Somatoform Disorders

1. Somatoform Disorders When Inner Conflict Leads to the Unconscious production of Physical Symptoms

2. Somatoform Disorders • Somatization Disorder • Conversion Disorder • Pain Disorder • Hypochondriasis • Body Dysmorphic Disorder

3. What is Somatization? • Experiencing physical distress/symptoms in response to mental/emotional conflict • Seeking medical attention for that physical distress

4. 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

5. 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

6. 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

7. Sensory Double vision (diplopia) Blindness Deafness Numbness Motor Paralysis Difficulty swallowing (dysphagia) Difficulty walking (ataxia) Tremor Inability to talk (aphonia) Seizures (Pseudoseizures) Examples of Conversion Symptoms

8. 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

9. 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

10. 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

11. 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

12. 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

13. Factitious Disorder “I know I’m producing my symptoms, but I don’t understand why”

14. 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)

15. Examples of methods to produce Factitious symptoms

16. 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.)

17. Munchausen Syndrome? • Another term for Factitious Disorder • Baron Von Munchausen was a fictional eighteenth-century character known for story-telling, exaggeration and frequent travel

18. 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)

19. Malingering “I’m faking it, I know it, and I’m getting something out of it”

20. 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)

21. In Summary…