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Somatoform Disorders

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Can not be 'disproved' by medical tests. Often vague, resistance to treatment ... asthma (mild), headaches (including migraine), back pain, hypoglycemia (in ... – PowerPoint PPT presentation

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Title: Somatoform Disorders


1
Somatoform Disorders
  • Physical symptoms lacking medical cause
  • Or in excess of physical problem
  • Conversion of stress
  • Symptoms depend on medical sophistication of
    individual
  • Ex. glove paralysis
  • Not Malingering
  • Faking for gain

2
Non-falsifiable medical symptoms
  • Can not be disproved by medical tests
  • Often vague, resistance to treatment
  • Person makes little effort to overcome
  • Possible examples CFS, IBS, asthma (mild),
    headaches (including migraine), back pain,
    hypoglycemia (in absence of supporting medical
    tests), weakness, dizzy spells, etc.

3
Somatization Disorder
  • At least 4 sets of health related symptoms
  • 2 gasto (i.e. nausea, IBS)
  • Sexual symptoms
  • Neurological (weakness, dizziness, etc.)
  • pain
  • Often other non-falsifiable symptoms
  • Used to avoid life tasks
  • Dr. visits
  • Moderate somatization common
  • stress headaches

4
Causes treatment
  • Runs in families
  • Genetic or environmental?
  • More common in Latin/Asian cultures
  • Treatment
  • Prognosis poor.why?
  • Avoid catastrophizing medical symptoms
  • Diet changes can help some (ex. IBS)
  • Found in less than 1 of US population

5
Hypochondraisis
  • Unrealistic exaggeration of health symptoms
  • i.e. flu symptoms Anthrax
  • Focus on health concerns
  • Worry about future illness
  • Preventative measures
  • Ex. Excessive, diet, exercise, vitamines
  • Unnecessary medication/surgery
  • No treatment
  • Prevalence less than 1

6
Conversion Disorder (Hysteria)
  • Convert emotional distress to physical symptoms
    (usually neurological)
  • Deafness, blindness, paralysis
  • Reflexes still intact
  • Beautific (or Euphoric) indifference
  • Placebo treatments
  • Very rare
  • Mass psychogenic illnesses
  • 1989 kids in H.S. auditorium
  • Tarantella

7
Body Dysmorphic Disorder
  • Obsessed with exaggerated disfigurations
  • Weight, scars, imperfections, hair loss, etc.
  • Often restrict social activities
  • Treatment similar as to OCD
  • Comorbid anxiety/depression common
  • CBT treatment and SSRIs

8
Factitious Disorder
  • Munchausen's Syndrome
  • Medical Symptoms and attention
  • By Proxy
  • Waneta Hoyt Steinschneider

9
Malingering
  • Purposeful falsification of medical/psychological
    symptoms for personal gain
  • Why would one do that?
  • Identifying malingering
  • MFAST
  • TOMM
  • atypical responses

10
Dissociative Disorders
  • Dissociative Symptoms
  • Feelings of unreality, loss of appropriate
    emotion, disconnection with identity
  • Fairly common, particularly under stress
  • Psychological shock can involve dissociation
  • Altered states experiments
  • Many diagnoses are controversial

11
DID (MPS)
  • Dissociation from parts of personality
  • Controversial diagnosis (malingering, BPD, naïve
    therapists?)
  • Popularized by Sybil
  • Remains largely psychoanalytic in theory
  • Response to early, repeated childhood trauma
  • Controversial nature of trauma itself

12
DID Part 2
  • The Core
  • Secondary personality
  • Helper personalities
  • Amnesia, self-mutilation not uncommon
  • Therapy reintegration of personalities
  • Prevalence less than 1, more often in women

13
The controversy
  • Media presentations of DID
  • Dissociation or bad acting?
  • Majority of cases diagnoses by tiny fraction of
    therapists
  • Easy to Malinger
  • Kenneth Bianci

14
Psychogenic (Dissociative) Amnesia
  • Most common D.D.
  • Reaction to stressful event
  • Stress hormones (cortisol, adrenaline) interfere
    with encoding?
  • Distinct from neurological amnesia due to injury
  • No guarantee psychogenic amnesia will recover
  • Anterograde (rare for psychogenic) vs. retrograde
    amnesia
  • Also easy to malinger in criminal cases

15
Psychogenic (Dissociative) Fugue
  • Person suddenly abandons identity
  • May move and take up new identity
  • Claims no memory of previous identity
  • Often response to chronic stress
  • Very rare
  • Treated similarly as DID

16
Problems with the dissociative disorders
  • Easy to malinger
  • Linked closely with psychoanalytic theory
  • Use of hypnosis in diagnosing them
  • Linked with the repressed memory debate
  • Validity of these diagnoses remains controversial
  • Less than ¼ of psychologists/psychiatrists
    believe they are valid
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