1. Somatoform and Factitious Disorders Assessment & Diagnosis SW 593

2. Introduction  Somatoform disorders comprise disorders in which physical concerns are presented for which no medical basis can be found.  Infers that the physical symptoms are associated with psychological factors.  The production of symptoms is not under voluntary control.  Specific diagnoses depend on the number and kinds of physical symptoms, as well on the cognitive process that may occur.

3. Disorders  Somatization disorder: Chronic disorder Begins before the age of 30 Symptoms varied over time Four pain symptoms:  Two stomach or intestinal symptoms  A sexual symptom  A pseudoneurological symptom

4. Disorders  Somatization disorder (cont.) No physical basis has been discovered Complaints/impairment exceed what would be expected based on the general medical condition If diagnosed in the first 6 months; Undifferentiated Somatoform disorder would be appropriate.

5. Disorders  Conversion Disorders: Symptoms/deficits are focused on voluntary motor or sensory functions:  Impaired coordination  Paralysis  Blindness  Deafness  Seizures Psychosocial stressor/conflict can be identified. Again, not under voluntary control. Impairment/distress.

6. Disorders  Pain Disorder: Distinction is made between pain disorders in which general medical conditions are not present or play a minimal role and those in which both psychological factors and a general medical condition seem to be involved. Pain is judged to be excessive for the specific situation.

7. Disorders  Hypochondriasis: Less focused on physical symptoms and more focused on fears regarding having a serious disease. Misinterpretation of normal bodily signs Chronic and leads to preoccupation with bodily functions Extreme worries is associated

8. Disorders  Body Dysmorphic Disorder: Preoccupation or fear is based on an imagined or slight physical anomaly.

9. Disorders  Factitious Disorders: Are under voluntary control Client engages in conscious fabrication, falsification, exaggeration, and self-infliction of physical or psychological symptoms. Assumes the client is seeking the “sick” role If for external gains (economic, avoiding legal trouble) then rules out these diagnoses Not to be confused with Malingering

10. Disorders  Factitious disorder by Proxy (Munchausen by Proxy): Production of medical/psychological symptoms is targeted toward a third party Is currently under the client’s care.

11. Assessment  In depth medical screening is the primary form of assessment.  Exception: Factitious disorder with Predominantly Psychological signs and symptoms.  Some clients may be sophisticated enough to feign the psychological symptoms.

12. Assessment  Most commonly used self-report instruments: MMPI-2 MMPI-A SCL-90-R Children’s Somatization Inventory Multidimensional Pain Inventory (MPI) Illness Attitude Scale (IAS)  For hypochodriasis

13. Cultural Considerations  Type and frequency will be influenced by cultural factors.  Majority of persons diagnosed are women.  Greek and Puerto Rican men also rate high.  With hypochondriasis and Body Dysmorphic disorder the rate of prevalence seems to be equal by gender.

14. Cultural Considerations  Somatoform disorders tend to be presented by individuals who are considered “unsophisticated”. Rural Uneducated Lower socioeconomic class  Women have higher rates of Factitious Disorders but men present severe and more chronic conditions.