Somatoform Factitious and Dissociative Disorders Rebecca Sposato MS
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
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