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Somatoform Disorders Mass Psychogenic Illness Malingering

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Malingering Factitious Disorders Munchausen Syndrome Munchausen Syndrome by Proxy Malingering Faking physical illnesses to avoid responsibility or for economic gain ... – PowerPoint PPT presentation

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Title: Somatoform Disorders Mass Psychogenic Illness Malingering


1
Somatoform DisordersMass Psychogenic
IllnessMalingering Factitious
DisordersDissociative Disorders
  • Abnormal Psychology
  • Chapter 8
  • Feb 5-10, 2009
  • Classes 8-9

2
Somatoform Disorders
  • Physical symptoms with an absence of physical
    reasons for the symptoms
  • No physical damage results from the disorder
  • These individuals believe that their illnesses
    are real

3
Psychosomatic Disorders
  • Tension headaches, cardiovascular problems, etc.
    which cause physical damage
  • State of mind appears to be causing the illness

4
Somatoform Disorders
  • Somatization Disorder (Briquets)
  • Pain Disorder
  • Hypochondriasis
  • Body Dysmorphic Disorder
  • Conversion Disorder

5
Somatization Disorder
  • Diagnostic Criteria
  • To be diagnosed a person must have reported at
    least the following
  • Gastrointestinal symptoms (2)
  • Sexual symptoms (1)
  • Neurological symptoms (1)
  • Pain (4 locations)
  • These symptoms cannot be explained by a physical
    disorder

6
Somatization Disorder
  • Sex difference
  • F gt M
  • Primarily a female disorder with about 1
    suffering from this disorder
  • Onset
  • Usually by age 30 but its seen from childhood on
    up
  • Familial tendencies
  • 5 to 10 times more common in female first-degree
    relatives
  • Genetic links to antisocial personality and
    alcoholism

7
A typical scenario
  • Typically, patients are dramatic and emotional
    when recounting their symptoms
  • They are often described as exhibitionistic and
    seductive and self-centered
  • In an attempt to manipulate others, they may
    threaten or attempt suicide

8
These patients doctor-shop
  • Often dissatisfied with their medical care, they
    go from one physician to another
  • What would be a recommended route for these
    patients to choose insofar a medical/mental
    health care is concerned???

9
They usually dont go and further than their
General Practitioner
  • Bottom line
  • Psychologists and psychiatrists rarely manage the
    majority of patients with somatoform disorders --
    this difficult undertaking falls predominantly on
    general practitioners

10
Somatization Disorder Explanations
  • Psychodynamic Explanation
  • Behavioral (Learning) Explanation
  • Physiological (Biological) Explanation
  • Cognitive Explanation

11
Psychodynamic Explanation
  • They have an unconscious conflict, wish, or need
    which is converted to a somatic symptom
  • Pent-up emotional energy is converted to a
    physical symptom
  • They may have identification with an important
    figure who suffered from the symptom
  • They may have the need for punishment because of
    an unacceptable impulse directed against a loved
    one
  • There may be an unconscious somatized plea for
    attention and care from these individuals

12
Learning Explanation
  • A child with an injury quickly learns the
    benefits of playing the sick role
  • Reinforced by increased parental attention and
    avoidance of unpleasant responsibilities

13
Physiological Explanation
  • Genes

14
Cognitive Explanation
  • They do not accept doctors advice
  • Therefore treatment is difficult

15
Treatments
  • Really havent been successful because patient
    usually wont consider their problem as
    psychological
  • In rare cases when individual is receptive to
    treatment, both psychoanalysis and cognitive
    treatments have brought improvement
  • Drug treatments (anti-depressants and
    anti-anxiety meds) are often used to treat some
    of the residual symptoms but are not effective in
    helping with the somatization problems

16
Complications
  • There are several major complications to this
    disorder

17
Etiology
  • Unknown
  • We know it tends to run in families but the cause
    is unknown at this time
  • More research is needed for this one

18
Prognosis
  • Poor
  • Its usually a lifelong disorder
  • Complete relief of symptoms for any extended
    period is rare

19
Pain Disorder
  • The patient complains of pain without an
    identifiable physical cause to explain the
    symptoms the person is complaining about
  • Basically, the same as somatization disorder
    except that pain is the only symptom

20
Body Dysmorphic Disorder
  • Preoccupation with an imagined or minor defect in
    one's physical appearance
  • It is distinguished from normal concerns about
    appearance because it is time-consuming, causes
    significant distress, and impairs functioning
  • Depression, phobias, and OCD may accompany this
    disorder
  • Sex difference Females gt Males
  • Females breasts, legs
  • Males genitals, height, and body hair

21
Symptoms
  • Major concerns involving especially the face or
    head but may involve any body part and often
    shifts from one to another
  • Examples hair thinning, acne, wrinkles, scars,
    eyes, mouth, breasts, buttocks, etc.

