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Somatoform, Factitious and Dissociative Disorders


Rebecca Sposato MS, RN Somatoform Disorders A collection of syndromes where the body experiences mental anxiety as a physical symptom Severe enough to cause distress ... – PowerPoint PPT presentation

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Title: Somatoform, Factitious and Dissociative Disorders

Somatoform, Factitious and Dissociative Disorders
  • Rebecca Sposato MS, RN

Somatoform Disorders
  • A collection of syndromes where the body
    experiences mental anxiety as a physical symptom
  • Severe enough to cause distress and impairment
  • Rule out medical causes
  • Symptoms are not intentionally produced
  • Psychosomatic symptoms are still symptoms, they
    just need psychosomatic care
  • Repression of a conflict
  • Attempt to feel cared for in response to helpless
    with unmet needs

  • A collection of symptoms and impaired bodily
    functions. DSM IV requires
  • Begins before the age of thirty
  • 4 areas of pain head, back, chest, joints etc
  • 2 GI symptoms nausea, cramping, bloating etc.
  • 1 sexual effect ED, dyspareunia, irregular cycle
  • 1 pseudoneurological side effect aphonia,
    vertigo, paralysis, localized weakness, visual
  • Chronic and fluctuating disorder, rarely fully
    remits for extended period of time

  • Preoccupation or fear of having a serious disease
    based on a misinterpretation of symptom or
    clinical data
  • Anxiety persists beyond reassurance or normal
  • Condition lasts over 6 months
  • Causes distress and impairs social and
    occupational abilities
  • Often includes the presence of doctor-shopping
    and a deteriorated doctor-patient relationship
  • Typically do not have better health habits
  • Prevalence of 3 of general population

Pain Syndrome
  • Primary symptom is significant pain without an
    obvious physiological etiology
  • Severe enough to cause distress and impair
    important areas of function
  • Psychological factors contribute to clinical
    picture and features of pain
  • Symptom is not intentionally produced or feigned
    to obtain a substance or other benefit

Body Dysmorphic Disorder
  • Excess preoccupation and distress over
    appearance of a normal or slightly flawed
    physical feature
  • Person engages in time consuming and restricting
    habits in response to the flaw
  • About 10 dermatology and cosmetic surgery
    patients have this disorder

Conversion Disorder
  • Deficit of a voluntary motor or sensory function
    in response to psychological conflict or stressor
  • Not intentionally produced or feigned, although a
    secondary gain is often present
  • Deficits do not follow a natural pathology, but
    the persons concept of a condition
  • Objective clinical data does not support presence
    of condition
  • Normal EEG/EMG, reflexes, labs
  • Most symptoms will remit with time and treatment

Factitious Disorders
  • Intentionally produce symptoms of illness in
    order to assume the sick role.
  • Subjective complaints
  • Dramatic yet vague descriptions of their illness
  • Tamper with objective signs
  • Self inflicted injuries
  • Exacerbate current medical condition
  • Evolving medical history
  • Strongly resistant to confrontation and
    psychological evaluation

Factitious Disorders
  • Munchausen by proxy person will falsify a
    disease in a dependent for ones own
    psychological gain
  • Child abuse
  • Malingering a person is motivated to present as
    ill for a personal or material gain

Dissociative Disorders
  • Disruption in the integration of consciousness,
    memory, identity or perception that cannot be
    explained by injury or disease prcoesses

Dissociative Amnesia
  • Inability to recall important personal
    information of a stressful or traumatic nature
    that is too extensive to be explained by normal
  • Localized failure to recall the events adjacent
    to the circumscribed period of time related to a
    stressful event
  • Selective unable to recall some, but not all,
    specific features of a traumatic event
  • Generalized memory loss covers most of life
  • Continuous memory loss from specific time up to
    the present
  • Systematized memory loss is specific to category

Dissociative Fugue
  • Sudden and unexpected travel away from ones
    residence and routine with inability to recall
    some or all of ones past
  • Loss of personal identity
  • May last hours to months
  • No other obvious pathology or mental impairments

Dissociative Identity Disorder
  • Presence of 2 or more distinct identities or
    personality states that recurrently take control
    of behavior
  • Alternate identities have distinct and often
    stereotypical personal traits and histories
  • Primary identity is unable to recall memories
    obtained when alternate identity is consciously
  • Method of self protection resulting from extreme
    childhood abuse

Depersonalization Disorder
  • Recurrent and intrusive episodes characterized
    by a feeling of detachment from self
  • Describes being removed from sensory input, out
    of ones body or mental processes or environment
  • Person has awareness of the episodes
  • About 1/3 adults will describe a single brief
    depersonalization episode when exposed to life
    threatening event