1. Somatoform Disorders When Inner Conflict Leads to the Unconscious production of Physical Symptoms

2. Somatoform Disorders Somatization Disorder Somatization Disorder Conversion Disorder Conversion Disorder Pain Disorder Pain Disorder Hypochondriasis Hypochondriasis Body Dysmorphic Disorder Body Dysmorphic Disorder

3. What is Somatization? What is Somatization? Experiencing physical distress/symptoms in response to mental/emotional conflict Experiencing physical distress/symptoms in response to mental/emotional conflict Seeking medical attention for that physical distress Seeking medical attention for that physical distress

4. Somatization Disorder: DSM-IV Criteria Seeking treatment for many physical complaints, with onset before age 30 Seeking treatment for many physical complaints, with onset before age 30 Four pain symptoms Four pain symptoms Two gastrointestinal symptoms Two gastrointestinal symptoms One sexual symptom One sexual symptom One pseudoneurological symptom One pseudoneurological symptom The symptoms are NOT intentionally produced The symptoms are NOT intentionally produced

5. Conversion Disorder: DSM-IV Criteria One or more symptoms affecting voluntary motor or sensory function One or more symptoms affecting voluntary motor or sensory function Resembles neurological or medical disease Resembles neurological or medical disease Psychological factors must be involved Psychological factors must be involved The symptoms are NOT intentionally produced The symptoms are NOT intentionally produced

6. Where does the concept of “Conversion” come from? Freudian term Freudian term Patients noted to “convert” psychic conflict into bodily symptoms as a defense mechanism Patients noted to “convert” psychic conflict into bodily symptoms as a defense mechanism Commonly association with trauma Commonly association with trauma

7. Examples of Conversion Symptoms Sensory Sensory –Double vision (diplopia) –Blindness –Deafness –Numbness Motor Motor –Paralysis –Difficulty swallowing (dysphagia) –Difficulty walking (ataxia) –Tremor –Inability to talk (aphonia) –Seizures (Pseudoseizures)

8. Pain Disorder: DSM-IV Criteria One or more sites of pain as primary focus One or more sites of pain as primary focus Pain causes significant impairment Pain causes significant impairment Psychological factors are felt to have an important role in the pain Psychological factors are felt to have an important role in the pain The symptom is NOT intentionally produced The symptom is NOT intentionally produced

9. Hypochondriasis: DSM-IV Criteria Preoccupation with fears of having a serious disease based on misinterpretation of bodily sensations Preoccupation with fears of having a serious disease based on misinterpretation of bodily sensations Preoccupation goes on despite medical evaluation and reassurance (poor insight) Preoccupation goes on despite medical evaluation and reassurance (poor insight) Duration is at least six months Duration is at least six months

10. Hypochondriasis: Associated Features Serious childhood illnesses and past experience with illness in a family member are common Serious childhood illnesses and past experience with illness in a family member are common “Doctor-shopping” and costly medical work-ups are common “Doctor-shopping” and costly medical work-ups are common Appears equally common in men and women Appears equally common in men and women

11. Body Dysmorphic Disorder: DSM-IV Criteria Preoccupation with an imagined defect in appearance Preoccupation with an imagined defect in appearance If the individual already has a mild physical “flaw,” the concern surrounding it is excessive If the individual already has a mild physical “flaw,” the concern surrounding it is excessive

12. Body Dysmorphic Disorder: Associated Features Frequent inspection of the “defect” can consume many hours a day, lead to suicidal thoughts Frequent inspection of the “defect” can consume many hours a day, lead to suicidal thoughts Insight is often poor- can become delusional Insight is often poor- can become delusional Medical and surgical treatments are often pursued Medical and surgical treatments are often pursued High prevalence in cosmetic surgery and dermatology clinics High prevalence in cosmetic surgery and dermatology clinics

13. Factitious Disorder “I know I’m producing my symptoms, but I don’t understand why”

14. Factitious Disorder: DSM-IV Criteria Intentional production of physical or psychological signs and symptoms Intentional production of physical or psychological signs and symptoms The motivation for the behavior is to assume the sick role (primary gain) The motivation for the behavior is to assume the sick role (primary gain) External incentives (such as economic gain, or avoiding responsibilities) are absent (ie, no secondary gain) External incentives (such as economic gain, or avoiding responsibilities) are absent (ie, no secondary gain)

15. Examples of methods to produce Factitious symptoms

16. Factitious Disorder: Associated Features Often involves multiple hospitalizations at multiple sites Often involves multiple hospitalizations at multiple sites Invasive procedures and surgery Invasive procedures and surgery Usually have few visitors while in the hospital Usually have few visitors while in the hospital Patients often have extensive knowledge of medical terminology (health care workers, etc.) Patients often have extensive knowledge of medical terminology (health care workers, etc.)

17. Munchausen Syndrome? Another term for Factitious Disorder Another term for Factitious Disorder Baron Von Munchausen was a fictional eighteenth-century character known for story-telling, exaggeration and frequent travel Baron Von Munchausen was a fictional eighteenth-century character known for story-telling, exaggeration and frequent travel

18. Munchausen by Proxy Parent induces illness in a child (most common) Parent induces illness in a child (most common) The child is repeatedly hospitalized as a result The child is repeatedly hospitalized as a result This is abuse (a crime, NOT a mental illness) This is abuse (a crime, NOT a mental illness)

19. Malingering “I’m faking it, I know it, and I’m getting something out of it”

20. Malingering Intentional production of false or exaggerated physical or psychological symptoms Intentional production of false or exaggerated physical or psychological symptoms The malingerer is aware that he is producing the symptoms for gain (secondary gain) The malingerer is aware that he is producing the symptoms for gain (secondary gain)

21. In Summary…