Transcript Somatoform and Factitious Disorders

Somatoform and Factitious
Disorders
Assessment & Diagnosis
SW 593
Introduction
 Somatoform disorders comprise disorders
in which physical concerns are presented
for which no medical basis can be found.
 Infers that the physical symptoms are
associated with psychological factors.
 The production of symptoms is not under
voluntary control.
 Specific diagnoses depend on the number
and kinds of physical symptoms, as well on
the cognitive process that may occur.
Disorders
 Somatization disorder:
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Chronic disorder
Begins before the age of 30
Symptoms varied over time
Four pain symptoms:
 Two stomach or intestinal symptoms
 A sexual symptom
 A pseudoneurological symptom
Disorders
 Somatization disorder (cont.)
 No physical basis has been discovered
 Complaints/impairment exceed what
would be expected based on the general
medical condition
 If diagnosed in the first 6 months;
Undifferentiated Somatoform disorder
would be appropriate.
Disorders
 Conversion Disorders:
 Symptoms/deficits are focused on voluntary
motor or sensory functions:
 Impaired coordination
 Paralysis
 Blindness
 Deafness
 Seizures
 Psychosocial stressor/conflict can be identified.
 Again, not under voluntary control.
 Impairment/distress.
Disorders
 Pain Disorder:
 Distinction is made between pain
disorders in which general medical
conditions are not present or play a
minimal role and those in which both
psychological factors and a general
medical condition seem to be involved.
 Pain is judged to be excessive for the
specific situation.
Disorders
 Hypochondriasis:
 Less focused on physical symptoms and
more focused on fears regarding having
a serious disease.
 Misinterpretation of normal bodily signs
 Chronic and leads to preoccupation with
bodily functions
 Extreme worries is associated
Disorders
 Body Dysmorphic Disorder:
 Preoccupation or fear is based on an
imagined or slight physical anomaly.
Disorders
 Factitious Disorders:
 Are under voluntary control
 Client engages in conscious fabrication,
falsification, exaggeration, and self-infliction of
physical or psychological symptoms.
 Assumes the client is seeking the “sick” role
 If for external gains (economic, avoiding legal
trouble) then rules out these diagnoses
 Not to be confused with Malingering
Disorders
 Factitious disorder by Proxy
(Munchausen by Proxy):
 Production of medical/psychological
symptoms is targeted toward a third
party
 Is currently under the client’s care.
Assessment
 In depth medical screening is the
primary form of assessment.
 Exception: Factitious disorder with
Predominantly Psychological signs
and symptoms.
 Some clients may be sophisticated
enough to feign the psychological
symptoms.
Assessment
 Most commonly used self-report
instruments:
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MMPI-2
MMPI-A
SCL-90-R
Children’s Somatization Inventory
Multidimensional Pain Inventory (MPI)
Illness Attitude Scale (IAS)
 For hypochodriasis
Cultural Considerations
 Type and frequency will be influenced by
cultural factors.
 Majority of persons diagnosed are women.
 Greek and Puerto Rican men also rate high.
 With hypochondriasis and Body Dysmorphic
disorder the rate of prevalence seems to be
equal by gender.
Cultural Considerations
 Somatoform disorders tend to be
presented by individuals who are
considered “unsophisticated”.
 Rural
 Uneducated
 Lower socioeconomic class
 Women have higher rates of
Factitious Disorders but men present
severe and more chronic conditions.