Download - Somatoform Disorders When Inner Conflict Leads to the Unconscious production of Physical Symptoms
Somatoform Disorders
When Inner Conflict Leads to the Unconscious production of
Physical Symptoms
Somatoform Disorders
Somatization DisorderConversion DisorderPain DisorderHypochondriasisBody Dysmorphic Disorder
What is Somatization?
Experiencing physical distress/symptoms in response to mental/emotional conflict
Seeking medical attention for that physical distress
Somatization Disorder: DSM-IV Criteria
Seeking treatment for many physical complaints, with onset before age 30
Four pain symptoms Two gastrointestinal symptoms One sexual symptom One pseudoneurological symptom The symptoms are NOT intentionally
produced
Conversion Disorder: DSM-IV Criteria
One or more symptoms affecting voluntary motor or sensory function
Resembles neurological or medical disease
Psychological factors must be involved
The symptoms are NOT intentionally produced
Where does the concept of “Conversion” come from?
Freudian term
Patients noted to “convert” psychic conflict into bodily symptoms as a defense mechanism
Commonly association with trauma
Examples of Conversion Symptoms
Sensory– Double vision
(diplopia)– Blindness – Deafness– Numbness
Motor– Paralysis– Difficulty
swallowing (dysphagia)
– Difficulty walking (ataxia)
– Tremor– Inability to talk
(aphonia)– Seizures
(Pseudoseizures)
Pain Disorder: DSM-IV Criteria
One or more sites of pain as primary focus
Pain causes significant impairment
Psychological factors are felt to have an important role in the pain
The symptom is NOT intentionally produced
Hypochondriasis: DSM-IV Criteria
Preoccupation with fears of having a serious disease based on misinterpretation of bodily sensations
Preoccupation goes on despite medical evaluation and reassurance (poor insight)
Duration is at least six months
Hypochondriasis: Associated Features
Serious childhood illnesses and past experience with illness in a family member are common
“Doctor-shopping” and costly medical work-ups are common
Appears equally common in men and women
Body Dysmorphic Disorder: DSM-IV Criteria
Preoccupation with an imagined defect in appearance
If the individual already has a mild physical “flaw,” the concern surrounding it is excessive
Body Dysmorphic Disorder: Associated Features
Frequent inspection of the “defect” can consume many hours a day, lead to suicidal thoughts
Insight is often poor- can become delusional
Medical and surgical treatments are often pursued
High prevalence in cosmetic surgery and dermatology clinics
Factitious Disorder
“I know I’m producing my symptoms, but I don’t
understand why”
Factitious Disorder: DSM-IV Criteria
Intentional production of physical or psychological signs and symptoms
The motivation for the behavior is to assume the sick role (primary gain)
External incentives (such as economic gain, or avoiding responsibilities) are absent (ie, no secondary gain)
Examples of methods to produce Factitious symptoms
Factitious Disorder: Associated Features
Often involves multiple hospitalizations at multiple sites
Invasive procedures and surgery
Usually have few visitors while in the hospital
Patients often have extensive knowledge of medical terminology (health care workers, etc.)
Munchausen Syndrome?
Another term for Factitious Disorder Baron Von Munchausen was a fictional
eighteenth-century character known for story-telling, exaggeration and frequent travel
Munchausen by Proxy
Parent induces illness in a child (most common)
The child is repeatedly hospitalized as a result
This is abuse (a crime, NOT a mental illness)
Malingering
“I’m faking it, I know it, and I’m getting something out of
it”
Malingering
Intentional production of false or exaggerated physical or psychological symptoms
The malingerer is aware that he is producing the symptoms for gain (secondary gain)
In Summary…