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Somatoform Disorders

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B. Each of the following must have been met, with individual symptoms occurring ... Breasts/chest/nipples 21% Body Dysmorphic Disorder. Possible Causes and Treatment ... – PowerPoint PPT presentation

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Title: Somatoform Disorders


1
Somatoform Disorders
  • 2.20.2007

2
Somatization Disorder
  • A. A history of many physical complaints that
    occur over a period of several years and result
    in treatment being sought or significant
    impairment in functioning beginning before age 30
  • B. Each of the following must have been met, with
    individual symptoms occurring at any time during
    the course of the disturbance
  • 4 pain symptoms
  • 2 gastrointestinal symptoms
  • 1 sexual symptom
  • 1 pseudoneurological symptom

3
Somatization Disorder
  • C. Either 1 or 2
  • 1. After appropriate investigation, each of the
    symptoms in Criterion B cannot be fully explained
    by a known GMC or substance
  • 2. When there is a related GMC, the physical
    complaints or resulting social or occupational
    impairment are in excess of what would be
    expected from the history, physical examination,
    or laboratory findings.
  • D. The symptoms are not intentionally produced or
    feigned (as in Factitious Disorder or Malingering)

4
Facts about Somatization Disorder
  • Prevalence
  • Gender
  • Age of Onset
  • Course
  • Culture

5
Undifferentiated Somatoform Disorder
  • A. One or more physical complaints
  • B. Either 1 or 2
  • 1. After appropriate investigation, each of
    the symptoms in Criterion B cannot be fully
    explained by a known GMC or substance
  • 2. When there is a related GMC, the physical
    complaints or resulting social or occupational
    impairment are in excess of what would be
    expected from the history, physical examination,
    or laboratory findings.

6
Undifferentiated Somatoform Disorder
  • C. The symptoms cause clinically significant
    distress or impairment in functioning
  • D. The duration of the disturbance is at least 6
    months
  • E. Not better accounted for by another mental
    disorder
  • F. The symptom is not intentionally produced or
    feigned (as in Factitious Disorder or Malingering)

7
Conversion Disorder
  • One or more symptoms or deficits affecting
    voluntary motor or sensory function that suggest
    a neorological or other GMC
  • Psychological factors are judged to be associated
    with the symptom or deficit because the
    initiation or exacerbation of the symptom or
    deficit is preceded by conflicts or other
    stressors
  • The symptom or deficit is not intentionally
    feigned (as in Factitious Disorder or Malingering)

8
Conversion Disorder
  • D. The symptom or deficit cannot, after
    appropriate investigation, be fully explained by
    a general medical condition, or by the direct
    effects of a substance, or as a culturally
    sanctioned behavior or experience
  • E. The symptom or deficit causes clinically
    significant distress or impairment in functioning
  • F. The symptom or deficit is not limited to pain
    or sexual dysfunction, does not occur exclusively
    during the course of Somatization Disorder, and
    is not better accounted for by another mental
    disorder

9
Facts about Conversion Disorder
  • Prevalence
  • Gender
  • Age of Onset
  • Course
  • Culture

10
Pain Disorder
  • A. Pain in one or more anatomical sites that is
    of sufficient severity to warrant clinical
    attention
  • B. The pain causes clinically significant
    distress or impairment in functioning
  • C. Psychological factors are judged to have an
    important role in the onset, severity,
    exacerbation, or maintenance or the pain
  • D. The symptom or deficit in not intentionally
    produced or feigned (as in Factitious Disorder or
    Malingering)
  • E. The pain is not better accounted for by
    another mental disorder

11
Pain Disorder
  • Prevalence
  • Gender
  • Age of onset
  • Course
  • Associated w/

12
Hypochondriasis
  • A. Preoccupation with fears of having, or the
    idea that one has, a serious disease based on the
    persons misinterpretation of bodily symptoms
  • B. The preoccupation persists despite apprpriate
    medical evaluation and reassurance
  • C. The belief in Criterion A is not of delusional
    intensity

13
Hypochondriasis
  • D. The preoccupation causes significant distress
    or impairment in functioning
  • E. The duration of the disturbance is at least 6
    months
  • F. The preoccupation is not better accounted for
    by another mental disorder

14
Facts about Hypochondriasis
  • Prevalence
  • Gender
  • Age of Onset
  • Course
  • Associated w/

15
HypochondriasisSomatoform Disorder or Anxiety
Disorder???
  • Somatoform Disorder
  • Focus is a perceived dysfunction of bodily
    function
  • Phobias person recognizes that fear is
    unreasonable or excessive
  • Hypochondriasis person views their fears as
    reasonable and justified
  • Anxiety Disorder
  • Primary emotion is fear
  • Excessive fear of disease
  • Panic Disorder acute fear response to body
    sensations that may indicate pending physical
    calamity
  • Hypochodriasis chronic fear response to body
    sensations that may indicate pending physical
    calamity

16
Somatoform Disorders Possible Causes
  • Little certain information known
  • Attention bias to bodily sensations/illness-relate
    d information
  • Misinterpretation of bodily sensation
  • Secondary reinforcements

17
Somatoform Disorders - Treatment
  • Integration of patient care by one physician
  • Reduction of medications and unnecessary testing
  • Cognitive Behavior Therapy
  • Reducing secondary gains
  • Hypnosis?

