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Somatoform, Factitious


Chronic multiple symptoms that do not have an adequate explanation ... Total environment allergy syndrome. Chronic Fatigue Syndrome. Other. Factitious Disorder ... – PowerPoint PPT presentation

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Title: Somatoform, Factitious

Somatoform, Factitious Dissociative Disorders
  • RCS 6931
  • June 14, 2007
  • Steven R. Pruett, Ph.D.

Somatoform Disorders
  • Physical symptoms and health concerns that are
    psychogenic in nature.
  • Symptoms
  • Excessive or chronic pain
  • Conversion symptoms
  • Suggests a neurological deficit where there is
    evidence that one does not exist
  • Chronic multiple symptoms that do not have an
    adequate explanation
  • Complaints that do not improve despite treatment
    that helps most patients
  • Excessive concern with health or body appearance
  • Individuals with Somatoform Disorders are NOT
  • Thats a different disorder.

Somatoform Disorders
  • Individuals with Somatoform Disorders usually
    have been evaluated for a physical disease.
  • These usually involve expense tests and time
    consuming treatments that are ineffective and
    sometimes dangerous.
  • These individuals often have other mental
    disorders or can form other mental disorders.

Somatoform Disorders
  • Other causes of Somatic Complaints
  • General Medical Condition
  • Mood Disorder
  • Substance Use
  • Factitious Disorder
  • Malingering

Somatoform Disorders
  • Somatization Disorder
  • Undifferentiated Somatoform Disorder
  • Conversion Disorder
  • Pain Disorder
  • Hypochondriasis
  • Body Dysmorphic Disorder
  • Somatoform Disorder NOS

Conversion Disorder 300.11
  • Relatively rare (about 1 in 10,000)
  • Usually a disorder of young people and more
    common in women than men.
  • Requires a clinicians judgment that
    psychological factors play an important role the
    development/maintenance of the symptoms
  • Conversion symptom defined as
  • A change in how the body functions when
  • No causative physical or physiological
    malfunction can be found and
  • An emotional conflict seems to play some role in
    the development of the symptom.
  • Diagnostic Criteria
  • Morrison p. 291 DSM-IV-TR p. 498.

Somatization Disorder 300.81
  • People with Somatization Disorder have a pattern
    of numerous physical and emotional symptoms that
    last for years.
  • Symptoms affect various parts of the body such.
  • Symptoms must include at least pain,
    gastrointestinal, sexual and pseudoneological.
  • One of the oldest mental health diagnoses
  • Ancient Greeks believed that it originated in the
    uterus and wandered through the body.
  • Begins in teens or early 20s and can last for
    years. Condition affects about 1 of all women,
    but only rarely occurs in men.
  • Diagnostic Criteria
  • Morrison p. 294-295 DSM-IV-TR p. 490.

Undifferentiated Somatoform Disorder 300.82
  • Individuals who dont quite meet all the criteria
    for a Somatization Disorder but their symptoms
    suggest that disorder.
  • Usually with time they can be reclassified as
    having a Somatization Disorder.
  • Diagnositic Criteria
  • Morrison p. 298 DSM-IV-TR p. 492

Pain Disorder 307.8x
  • Pain is the predominant focus of the clinical
  • Some problems with this disorder
  • Like Conversion Disorder, Pain Disorder requires
    a clinicians judgment that psychological factors
    play an important role the development/maintenance
    of the symptoms
  • problem with inter-rater reliability
  • Subjectivity of Pain.
  • Most often diagnosed in women and usually begin
    in 30s and 40s often following an accident
  • Can occur as having only a psychological origin
    as well as being associated with a General
    Medical Condition or both.
  • Diagnostic Criteria
  • Morrison. p 300 DSM-IV-TR p. 503.

Hypochondriasis 300.7
  • Preoccupation with fears of having or the idea of
    having a serious disease on a misinterpretation
    of one or more bodily signs or symptoms.
  • Hypochondriasis has been around for very long
    time, but it has never been studied well. DSM-IV
    says is exists in 1-5 of general population.
  • Diagnostic Criteria
  • Morrison p. 304 DSM-IV-TR p. 507

Body Dysmorphic Disorder 300.7
  • Individuals are concerned that there is something
    wrong with the appearance or shape of a body
  • E.g. breasts, nose, genitalia etc.
  • Not delusional just overvalued ideas.
  • Patients are very concerned about their physical
  • Diagnostic Criteria
  • Morrison p. 307 DSM-IV-TR p. 510

Somatoform Disorder NOS 300.82
  • For individuals that dont meet the criteria for
    other Somatoform Disorders yet have somatic
    symptoms that have a strong psychological
  • Psuedocyesis False pregnancy
  • Transient hypochondriacal states
  • Total environment allergy syndrome
  • Chronic Fatigue Syndrome
  • Other

Factitious Disorder
  • Physical or psychological symptoms that are
    intentionally produced or feigned to assume a
    sick role.
  • Can fabricate subjective complaints, feign
    general medical conditions, falsify objective
    signs, or self-inflict various conditions.
  • No external incentives for the behavior is

Factitious Disorder
  • Usually these individuals are dramatic in their
    presentation, but are vague and inconsistent when
    questioned in detail.
  • When confronted with evidence that their symptoms
    are factitious they usually deny the allegation
    or rapidly discharge themselves against medical
    advice only to be admitted to another hospital
    soon thereafter.

