2.  Soma = Body  Preoccupation with health or appearance  Physical complaints  No identifiable medical condition

3.  Types of disorders:  Somatic symptom disorder (somatization D/O)  Illness anxiety disorder (hypochondriasis)  Psychological Factors affecting medical condition  Conversion disorder  Factitious disorder

4.  formerly Briquet’s syndrome  Continually feel weak and ill  Severe pain  Physical symptoms

6.   formerly known as hypochondriasis”   Less concerned with any specific physical symptom and more worried about the idea that she/he was either ill or developing an illness   Reassurances from numerous doctors ____________________

7.  Statistics  1% to 5% prevalence  6.7% median prev of medical patients  Female : Male = 1:1  Onset at any age  Peaks: adolescence, middle age, elderly  Chronic course

9.  Disorder of cognition or perception  Physical signs and sensations  Cause is unlikely to be found in isolated biological or psychological factors  Familial history of illness and learning  Three factors that may contribute to etiology  _______________________________  High family disease incidence  _______________________________

10.  Psychodynamic  ___________________________  Limited efficacy data  Educational & supportive  _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

11.  Cognitive-behavioral  Identify and challenge misinterpretations  “Symptom creation” – enhance control and empowerment  Stress-reduction

12.  The essential feature of this disorder is the presence of a diagnosed medical condition such as asthma, diabetes or severe pain  Behavioral or psychological factors would have a direct influence on the course or perhaps the treatment of the medical condition

13. Conversion Disorder Functional Neurological Symptom Disorder: Conversion Disorder  Conversion disorders generally have to do with physical malfunctioning, such as paralysis, blindness, or difficulty speaking (aphonia), without any physical or organic pathology

14. Conversion Disorder   Clinical description  Physical malfunctioning  Sensory-motor areas  Lack physical or organic pathology  Lack awareness  “La belle indifference”  Possible, but not always  Intact functioning at other times  Often seen as malingering (faking)

15. Conversion Disorder

16.   Statistics  Rare in MH settings but…  Prevalence depends on setting  Female > male  Onset = adolescence  Chronic, intermittent course  Unconscious mental processes  Anna O = Bertha Pappenheim  DID?

17. Conversion Disorder  Special populations  Soldiers  Children  Better prognosis?  Cultural considerations  Religious experiences  Rituals

18. Causes  Freudian and psychodynamic view  Trauma, conflict experience  Repression  “Conversion” to physical symptoms  Primary gain  Attention and support  Secondary gain

19. Causes Behavioral view Family/social/cultural factors

20. Treatment  Similar to somatic symptom disorder  Similar to somatic symptom disorder  Attending to trauma  Remove secondary gain  Reduce supportive consequences  Reward positive health behaviors

21. Treatment  No “cures”  Cognitive-behavioral interventions  Initial reassurance  Stress-reduction  Reduce frequency of help-seeking behaviors  “Gatekeeper” physician  Reduce visits to numerous specialists

22.  Munchausen’s  Intentionally produced symptoms  No obvious benefit  Sick role?  Factitious disorder imposed on another known previously as Munchausen syndrome by proxy  Intentionally produced symptoms in another person  Is this behavior malingering?

23. Factitious Disorders

24. Detection and Treatment?