Somatoform, Factitious

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Somatoform, Factitious Dissociative Disorders

• RCS 6931
• June 14, 2007
• Steven R. Pruett, Ph.D.

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Somatoform Disorders

• Physical symptoms and health concerns that are
  psychogenic in nature.
• Symptoms
• Excessive or chronic pain
• Conversion symptoms
• Suggests a neurological deficit where there is
  evidence that one does not exist
• Chronic multiple symptoms that do not have an
  adequate explanation
• Complaints that do not improve despite treatment
  that helps most patients
• Excessive concern with health or body appearance
• Individuals with Somatoform Disorders are NOT
  INTENTIONALLY FAKING THEIR SYMPTOMS.
• Thats a different disorder.

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Somatoform Disorders

• Individuals with Somatoform Disorders usually
  have been evaluated for a physical disease.
• These usually involve expense tests and time
  consuming treatments that are ineffective and
  sometimes dangerous.
• These individuals often have other mental
  disorders or can form other mental disorders.

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Somatoform Disorders

• Other causes of Somatic Complaints
• General Medical Condition
• Mood Disorder
• Substance Use
• Factitious Disorder
• Malingering

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Somatoform Disorders

• Somatization Disorder
• Undifferentiated Somatoform Disorder
• Conversion Disorder
• Pain Disorder
• Hypochondriasis
• Body Dysmorphic Disorder
• Somatoform Disorder NOS

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Conversion Disorder 300.11

• Relatively rare (about 1 in 10,000)
• Usually a disorder of young people and more
  common in women than men.
• Requires a clinicians judgment that
  psychological factors play an important role the
  development/maintenance of the symptoms
• Conversion symptom defined as
• A change in how the body functions when
• No causative physical or physiological
  malfunction can be found and
• An emotional conflict seems to play some role in
  the development of the symptom.
• Diagnostic Criteria
• Morrison p. 291 DSM-IV-TR p. 498.

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Somatization Disorder 300.81

• People with Somatization Disorder have a pattern
  of numerous physical and emotional symptoms that
  last for years.
• Symptoms affect various parts of the body such.
• Symptoms must include at least pain,
  gastrointestinal, sexual and pseudoneological.
• One of the oldest mental health diagnoses
  Hysteria
• Ancient Greeks believed that it originated in the
  uterus and wandered through the body.
• Begins in teens or early 20s and can last for
  years. Condition affects about 1 of all women,
  but only rarely occurs in men.
• Diagnostic Criteria
• Morrison p. 294-295 DSM-IV-TR p. 490.

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Undifferentiated Somatoform Disorder 300.82

• Individuals who dont quite meet all the criteria
  for a Somatization Disorder but their symptoms
  suggest that disorder.
• Usually with time they can be reclassified as
  having a Somatization Disorder.
• Diagnositic Criteria
• Morrison p. 298 DSM-IV-TR p. 492

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Pain Disorder 307.8x

• Pain is the predominant focus of the clinical
  presentation.
• Some problems with this disorder
• Like Conversion Disorder, Pain Disorder requires
  a clinicians judgment that psychological factors
  play an important role the development/maintenance
  of the symptoms
• problem with inter-rater reliability
• Subjectivity of Pain.
• Most often diagnosed in women and usually begin
  in 30s and 40s often following an accident
• Can occur as having only a psychological origin
  as well as being associated with a General
  Medical Condition or both.
• Diagnostic Criteria
• Morrison. p 300 DSM-IV-TR p. 503.

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Hypochondriasis 300.7

• Preoccupation with fears of having or the idea of
  having a serious disease on a misinterpretation
  of one or more bodily signs or symptoms.
• Hypochondriasis has been around for very long
  time, but it has never been studied well. DSM-IV
  says is exists in 1-5 of general population.
• Diagnostic Criteria
• Morrison p. 304 DSM-IV-TR p. 507

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Body Dysmorphic Disorder 300.7

• Individuals are concerned that there is something
  wrong with the appearance or shape of a body
  part.
• E.g. breasts, nose, genitalia etc.
• Not delusional just overvalued ideas.
• Patients are very concerned about their physical
  appearance.
• Diagnostic Criteria
• Morrison p. 307 DSM-IV-TR p. 510

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Somatoform Disorder NOS 300.82

• For individuals that dont meet the criteria for
  other Somatoform Disorders yet have somatic
  symptoms that have a strong psychological
  connection.
• Psuedocyesis False pregnancy
• Transient hypochondriacal states
• Total environment allergy syndrome
• Chronic Fatigue Syndrome
• Other

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Factitious Disorder

• Physical or psychological symptoms that are
  intentionally produced or feigned to assume a
  sick role.
• Can fabricate subjective complaints, feign
  general medical conditions, falsify objective
  signs, or self-inflict various conditions.
• No external incentives for the behavior is
  present

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Factitious Disorder

• Usually these individuals are dramatic in their
  presentation, but are vague and inconsistent when
  questioned in detail.
• When confronted with evidence that their symptoms
  are factitious they usually deny the allegation
  or rapidly discharge themselves against medical
  advice only to be admitted to another hospital
  soon thereafter.

