Transcript This is Where You Type the Slide Title

differences
(a psychological conflict converted into a physical problem)
SOMATIZATION DISORDERS
Hysterical
Preoccupation
conversion disorder
somatization disorder
pain disorder
hypochondriasis
BDD
suffer changes in
physical functioning
misinterpret/overreact to
body symptom or
features
purposely faking
these are NOT somatization disorders
Why do it?
factitious
disorder
to play the sick role; attn
malingering
to gain profit or avoid
work/jail time
conversion disorder
DIAGNOSTIC CRITERIA
• 1+ sensory or voluntary motor deficit
• an associated stressor
e.g. blindness, numbness, paralysis, gait,
seizures, deafness, mutism
STATS
• .005% prevalence
• onset: at time of extreme stress
• sex ratio: 2-10:1
• course: resolves w/in 2 weeks after stressor
conversion disorder
CAUSE
a trauma where escape was needed but
running away was not possible or acceptable
(major mood disorder + severe stress event)
TREATMENT
• therapy for original trauma
• exposure to stimuli that “produce” symptoms
• do not reinforce with attention
• positive reinforcement when deficits go away
• SSRIs
somatization disorder
DIAGNOSTIC CRITERIA
before 30 yrs old, years of many long-lasting
physical complaints (in excess or not
explainable by GMC):
• 4 pain
• 2 gastro-intestinal
•1 sexual
•1 neurological/sensory/motor
(just symptoms, not worried about a specific
disease)
somatization disorder
STATS
• prevalence 4%
• sex ratio: 2:1
• onset: adolescence
• course: chronic
• low SES, low edu, unmarried
• runs in families (10-20% close female
relatives are concordant)
somatization disorder
CAUSE
(genes for ASPD)
impulsiveness – short term gain (attn)
– long term probs (social isolation)
pleasure-seeking – provocative sexual behavior
TREATMENT
teach how to interact & relate to others w/o relying
on conversations about symptoms
pain disorder
DIAGNOSTIC CRITERIA
• pain in 1+ sites
• not faked
• associated w/ a stressor
STATS
• 5-12% prevalence
• onset: any
• can start from condition w/ real pain but persists
TREATMENT
• cognitive therapy & relaxation
hypochondriasis
DIAGNOSTIC CRITERIA
• 6+ months
• preoccupied that has serious disease despite
medical reassurance otherwise
STATS
• prevalence 1-5%
• sex ratio: 1:1
• onset: early adulthood; trimodal (14,45,60+)
• course: chronic but waxes & wanes
hypochondriasis
CAUSE
• modeling reinforcement by escaping
circumstances, classical conditioning, cognitive
misinterpretation of interoceptive sensation
TREATMENT
• SSRIs
• cognitive therapy
body dysmorphic disorder
DIAGNOSTIC CRITERIA
• preoccupied w/ imagined defect or excessive
concern over a defect
STATS
• 1-5% prevalence
• sex ratio: 1:1
• onset: adolescence to 20’s
• 30% are housebound, 17% attempt suicide
• 50% comorbid w/ depression
body dysmorphic disorder
TREATMENT
• SSRIs
• exposure & response prevention helps 80%
• cognitive therapy
ADDITIONAL DIAGNOSIS
If firmly held, get “Delusional Disorder, Somatic Type”
purposely faking
MALINGERING (external incentive)
• avoid military duty
• avoid incarceration
• avoid work
• gain insurance or lawsuit money
purposely faking
FACTITIOUS DISORDER
Wants attention & sympathy
associated features:
• childhood exposure to extensive med treatment
• childhood abuse or disruption
• grudge against medical profession
• worked in medical profession
• dependent personality
• no social supports
dissociative disorders
(disruption in conscious awareness, perception, memory, or identity )
Dissociative
Amnesia
conscious awareness &
memory
Depersonalization
Disorder
DID
conscious awareness &
perception
conscious awareness,
memory, & identity
depersonalization disorder
DIAGNOSTIC CRITERIA
recurrent sense of detachment from thoughts or
body (causes distress or impairment)
MISC
• depersonalization and/or derealization
• mostly case study research
• decreased emotional responsiveness
• no treatments effective
STATS
• 1% prevalence
• onset: 23 yrs average
• course: chronic
dissociative amnesia
DIAGNOSTIC CRITERIA
1+ episodes of memory loss (usually of trauma)
(causes distress or impairment)
“generalized” – no memory for ANYTHING including
own identity
“localized” – a.k.a. “selective”, can’t recall specific
events or time period
TREATMENT
• remove from threatening situation, hypnosis,
tranquilizers with therapy
dissociative fugue
DIAGNOSTIC CRITERIA
• sudden, unexpected travel from home/work
w/ dissociative amnesia
• confusion about identity (maybe new identity)
TREATMENT
• same
dissociative identity disorder
DIAGNOSTIC CRITERIA
• 2+ identities that recurrently take control
• memory lapses
MISC
• identity, conscious awareness, & memory is
fragmented
• “alters”, “host”, & “switching”
• alters are not full personalities
• sex ratio: 3-9:1
dissociative identity disorder
CAUSE
Post Traumatic Theory:
• repeated traumatic abuse as child & autohypnotic
dissociation as defense
• develops by 9 yrs old (after PTSD likely)
Socio Cognitive Theory:
• highly suggestible person learns to adopt & enact
roles of identities due to clinician suggesting &
reinforcing them
TREATMENT
reintegrate identities, hypnosis, show client videotape
of alters