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35:30 Somatization35:30 Somatization 30:30 Conversion30:30 Conversion

Body Related Disorders: Body Related Disorders: Somatoform, Conversion, Somatoform, Conversion,

FactitiousFactitious

Psychological Disorders Psychological Disorders Related to Physical BodyRelated to Physical Body

Body Body Somatoform Disorders, Conversion Somatoform Disorders, Conversion

Disorders, Factitious DisordersDisorders, Factitious Disorders

Somatoform DisordersSomatoform Disorders

Somatization (Briquet’s or hysteria)Somatization (Briquet’s or hysteria) HypochondriasisHypochondriasis Psychogenic PainPsychogenic Pain Conversion DisorderConversion Disorder Body Dysmorphic DisorderBody Dysmorphic Disorder Undifferentiated Somatoform Undifferentiated Somatoform

DisorderDisorder

Somatoform Disorders Somatoform Disorders CommonalitiesCommonalities

1.1. Have body complaints or loss of Have body complaints or loss of functionfunction

2.2. No organic pathologyNo organic pathology

3.3. Psychological factors play important Psychological factors play important rolerole

4.4. ““la belle indifference”la belle indifference”

5.5. Precipitant Precipitant

Somatization (Briquet’s Somatization (Briquet’s Syndrome)Syndrome)

““Grand Hysterics or Chief Grand Hysterics or Chief Troublemakers”Troublemakers”

Complaints: characteristicsComplaints: characteristics Complaints splayedComplaints splayed PresentationPresentation

SomatizationSomatization

Common Complaints:Common Complaints:– Headaches, fatigue, heart Headaches, fatigue, heart

palpitations, fainting spells, nausea, palpitations, fainting spells, nausea, paralysis, numbness, blindnessparalysis, numbness, blindness

HypochondriasisHypochondriasis

Unrealistic interpretation of Unrealistic interpretation of physical signs or sensations as physical signs or sensations as abnormal leading to a abnormal leading to a preoccupation with having a preoccupation with having a serious diseaseserious disease

One of the most frequently seen One of the most frequently seen somatoform disorderssomatoform disorders

Video on Speaking OutVideo on Speaking Out

HypochondriasisHypochondriasis

May involve several systems or May involve several systems or may be specific preoccupation with may be specific preoccupation with one organ or diseaseone organ or disease

Vagueness in presentationVagueness in presentation Lots of “doctor shopping”Lots of “doctor shopping” Avid readers of medical journals, Avid readers of medical journals,

magazines, internet sitesmagazines, internet sites

Conversion DisordersConversion Disorders

Conversion DisordersConversion Disorders

Old Hysteria or Hysterical Old Hysteria or Hysterical NeurosesNeuroses

Thought to be restricted to womenThought to be restricted to women Pattern in which symptoms of Pattern in which symptoms of

some physical malfunction or loss some physical malfunction or loss of control appear with no organic of control appear with no organic pathologypathology

Conversion DisordersConversion Disorders

Voluntary control?Voluntary control? Stressful eventStressful event Most classic symptoms:Most classic symptoms:

– Paralysis, anesthesia, blindness, Paralysis, anesthesia, blindness, tunnel vision tunnel vision

Conversion DisordersConversion Disorders

Usually appears in stressful Usually appears in stressful situationssituations

La belle indifferenceLa belle indifference Onset often in early adults but can Onset often in early adults but can

appear at other points in lifeappear at other points in life

Conversion DisordersConversion Disorders

Pianist who developed Glove Pianist who developed Glove anesthesiaanesthesia

Hysterically blind individualsHysterically blind individuals Individuals in Wartime who lose Individuals in Wartime who lose

capacity to use firearmscapacity to use firearms Neurologist who developed Neurologist who developed

conversion disorderconversion disorder

Conversion DisordersConversion Disorders

Three Categories of Symptoms:Three Categories of Symptoms:– Sensory: any sense can become Sensory: any sense can become

involvedinvolved– Motor: paralysis, tremors, tics, Motor: paralysis, tremors, tics,

aphoniaaphonia– Visceral: headache, lump in throat, Visceral: headache, lump in throat,

choking, coughing, choking, coughing,

Conversion DisordersConversion Disorders

Primary GainPrimary Gain Secondary GainSecondary Gain

Conversion Disorders vs Conversion Disorders vs Physical BasisPhysical Basis

La belle indifferenceLa belle indifference Symptoms don’t conformSymptoms don’t conform Selective nature of the dysfunctionSelective nature of the dysfunction Under hypnosis can remove Under hypnosis can remove

symptomsymptom

Factitious DisordersFactitious Disorders

Separate Section of DSM IVTR in DSM V Separate Section of DSM IVTR in DSM V underunder Somatic Symptom & Related Disorders Somatic Symptom & Related Disorders

(also conversion disorder)(also conversion disorder) Muncheusen’s SyndromeMuncheusen’s Syndrome Not real, not genuineNot real, not genuine Characterized by physical symptoms Characterized by physical symptoms

produced by the individual and are produced by the individual and are under voluntary controlunder voluntary control

Factitious DisorderFactitious Disorder

Compulsive qualityCompulsive quality Person will injure him/herself or do Person will injure him/herself or do

other things to create real other things to create real symptoms in order to receive symptoms in order to receive medical attention, typically medical attention, typically seeking admission as an inpatientseeking admission as an inpatient

All organ systems potential targetsAll organ systems potential targets

Factitious DisordersFactitious Disorders

Present history with drama, but are Present history with drama, but are vague and inconsistent vague and inconsistent

Pathological liarsPathological liars Have extensive knowledge about Have extensive knowledge about

hospitalshospitals Demand attention, will undergo Demand attention, will undergo

very painful diagnostic procedures very painful diagnostic procedures including multiple surgerisincluding multiple surgeris

Disorder of PatienthoodDisorder of Patienthood

Extreme dependency and Extreme dependency and regressionregression

Muncheusen’s by Proxy (DSM-IV)Muncheusen’s by Proxy (DSM-IV)oror

Factitious Dis. Imposed on Factitious Dis. Imposed on Another (DSM – V)Another (DSM – V)

MalingeringMalingering

Patient has voluntary control of Patient has voluntary control of symptoms but the symptom symptoms but the symptom production is for purpose of production is for purpose of obtaining a specific and obtaining a specific and recognizable goal (e.g., money)recognizable goal (e.g., money)