Factitious Disorder
  • Subtypes
  • With Predominantly Psychological Signs Symptoms
  • Feigning a mental disorder
  • With Predominantly Physical Signs Symptoms
  • Feigning a General Medical Condition
  • Münchanusens syndrome
  • Combined Psychological and Physical Signs
    Symptoms 300.19

Factitious Disorder NOS 300.19
  • Other disorders with factitious symptoms that
    dont meet the criteria for Factitious Disorder
  • E.g. Münchanusens syndrome by proxy

Malingering V65.2
  • Similar to Factitious Disorders but
  • The motivation for this intentional production of
    false physical or psychological complaints has an
    external component such as
  • Financial gain
  • Evading criminal prosecution
  • Obtaining drugs
  • Avoiding military duty

Dissociative Disorders
  • Some of the patients thoughts, feelings, or
    behaviors were removed from conscious awareness
    or control.
  • Dissociative Disorders
  • Usually being and end suddenly
  • Episodes are often precipitated by psychological
  • Rare, but may be increasing
  • In most these disorders there is a profound
    disturbance of memory
  • Impaired functioning or a subjective feeling of
    distress is required only for Dissociative
    Amnesia, Dissociative Fuge, and Depersonalization

Dissociative Disorders
  • Dissociative Amnesia
  • Dissociative Fuge
  • Dissociative Identity Disorder
  • Depersonalization Disorder
  • Dissociative Disorder NOS

Dissociative Disorders
  • Other causes for severe memory loss besides
    Dissociative Disorders
  • PTSD
  • Acute Stress Disorder
  • Substance-Induced Disorders
  • Somatization Disorder
  • Sleepwalking Disorder
  • Malingering

Dissociative Amnesia 300.12
  • Formerly called Psychogenic Amnesia
  • Patient must have forgotten something important
  • Other Axis I disorders must be ruled out

Dissociative Amnesia
  • Patterns of Dissociative Amensia
  • Localized (or Circumscribed)
  • Patient has no recall for none of the events
    during a particular time
  • Selective
  • Certain portions of a time period have been
    forgotten pretty rare
  • Generalized
  • All experiences during patient entire life have
    been forgotten
  • Continuous
  • Patient forgets all events from a given time
    forward to the present
  • Systematized
  • Patient has forgotten certain classes of
    information such as that relating to family or

Dissociative Amnesia
  • Usually begins after a traumatic event or severe
  • After some time the amnesia suddenly ends with a
    complete restoration of memory.
  • It is rare for Dissociative Amnesia to occur
    again in the same individual
  • Diagnostic Criteria
  • Morrison p. 320 DSM-IV-TR p. 523

Dissociative Fuge 300.13
  • Formerly known as Psychogenic Fuge
  • Sudden, unexpected travel away from home or
    customary place of daily activities with an
    inabilty to recall some or all of ones past
  • Accompanied by confusion of personal identity or
    even assumption of new identity
  • Very rare stuff of novels and movies
  • Diagnostic criteria
  • Morrison p. 322 DSM-IV-TR p. 526

Dissociative Identity Disorder 300.14
  • Formerly Multiple Personality Disorder
  • Essential feature of DID is presence of two or
    more distinct identities or personality states .
  • There is an inability to recall important
    personal information the extent of which is too
    great to be explained by ordinary forgetfulness
  • Failure to integrate various aspects of identity,
    memory, and consciousness. Each personality
    state may be experienced as if it has a distinct
    personal history, self-image, and identity
    including a separate name.

Dissociative Identity Disorder
  • Many more case of DID in North America vs.
  • Is this because of the attention patients with
    DID get from mental health professionals in North
    America? European Mental Health professional
    indicate they do not make a big deal about DID
    when presented with a case.
  • Diagnositic Criteria
  • Morrison p. 325-326 DSM-IV-TR p. 529

Depersonalization Disorder 300.6
  • The sense of being cut off or detached from ones
  • Viewing ones own mental processes or behavior as
    in a dream.
  • Persons with this condition often experience
  • The external world is unreal or odd.
  • Episodes of depersonalization are often
    precipitated by stress. They begin and end
  • Diagnostic Criteria
  • Morrison p. 329 DSM-IV-TR p. 532

Dissociative Disorder NOS 300.15
  • For all disorders in which the predominate
    feature is a dissociative symptom that does not
    meet the criteria for a specific Dissociative
  • See examples in Morrison p. 331 DSM-IV-TR p.