Transcript 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
Somatization
 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 changes
 Chronic and fluctuating disorder, rarely fully remits
for extended period of time
Hypochondriasis
 Preoccupation or fear of having a serious disease based
on a misinterpretation of symptom or clinical data
 Anxiety persists beyond reassurance or normal findings
 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
person’s 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 one’s 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 forgetfulness
 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 history
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 one’s
residence and routine with inability to recall some or
all of one’s 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 present
 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
one’s 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