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Factitious Disorder

• Subtypes
• With Predominantly Psychological Signs Symptoms
  300.16
• Feigning a mental disorder
• With Predominantly Physical Signs Symptoms
  300.19
• Feigning a General Medical Condition
• Münchanusens syndrome
• Combined Psychological and Physical Signs
  Symptoms 300.19

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Factitious Disorder NOS 300.19

• Other disorders with factitious symptoms that
  dont meet the criteria for Factitious Disorder
• E.g. Münchanusens syndrome by proxy

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Malingering V65.2

• Similar to Factitious Disorders but
• The motivation for this intentional production of
  false physical or psychological complaints has an
  external component such as
• Financial gain
• Evading criminal prosecution
• Obtaining drugs
• Avoiding military duty

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Dissociative Disorders

• Some of the patients thoughts, feelings, or
  behaviors were removed from conscious awareness
  or control.
• Dissociative Disorders
• Usually being and end suddenly
• Episodes are often precipitated by psychological
  conflicts
• Rare, but may be increasing
• In most these disorders there is a profound
  disturbance of memory
• Impaired functioning or a subjective feeling of
  distress is required only for Dissociative
  Amnesia, Dissociative Fuge, and Depersonalization
  Disorder.

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Dissociative Disorders

• Dissociative Amnesia
• Dissociative Fuge
• Dissociative Identity Disorder
• Depersonalization Disorder
• Dissociative Disorder NOS

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Dissociative Disorders

• Other causes for severe memory loss besides
  Dissociative Disorders
• PTSD
• Acute Stress Disorder
• Substance-Induced Disorders
• Somatization Disorder
• Sleepwalking Disorder
• Malingering

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Dissociative Amnesia 300.12

• Formerly called Psychogenic Amnesia
• Patient must have forgotten something important
• Other Axis I disorders must be ruled out

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Dissociative Amnesia

• Patterns of Dissociative Amensia
• Localized (or Circumscribed)
• Patient has no recall for none of the events
  during a particular time
• Selective
• Certain portions of a time period have been
  forgotten pretty rare
• Generalized
• All experiences during patient entire life have
  been forgotten
• Continuous
• Patient forgets all events from a given time
  forward to the present
• Systematized
• Patient has forgotten certain classes of
  information such as that relating to family or
  work.

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Dissociative Amnesia

• Usually begins after a traumatic event or severe
  stress.
• After some time the amnesia suddenly ends with a
  complete restoration of memory.
• It is rare for Dissociative Amnesia to occur
  again in the same individual
• Diagnostic Criteria
• Morrison p. 320 DSM-IV-TR p. 523

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Dissociative Fuge 300.13

• Formerly known as Psychogenic Fuge
• Sudden, unexpected travel away from home or
  customary place of daily activities with an
  inabilty to recall some or all of ones past
• Accompanied by confusion of personal identity or
  even assumption of new identity
• Very rare stuff of novels and movies
• Diagnostic criteria
• Morrison p. 322 DSM-IV-TR p. 526

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Dissociative Identity Disorder 300.14

• Formerly Multiple Personality Disorder
• Essential feature of DID is presence of two or
  more distinct identities or personality states .
• There is an inability to recall important
  personal information the extent of which is too
  great to be explained by ordinary forgetfulness
• Failure to integrate various aspects of identity,
  memory, and consciousness. Each personality
  state may be experienced as if it has a distinct
  personal history, self-image, and identity
  including a separate name.

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Dissociative Identity Disorder

• Many more case of DID in North America vs.
  Europe.
• Is this because of the attention patients with
  DID get from mental health professionals in North
  America? European Mental Health professional
  indicate they do not make a big deal about DID
  when presented with a case.
• Diagnositic Criteria
• Morrison p. 325-326 DSM-IV-TR p. 529

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Depersonalization Disorder 300.6

• The sense of being cut off or detached from ones
  self.
• Viewing ones own mental processes or behavior as
  in a dream.
• Persons with this condition often experience
  derealization
• The external world is unreal or odd.
• Episodes of depersonalization are often
  precipitated by stress. They begin and end
  suddenly.
• Diagnostic Criteria
• Morrison p. 329 DSM-IV-TR p. 532

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Dissociative Disorder NOS 300.15

• For all disorders in which the predominate
  feature is a dissociative symptom that does not
  meet the criteria for a specific Dissociative
  Disorder
• See examples in Morrison p. 331 DSM-IV-TR p.
  532-533.