Somatoform Disorders Flashcards
Somatoform disorder definition
- broad group of illnesses that have bodily signs as a major component
- pt’s with these believe their suffering come from some type of presumably undetected and untx’d bodily derangement
Factitious disorder
- conscious feigning of illness/sx’s for primary gain
- intentional production of physical and psych sx’s including self inflicted cndtns mainly to gain the emotional care and attn that comes with playing the role of the pt
- **no external incentives present
Munchauser syndrome
pt’s embellish personal history, psychiatric sx’s to gain hospital admission; move from hospital to hospital
Factitious disorder by proxy
- intentional production or feigning of physical/psych sx’s in another person who is under an individual’s care
- **usually mother and child
Factitious tx
-supportive confrontation, inpatient hospitalization
Malingering
- conscious feigning of sx’s for obvious recognizable environmental goal : get out of jail/work, get money
- can stop producing S/S when they are no longer profitable or risk is too great
Dissociative disorder essential features
-disruption in the usually integrated fxns of consciousness, memory, identity or perception of the environment
Dissociative amnesia
- inability to recall important personal info, usually of a traumatic and stressful nature, that is too extensive to be explained by ordinary forgetfulness
Dissociative amnesia main cause
trauma or stressful event
Dissociative amnesia tx
-patience and hypnotherapy
Dissociative fugue features
- unexpected travel away from home or one’s customary place of work, with inability to recall one’s past
- confusion about personal identity or assumption of new identity
Main cause of Dissociative fugue
- due to tramatic circumstance, leading to an altered state of consciousness dominated by a wish to flee
- other causes: pts are struggling with extreme emotions or impulses that are in conflict with pts’s conscience or ego ideals
Dissociative fugue tx
patience, hypnotherapy, elective psychodynamically oriented therapy
Dissociative identity disorder DSM IV criteria:
- aka: Multiple personality disorder
- DSM IV criteria:
1) presence of 2+ distinct identities or personality states ( each with its own relatively enduring pattern of perceiving, relating to, and thinking about environment and self)
2) at least o2 of these identities or personality states recurrently take control of the person’s behavior
3) Inability to recall important personal info that is too extensive to be explained by ordinary forgetfulness
Dissociative Identity disorder features
- begins in childhood
- usually 10 personalities
- usually develop to help child develop with recurrent abuse
- personality states or identities referred to as alters, self-states, parts
Dissociative identity disorder tx
- psychotherapy (psychoanalytic, behavioral, cognitive therapy)
- hypnotherapy
- meds to decrease depression and stabalize mood
Body Dysmorphic D/o clinical features
- preoccupation with an imagined or grossly exaggerated defect in appearance that causes significant distress or impairment in areas of fxn’ing
- Women > men
- onset is adolescence but mean age of dx is 30 y/o
- comorbid with depression, anxiety and psychosis
Body dysmorphic tx
-CBT and SSRIs (clomipramine or fluoxetine)
Conversion disorder clinical features
- short course with sudden onset and resolution (90% resolve in few days)
- 2 to 3 times more common in women than men
- onset is adolescence or early adulthood
- more common in rural, low education or low SES
Conversion disorder Diagnosis
- symptoms or deficits that affect voluntary motor or sensory fxns; illness is preceded by conflicts or other stressors
- sx’s suggest a neuro or medical cndtn but not cndtn can explain the ax’s
- sx’s occur after conflicts or stressors
Common Conversion Disorder sx’s
- involuntary mvmnts
- tics
- torticollis
- seizures
- abnormal gait
- paralysis or weakness
- anesthesia
- blindness
- deafness
- psychogenic vomiting
- syncope
- urinary retention
- diarrhea
Conversion disorder rx
- usually have spontaneous recovery
- supportive therapeutic rltnshp
- suggestion tx
- sodium amytal
Hypochondriasis dx
- 6 months or more of a general and non delusional preoccupation with fears of having or idea that one has, a serious dz based on the person’s misinterpretation of bodily ax’s
- cannot have intensity of delusion or restricted to distress about appearance
Hypochondriasis clinical features
- onset is young adulthood, 20-30 y/o
- 4-10% medical pts
- no gender bias
- cannot be persuaded and will remain despite negative phys exam and lab results
Hypochondriasis tx
- group psychotherapy
- SSRI: only when have drug responsive cndtn
Somatization disorder dx:
- illness of somatic complaints in multiple organ systems that occurs over a period of several yrs and results in significant impairment or treatment seeking or both
- must have 4 pain, 2 GI, 1 sexual, 1 pseudoneuro
- sx’s cannot be explained by medical cndtn
4 pain, 2 GI, 1 sexual, 1 pseudoneuro =
- 4 pain of the: head, abdomen, back, joints, chest, extremities, rectum, during menstruation, sex or urination
- 2 GI: nasuea, bloating, vomiting, diarrhea
- 1 sexual: sexual indifference, ED, irregular menses, excessive menstrual bleeding
- 1 pseudoneuro: impaired coordination/balance, paralysis, or localized weakness, aphonia, urinary retention, loss of touch/pain sensations, seizures, blindness/deafness
Somatization disorder differs from other somataform disorders by:
-multiplicity of complaints and multiple organ systems affected
Somatization disorder tx:
- mainly psychotherapy
- regular appnts are helpful
Somatoform pain disorder
- characterized by a presence of and focus on, pain in one or more body sites and sufficiently severe to come to clinical attn
- diagnostic focus is on the importance of psychological factors and degree of impairment caused by the pain
Somatoform pain disorder tx
- psychodynamic therapy
- antidepressants: TCAs, SSRIs
