Somatoform and Factitious Disorders

1. Somatoform and Factitious Disorders Assessment & Diagnosis SW 593

2. Introduction • Somatoform disorders comprise disorders in which physical concerns are presented for which no medical basis can be found. • Infers that the physical symptoms are associated with psychological factors. • The production of symptoms is not under voluntary control. • Specific diagnoses depend on the number and kinds of physical symptoms, as well on the cognitive process that may occur.

3. Disorders • Somatization disorder: • Chronic disorder • Begins before the age of 30 • Symptoms varied over time • Four pain symptoms: • Two stomach or intestinal symptoms • A sexual symptom • A pseudoneurological symptom

4. Disorders • Somatization disorder (cont.) • No physical basis has been discovered • Complaints/impairment exceed what would be expected based on the general medical condition • If diagnosed in the first 6 months; Undifferentiated Somatoform disorder would be appropriate.

5. Disorders • Conversion Disorders: • Symptoms/deficits are focused on voluntary motor or sensory functions: • Impaired coordination • Paralysis • Blindness • Deafness • Seizures • Psychosocial stressor/conflict can be identified. • Again, not under voluntary control. • Impairment/distress.

6. Disorders • Pain Disorder: • Distinction is made between pain disorders in which general medical conditions are not present or play a minimal role and those in which both psychological factors and a general medical condition seem to be involved. • Pain is judged to be excessive for the specific situation.

7. Disorders • Hypochondriasis: • Less focused on physical symptoms and more focused on fears regarding having a serious disease. • Misinterpretation of normal bodily signs • Chronic and leads to preoccupation with bodily functions • Extreme worries is associated

8. Disorders • Body Dysmorphic Disorder: • Preoccupation or fear is based on an imagined or slight physical anomaly.

9. Disorders • Factitious Disorders: • Are under voluntary control • Client engages in conscious fabrication, falsification, exaggeration, and self-infliction of physical or psychological symptoms. • Assumes the client is seeking the “sick” role • If for external gains (economic, avoiding legal trouble) then rules out these diagnoses • Not to be confused with Malingering

10. Disorders • Factitious disorder by Proxy (Munchausen by Proxy): • Production of medical/psychological symptoms is targeted toward a third party • Is currently under the client’s care.

11. Assessment • In depth medical screening is the primary form of assessment. • Exception: Factitious disorder with Predominantly Psychological signs and symptoms. • Some clients may be sophisticated enough to feign the psychological symptoms.

12. Assessment • Most commonly used self-report instruments: • MMPI-2 • MMPI-A • SCL-90-R • Children’s Somatization Inventory • Multidimensional Pain Inventory (MPI) • Illness Attitude Scale (IAS) • For hypochodriasis

13. Cultural Considerations • Type and frequency will be influenced by cultural factors. • Majority of persons diagnosed are women. • Greek and Puerto Rican men also rate high. • With hypochondriasis and Body Dysmorphic disorder the rate of prevalence seems to be equal by gender.

14. Cultural Considerations • Somatoform disorders tend to be presented by individuals who are considered “unsophisticated”. • Rural • Uneducated • Lower socioeconomic class • Women have higher rates of Factitious Disorders but men present severe and more chronic conditions.