1. Rebecca Sposato MS, RN

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Dissociative Disorders Disruption in the integration of consciousness, memory, identity or perception that cannot be explained by injury or disease prcoesses

11. 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

12. 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

13. 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

14. 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