18
Factitious Disorder
  • Intentional production or feigning of physical or
    psychological signs or symptoms
  • The motivation for the behavior is to assume the
    sick role
  • External incentives for the behavior (such as
    economic gain, avoiding legal responsibility, or
    improving physical well-being, as in Malingering)
    are absent

19
Facts about Factitious Disorder
  • Prevalence
  • Gender
  • Age of onset
  • Course

20
Malingering
  • Intentional production of false or grossly
    exaggerated physical or psychological symptoms
  • Motivated by external incentives

21
Malingering
  • Warning signs

22
Factitious Disorder vs. Malingering
  • Motivation
  • Factitious Disorder
  • Malingering

23
Body Dysmorphic Disorder
  • Preoccupation with an imagined defect in
    appearance. If a slight physical anomaly is
    present, the persons concern is markedly
    excessive.
  • The preoccupation causes clinically significant
    distress or impairment in functioning
  • The preoccupation is not better accounted for by
    another mental disorder

24
Facts about Body Dysmorphic Disorder
  • Prevalence
  • Gender
  • Course
  • Associated w/

25
Body Dysmorphic Disorder
  • Comorbidity with depression
  • Some believe it is similar to OCD
  • Obsessions
  • Compulsions
  • 5 most common locations for perceived deficits
  • Skin 73
  • Hair 56
  • Nose 37
  • Stomach 22
  • Breasts/chest/nipples 21

26
Body Dysmorphic DisorderPossible Causes and
Treatment
  • Possible Causes
  • Attention bias to information relating to
    attractiveness
  • Misinterpretation of information relating to
    attractiveness
  • Experienced teasing/criticism related to
    attractiveness
  • Sociocultural context
  • Treatment
  • CBT Exposure and Response Prevention very
    effective
  • Antidepressants SSRIs moderately effective

27
Dissociative Disorders
28
Dissociative Identity Disorder
  • A. The presence of two or more distinct
    identities or personality states
  • B. At least two of these identities or
    personality states recurrently take control of
    the persons behavior
  • C. Inability to recall important personal
    information that is too extensive to be explained
    by ordinary forgetfulness
  • D. Not due to a GMC or substance

29
Dissociative Identity Disorder
  • Identities
  • At least two of these recurrently take control of
    a persons behavior
  • Can be categorized into three types
  • Core identity superego
  • 1st alternate identity id
  • 2nd alternate identity ego

30
Facts about Dissociative Identity Disorder
  • Prevalence
  • Gender
  • Age of Onset
  • Course

31
Dissociative Identity Disorder
  • Prevalence
  • Up for debate
  • Rates have increased dramatically over few
    decades
  • First case reported in the 1850s
  • Several cases in 1880s-1900s
  • By the 1970s, only about 200 cases in all
  • Now, some psychologists claim that up to 1 of
    the general population has this disorder
  • Individual clinicians are not reporting having
    dozens to hundreds of such clients

32
Dissociative Identity Disorder
  • Explanations for increasing prevalence
  • Increased public awareness of the disorder
  • Changes in the diagnostic criteria for
    schizophrenia
  • Therapists may be actively looking for DID
  • Prevalence, continued
  • Rates very uneven across countries
  • Rates very uneven across clinicians within
    countries
  • The rates of this disorder is very
    controversialsome psychologists doubt its
    existence at all

33
Dissociative Identity Disorder
  • Risk Factors
  • Severe child abuse, especially sexual abuse
    (reported in 95 of cases
  • Remembered or Recovered???
  • Having generous psychiatric medical coverage

34
Dissociative Identity Disorder
  • Question of Validity
  • Studies show differences in psychological test
    results and physiological states between alters
  • Alternative theories
  • Could be due to distinct personalities
  • Could be due to role enactments
  • Extremely heated controversy over iatrogenesis
    vs. natural occurrence (iatrogenesis caused
    by treatment)

35
Dissociative Identity Disorder
  • Can people actually dissociate?
  • Have you had a dissociative experience?
  • Common dissociative experiences
  • Reading a paragraph and then having no
    recollection of what you read
  • Driving somewhere and not knowing how you got
    there
  • Talking to someone and not knowing what youre
    actually talking about

36
Dissociative Identity Disorder
  • Perhaps there is an underlying continuum

Normal Dissociative Experiences
Dissociative Identity Disorder
37
Dissociative Amnesia
  • One or more episodes of inability to recall
    important personal information, usually of a
    traumatic or stressful nature, that is too
    extensive to be explained by ordinary
    forgetfulness
  • Not better explained by a another mental disorder
    and is not due to a GMC or substance
  • Symptoms cause clinically significant distress or
    impairment in functioning

38
Facts about Dissociative Amnesia
  • Prevalence
  • Gender
  • Age of Onset
  • Course

39
Dissociative Fugue
  • Sudden, unexpected travel away from home or ones
    customary place of work, with inability to recall
    ones past
  • Confusion about personal identity or assumption
    of a new identity (partial or complete)
  • Not better explained by a another mental disorder
    and is not due to a GMC or substance
  • Symptoms cause clinically significant distress or
    impairment in functioning

40
Facts about Dissociative Fugue
  • Prevalence
  • Gender
  • Age of Onset
  • Course

41
Depersonalization Disorder
  • Persistent or recurrent experiences of feeling
    detached from, and as if one is an outside
    observer of, ones mental processes or body
  • During the depersonalization experience, reality
    testing remains intact
  • Not better explained by a another mental disorder
    and is not due to a GMC or substance
  • Symptoms cause clinically significant distress or
    impairment in functioning

42
Facts about Depersonalization Disorder
  • Prevalence
  • Gender
  • Age of Onset
  • Course
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