Lecture 13 Flashcards
1
Q
What are some Somatic Symptom Disorders?
A
- Somatic symptom disorder
- Illness anxiety disorder
- Conversion disorder
- Factitious disorders
2
Q
What is Somatic Symptom Disorder?
A
- Soma—meaning “body”
- Preoccupation with health and/or body appearance and functioning
- No identifiable medical condition causing the physical complaints
3
Q
What is Conversion Disorder?
A
- Physical malfunctioning of sensory or motor
functioning - E.g., blindness or difficulty speaking (aphonia)
- Lack physical or organic pathology
- Retain most normal functions, but lack awareness
4
Q
What are the features of Conversion Disorder?
A
- One or more symptoms of altered voluntary motor or sensory function
- Evidence of incompatibility between the symptom and recognized neurological or medical conditions
- The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation
5
Q
What are the statistics of Conversion Disorder?
A
- Rare condition, with a chronic intermittent course
- Often comorbid with anxiety and mood disorders
- Seen primarily in females
- Onset usually in adolescence
- Common in some cultural and/or religious groups
6
Q
What are the causes of Conversion Disorder?
A
- Not well understood
- Freudian psychodynamic view is still common, though
unsubstantiated - Past trauma or unconscious conflict is “converted” to a more acceptable manifestation, i.e., physical symptoms
- Primary/secondary gains
- Freud thought primary gain was the escape from
dealing with a conflict - Secondary gains: attention, sympathy, etc.
7
Q
What is the treatment for Conversion Disorder?
A
- Similar to somatic symptom disorder
- If onset after a trauma, may need to process trauma or treat post traumatic symptoms
- Remove sources of secondary gain
= Reduce supportive consequences of talk about physical symptoms
8
Q
What is illness Anxiety?
A
- Defined by excessive worry about having or developing a serious disease/ illness that has not been diagnosed.
- Persistent anxiety, internet searching, misinterpretation of physical symptoms/bodily sensations.
- Pre occupation with bodily functions
- Death anxiety.
- THEY MAY HAVE ACTUAL SOMATIC SYMPTOMS! They attribute them to having a very serious underlying illness, even if there is no evidence this is the case.
9
Q
What are some risk factors of illness anxiety?
A
- Having a serious childhood illness.
- Experiencing a significant health scare.
- Close family member or friend with a serious illness or death.
- Anxiety disorder diagnosis in the past.
- Family Hx of anxiety disorders.
10
Q
What is the psycho dynamic of illness anxiety?
A
- Unconscious conflicts underlie the disorder
- Unconscious aggressive feelings manifest as physical complaints.
- Undealt with traumatic or frustration during childhood manifest in adult life as symptoms.
- Defense against guilt, sexual or hostile feelings or fantasies.
- Defense used to avoid attendance to actual problems that are too difficult to face.
11
Q
What are some areas of anxiety and/or underlying conflicts?
A
- Trauma. (Remembered in the body)
- Feelings of anger/hostility.
- Feelings of being “trapped” in a situation.
- Loss of control?
- Resolve on a conscious level.
- Object-Relations: Attachment transferred to physical symptoms?
12
Q
What is Factitious Disorder?
A
- Purposely faking physical symptoms
- May actually induce physical symptoms or just pretend to have them
- No obvious tangible external gains
- “malingering” a physical symptoms faked to achieving an objective (e.g., PTO, avoiding military service)
13
Q
What is Factitious Disorder imposed on another?
A
- A form of child abuse where parents or caregivers falsify accounts of illness and and substantiate these accounts by inducing physical symptoms in the child.
- Formerly referred to as Munchausen Syndrome by Proxy
14
Q
What are some distinctions of Factitious Disorder imposed on another from other forms of maltreatment?
A
- Unlike other forms of abuse, psychodynamics of FDIA are used as a pathway to draw attention to the parent/caregiver instead of giving harm.
- The perpetrator INTENTIONALLY induces physical or mental health symptoms in another person- typically a child- most often, their child.
- Rare compared with other types of child maltreatment.
15
Q
What are the facts of Factitious Disorder imposed on another?
A
- Approximately 200 cases per year are reported in the United States.
- There are most likely many more- it involves deception
- Approximately 10 percent of the children die from injuries/illness.
- It appears in all ethnic groups, socioeconomic status and educational backgrounds.
- However, it is known that the actual incidence is higher than this and there might yet be undiagnosed cases.
16
Q
Who is the main perpetrator typically in Factitious Disorder imposed on another?
A
- The perpetrator is typically the child’s mother.
- Affected mothers are usually classified into three groups:
- Active inducers exaggerate the illnesses of their children
- Help seekers use the children to avoid social problems such as domestic violence and unhappy marriage
- Doctor addicts are described as more suspicious and paranoid.
17
Q
what are the statistics of Factitious Disorder imposed on another?
A
- Most female (97.6%) mother (95.6%).
- Married (75.8%).
- Mean age 27.6 years.
- Healthcare-related professions (45.6%)
- Pregnancy/birth complications (23.5%)
- Childhood maltreatment (30%).
- The most common diagnoses of factitious disorder imposed on self (30.9%)
- Personality disorder (18.6%)
- Depression (14.2%)
18
Q
What is the presentation of Factitious Disorder imposed on another?
A
- Symptoms and signs that occur only in the mother’s presence
- A mother who is extremely attentive and always in the hospital
- A child who is frequently intolerant of treatment
- May be seen as a caring parent, however they are causing
symptoms in the child - Injuries include broken bones, giving the child rotten food, injecting them with substances such as urine, chemicals or insulin, purposely infecting wounds by rubbing soil into them
- Can be psychological symptoms as seen in our documentary
- There are no reliable statistics regarding this disorder; however it is estimated that 1% of patients may be suffering with it.
19
Q
What are some of the more common induced illness of Factitious Disorder imposed on another?
A
- Apnea (stopped breathing)
- Feeding problems/anorexia
- Seizures
- Fever/infection
20
Q
What are the tell tale signs of the care giver who is suffering from Factitious Disorder imposed on another?
A
- In public-overly caring and doting.
- In private- disinterested in the child, distracted by other things.
- Comorbid personality disorder- cluster B (not enough research)
- Pseudologia fantastica (Pathological LYING)
- Inappropriate disclosure on social media regarding private medical information about child to gain support and sympathies
- Happiest when child is close to death…Some research suggests.
21
Q
How is Factitious Disorder imposed on another identified and diagnosed?
A
- Inconsistency of the symptoms and the history of the illness
- Inconsistency of the effect of the treatment.
- Calm and insistent about painful medical tests and
procedures - History of sudden death of child.
- History of similar illness in the family.
- Symptoms go away upon separation (the separation test).
- PROTECT THE REMAINING CHILDREN OF THE FAMILY
22
Q
What is the etiology of Factitious Disorder imposed on another?
A
- The exact cause of FDIA is not clear.
- Theories include history of neglect, sexual or emotional abuse when a child.
- Untreated psychiatric disorder such as personality disorder and/or mood disorder.
- Early loss of a parent
- Major stressful event.
- Disrupted attachment
23
Q
If you are suspicious that a caregiver is subjecting their charge with Factitious Disorder imposed on another, what questions should ask?
A
- Is the child’s physical/mental status congruent with what the caregiver is reporting?
- Does objective diagnostic information connect with the reported issues?
- Has anyone else besides the caregiver witnessed the symptoms?
- Do negative test findings reassure the caregiver/mother?
- Is treatment being provided mostly because the caregiver/mother is demanding it?
