does not occur exclusively
  during the course of Somatization Disorder, and
  is not better accounted for by another mental
  disorder

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Facts about Conversion Disorder

• Prevalence
• Gender
• Age of Onset
• Course
• Culture

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Pain Disorder

• A. Pain in one or more anatomical sites that is
  of sufficient severity to warrant clinical
  attention
• B. The pain causes clinically significant
  distress or impairment in functioning
• C. Psychological factors are judged to have an
  important role in the onset, severity,
  exacerbation, or maintenance or the pain
• D. The symptom or deficit in not intentionally
  produced or feigned (as in Factitious Disorder or
  Malingering)
• E. The pain is not better accounted for by
  another mental disorder

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Pain Disorder

• Prevalence
• Gender
• Age of onset
• Course
• Associated w/

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Hypochondriasis

• A. Preoccupation with fears of having, or the
  idea that one has, a serious disease based on the
  persons misinterpretation of bodily symptoms
• B. The preoccupation persists despite apprpriate
  medical evaluation and reassurance
• C. The belief in Criterion A is not of delusional
  intensity

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Hypochondriasis

• D. The preoccupation causes significant distress
  or impairment in functioning
• E. The duration of the disturbance is at least 6
  months
• F. The preoccupation is not better accounted for
  by another mental disorder

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Facts about Hypochondriasis

• Prevalence
• Gender
• Age of Onset
• Course
• Associated w/

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HypochondriasisSomatoform Disorder or Anxiety
Disorder???

• Somatoform Disorder
• Focus is a perceived dysfunction of bodily
  function
• Phobias person recognizes that fear is
  unreasonable or excessive
• Hypochondriasis person views their fears as
  reasonable and justified

• Anxiety Disorder
• Primary emotion is fear
• Excessive fear of disease
• Panic Disorder acute fear response to body
  sensations that may indicate pending physical
  calamity
• Hypochodriasis chronic fear response to body
  sensations that may indicate pending physical
  calamity

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Somatoform Disorders Possible Causes

• Little certain information known
• Attention bias to bodily sensations/illness-relate
  d information
• Misinterpretation of bodily sensation
• Secondary reinforcements

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Somatoform Disorders - Treatment

• Integration of patient care by one physician
• Reduction of medications and unnecessary testing
• Cognitive Behavior Therapy
• Reducing secondary gains
• Hypnosis?

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Factitious Disorder

• Intentional production or feigning of physical or
  psychological signs or symptoms
• The motivation for the behavior is to assume the
  sick role
• External incentives for the behavior (such as
  economic gain, avoiding legal responsibility, or
  improving physical well-being, as in Malingering)
  are absent

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Facts about Factitious Disorder

• Prevalence
• Gender
• Age of onset
• Course

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Malingering

• Intentional production of false or grossly
  exaggerated physical or psychological symptoms
• Motivated by external incentives

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Malingering

• Warning signs

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Factitious Disorder vs. Malingering

• Motivation
• Factitious Disorder
• Malingering

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Body Dysmorphic Disorder

• Preoccupation with an imagined defect in
  appearance. If a slight physical anomaly is
  present, the persons concern is markedly
  excessive.
• The preoccupation causes clinically significant
  distress or impairment in functioning
• The preoccupation is not better accounted for by
  another mental disorder

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Facts about Body Dysmorphic Disorder

• Prevalence
• Gender
• Course
• Associated w/

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Body Dysmorphic Disorder

• Comorbidity with depression
• Some believe it is similar to OCD
• Obsessions
• Compulsions
• 5 most common locations for perceived deficits
• Skin 73
• Hair 56
• Nose 37
• Stomach 22
• Breasts/chest/nipples 21

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Body Dysmorphic DisorderPossible Causes and
Treatment

• Possible Causes
• Attention bias to information relating to
  attractiveness
• Misinterpretation of information relating to
  attractiveness
• Experienced teasing/criticism related to
  attractiveness
• Sociocultural context
• Treatment
• CBT Exposure and Response Prevention very
  effective
• Antidepressants SSRIs moderately effective

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Dissociative Disorders
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Dissociative Identity Disorder

• A. The presence of two or more distinct
  identities or personality states
• B. At least two of these identities or
  personality states recurrently take control of
  the persons behavior
• C. Inability to recall important personal
  information that is too extensive to be explained
  by ordinary forgetfulness
• D. Not due to a GMC or substance

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Dissociative Identity Disorder

• Identities
• At least two of these recurrently take control of
  a persons behavior
• Can be categorized into three types
• Core identity superego
• 1st alternate identity id
• 2nd alternate identity ego

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Facts about Dissociative Identity Disorder

• Prevalence
• Gender
• Age of Onset
• Course

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Dissociative Identity Disorder

• Prevalence
• Up for debate
• Rates have increased dramatically over few
  decades
• First case reported in the 1850s
• Several cases in 1880s-1900s
• By the 1970s, only about 200 cases in all
• Now, some psychologists claim that up to 1 of
  the general population has this disorder
• Individual clinicians are not reporting having
  dozens to hundreds of such clients

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Dissociative Identity Disorder

• Explanations for increasing prevalence
• Increased public awareness of the disorder
• Changes in the diagnostic criteria for
  schizophrenia
• Therapists may be actively looking for DID
• Prevalence, continued
• Rates very uneven across countries
• Rates very uneven across clinicians within
  countries
• The rates of this disorder is very
  controversialsome psychologists doubt its
  existence at all

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Dissociative Identity Disorder

• Risk Factors
• Severe child abuse, especially sexual abuse
  (reported in 95 of cases
• Remembered or Recovered???
• Having generous psychiatric medical coverage

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Dissociative Identity Disorder

• Question of Validity
• Studies show differences in psychological test
  results and physiological states between alters
• Alternative theories
• Could be due to distinct personalities
• Could be due to role enactments
• Extremely heated controversy over iatrogenesis
  vs. natural occurrence (iatrogenesis caused
  by treatment)

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Dissociative Identity Disorder

• Can people actually dissociate?
• Have you had a dissociative experience?
• Common dissociative experiences
• Reading a paragraph and then having no
  recollection of what you read
• Driving somewhere and not knowing how you got
  there
• Talking to someone and not knowing what youre
  actually talking about

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Dissociative Identity Disorder

• Perhaps there is an underlying continuum

Normal Dissociative Experiences
Dissociative Identity Disorder
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Dissociative Amnesia

• One or more episodes of inability to recall
  important personal information, usually of a
  traumatic or stressful nature, that is too
  extensive to be explained by ordinary
  forgetfulness
• Not better explained by a another mental disorder
  and is not due to a GMC or substance
• Symptoms cause clinically significant distress or
  impairment in functioning

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Facts about Dissociative Amnesia

• Prevalence
• Gender
• Age of Onset
• Course

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Dissociative Fugue

• Sudden, unexpected travel away from home or ones
  customary place of work, with inability to recall
  ones past
• Confusion about personal identity or assumption
  of a new identity (partial or complete)
• Not better explained by a another mental disorder
  and is not due to a GMC or substance
• Symptoms cause clinically significant distress or
  impairment in functioning

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Facts about Dissociative Fugue

• Prevalence
• Gender
• Age of Onset
• Course

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Depersonalization Disorder

• Persistent or recurrent experiences of feeling
  detached from, and as if one is an outside
  observer of, ones mental processes or body
• During the depersonalization experience, reality
  testing remains intact
• Not better explained by a another mental disorder
  and is not due to a GMC or substance
• Symptoms cause clinically significant distress or
  impairment in functioning

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Facts about Depersonalization Disorder

• Prevalence
• Gender
• Age of Onset
• Course