22
Elise from First Wives Club
23
Treatments
  • Cognitive-Behavioral
  • Exposure is used to treat phobia-like symptoms
  • Therapy will focus on improving the distorted
    body image that these people possess

24
Treatments
  • Physiological
  • Preliminary evidence that selective serotonin
    reuptake inhibitors may be helpful but data on
    drug treatment is limited
  •  

25
Treatments
  • Family behavioral treatments can be useful
  • Support groups if available can also help
  •  

26
Prognosis
  • Poor
  • Since these individuals are reluctant to reveal
    their symptoms, it usually goes unnoticed for
    years
  • Very difficult to treat as they usually insist on
    a physical cause
  • More research is needed to determine any
    effective treatment for this disorder

27
Hypochondrasis
  • Unrealistic belief that a minor symptom reflects
    a serious disease
  • Excessive anxiety about one or two symptoms
  • Examination and reassurance by a physician does
    not relieve the concerns of the patient
  • They believe the doctor has missed the real reason

28
Hypochondrasis
  • Symptoms adversely affect social and occupational
    functioning
  • Diagnosis is suggested by the history and
    examination and confirmed if symptoms persist for
    at least 6 months and cannot be attributed to
    another psychiatric disorder (such as depression)

29
Hypochondrasis
  • Gender difference
  • More common in women than men (I couldnt find
    any stats though)
  • Onset
  • Usually in 30s
  • But seen in all age groups

30
Treatments
  • Much research suggests a cognitive-behavioral
    combo is best with therapist extremely gentle in
    his/her questioning the patients incorrect
    beliefs

31
Prognosis
  • Its not good (perhaps 5 recover) for the
    following reasons

32
Major Differences between Somatization Disorder
and Hypochondrasis
  • Focus of Complaint
  • Style of Complaint
  • Interaction with Clinician
  • Age
  • Physical Appearance
  • Personality Style

33
Conversion Disorder
  • Sensory/motor dysfunction in the absence of a
    physical basis
  • Symptoms develop unconsciously and are limited to
    those that suggest a neurological disorder
  • Examples numbness of limbs, paralysis, speech
    problems, blindness and hearing loss, difficulty
    swallowing, sensation of a lump in your throat,
    difficulty speaking, difficulty walking, etc.
  • Symptoms are not feigned (as in factitious
    disorder or malingering)
  • Individual is often highly dramatic

34
Conversion Disorder
  • History
  • Was first studied by the Nancy School of Hypnosis
    (Nancy, France) and Freud in examinations of
    hysteria (1880s)
  • Onset
  • Tends to be adolescence to adulthood but may
    occur at any age
  • Sex Difference
  • Appears to be "somewhat" more common in women
  • No stats
  • Prevalence
  • 1 - 3 of general population
  • Tends to occur in less educated, lower
    socioeconomic groups

35
Conversion Disorder Important Characteristics
  • Glove anesthesia

36
Conversion Disorder Important Characteristics
  • Doctor Shop
  • They visit many physicians hoping to find one who
    will propose a physical treatment for their
    non-physical problems
  • La Belle Indifference
  • The tendency of these people to be relatively
    unconcerned about their physical problem

37
Explanations
  • Pure speculation at this point

38
Treatment
  • Hypnotherapy
  • The patient is hypnotized and potentially
    etiologic psychological issues are identified and
    examined
  • Narcoanalysis
  • Similar to hypnotherapy except the patient is
    also given a sedative to induce a state of
    semi-sleep
  • Relaxation training
  • Often combined with cognitive therapy

39
Prognosis
  • No treatment is considered very effective
  •  

40
Mass Psychogenic Illness
  • Also referred to as Mass Hysteria
  • Epidemic of a particular manifestation of a
    somatoform disorder

41
Mass Psychogenic Illness
  • Sex difference F gt M
  • Age Difference Adolescents and children seem to
    be particularly at risk

42
Mass Psychogenic Illness
  • Physicians might consider a group sickness as
    being caused by mass psychogenic illness if
  • Physical exams and tests are normal
  • Doctors can't find anything wrong with the
    group's classroom or office (for example, some
    kind of poison in the air)
  • Many people get sick

43
Mass Psychogenic Illness
  • Symptoms
  • Include the following headache, dizziness,
    nausea, cramps, coughing, fatigue, drowsiness,
    sore or burning throat, diarrhea, rash, itching,
    trouble with vision, anxiety, loss of
    consciousness, etc.
  • Treatment
  • Removing patients from the place where the
    illness started
  • Separate patients
  • Understand that the illness is real
  • Reassure patients that they will be okay

44
Complications
  • Do you see any complications here???

45
Are somatoform disorders real or faked?
  • Malingering
  • Factitious Disorders
  • Munchausen Syndrome
  • Munchausen Syndrome by Proxy

46
Malingering
  • Faking physical illnesses to avoid responsibility
    or for economic gain
  • Seek medical care or hospitalization under false
    pretenses
  • Once they get what they want they usually stop
    all complaining about their alleged problems

47
Factitious Disorders
  • Here, a person is faking symptoms to receive the
    attention and/or sympathy that comes with being
    sick
  • Munchausen Syndrome
  • Munchausen Syndrome by Proxy

48
Munchausen Syndrome (Factitious Disorder By
Proxy)
  • Condition characterized by the feigning of the
    symptoms of the disease in order to undergo
    diagnostic tests, hospitalization, or medical or
    surgical treatment
  • These people (almost always women) fake serious
    symptoms in someone close to them (usually a
    child) to gain attention and sympathy ( a form of
    child abuse)
  •  

49
Munchausen Syndrome by Proxy
  • Signs and tests

50
Munchausen Syndrome by Proxy
  • Treatment
  • Offer parent help rather than accuse them
  • Psychiatric counseling will likely be recommended
  • Family therapy is often helpful if the husband is
    willing
  •  Prognosis
  • This is often a difficult disorder to treat and
    often requires years of psychiatric support

51
Dissociative Disorders
  • Dissociative Amnesia
  • Dissociative Fugue
  • Depersonalization Disorder
  • Dissociative Identity Disorder

52
Dissociative Amnesia
  • Formerly termed Psychogenic Amnesia. Name of
    illness also changed in DSM IV
  • The sudden inability to remember important
    personal information or events
  • Usually begins as a response to intolerable
    psychological stress
  • Very rare (less than 1)

53
Types of Dissociative Amnesia
  • Localized amnesia
  • The person fails to recall events that occurred
    during a particular period of time
  • Selective amnesia
  • The person can recall some but not all of the
    events during a certain time frame
  • Generalized amnesia
  • This lasts throughout a persons entire life
    very rare
  • Continuous amnesia
  • The inability to recall events subsequent to a
    specific time including the present
  • Systemized amnesia
  • The loss of memory for certain categories of
    information

54
Dissociative Amnesia
  • Treatment
  • Therapy can be useful to help with coping but is
    not always needed
  • Often, they become disoriented and may forget who
    they are but usually the amnesia vanishes as
    abruptly as it began

55
Dissociative Fugue
  • Formerly termed Psychogenic Fugue
  • Name of illness also changed in DSM IV
  • An episode during which an individual leaves his
    usual surroundings unexpectedly and forgets
    essential details about himself and his lives
  • It is very rare, with a prevalence rate of about
    0.2 in the general population

56
Symptoms
  • Sudden and unplanned travel away from home
    together with an inability to recall past events
    about one's life

57
Cause
  • Is usually triggered by traumatic and stressful
    events, such as wartime battle, abuse, rape,
    accidents, natural disasters, and extreme
    violence, although fugue states may not occur
    immediately

58
Treatment
  • Psychoanalysis
  • Cognitive therapy ("creative therapies")
  • Hypnotherapy
  • Medications
  • Family therapy

59
Depersonalization Disorder
  • These individuals report feeling detached from
    their mental processes or body
  • Occurs in as many as 30 of normal individuals at
    some time
  • Only constitutes a disorder if it interferes with
    a persons functioning

60
Cause
  • As with other disorders in this category, an
    acute stressor is often the precursor to onset

61
Symptoms
  • This disorder is characterized by feelings of
    unreality, that your body does not belong to you,
    or that you are constantly in a dreamlike state
  • Symptoms are most common between 25-44

62
Treatment
  • The disorder will typically dissipate on its own
    after a period of time
  • Therapy can be helpful to strengthen coping skills

63
Prognosis
  • Prognosis is very good

64
Dissociative Identity Disorder
  • Commonly referred to as Multiple Personality
    Disorder
  • Very rare Less than 1.
  • A person alternates between two or more distinct
    personality systems
  • Usually there is a main or basic personality
  • Sex difference F gt M (9 to 1 ratio)

65
Symptoms
  • The individual may change from one personality to
    another in a matter of a few minutes to several
    years (shorter time frames are more common)
  • The personalities are often dramatically
    different

66
Complications
  • Sleep disorders
  • Night terrors and/or sleep walking
  • Alcohol and drug abuse
  • OCD-like rituals
  • Eating disorders
  • Depression
  • High suicide rate

67
Probably the 1 Hollywood Disorder
68
Important Note
  • Until 1970's extremely rare with few reported
    cases (about 100) but since then its prevalence
    has increased dramatically.
  • Why this dramatic increase???

69
Dissociative Identity Disorder
  • Treatment
  • Psychoanalysis -- try to give therapy to the
    main personality who "knows" the others
  • Prognosis
  • Not good
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