Somatoform Disorders

1
Somatoform Disorders

• Physical symptoms lacking medical cause
• Or in excess of physical problem
• Conversion of stress
• Symptoms depend on medical sophistication of
  individual
• Ex. glove paralysis
• Not Malingering
• Faking for gain

2
Non-falsifiable medical symptoms

• Can not be disproved by medical tests
• Often vague, resistance to treatment
• Person makes little effort to overcome
• Possible examples CFS, IBS, asthma (mild),
  headaches (including migraine), back pain,
  hypoglycemia (in absence of supporting medical
  tests), weakness, dizzy spells, etc.

3
Somatization Disorder

• At least 4 sets of health related symptoms
• 2 gasto (i.e. nausea, IBS)
• Sexual symptoms
• Neurological (weakness, dizziness, etc.)
• pain
• Often other non-falsifiable symptoms
• Used to avoid life tasks
• Dr. visits
• Moderate somatization common
• stress headaches

4
Causes treatment

• Runs in families
• Genetic or environmental?
• More common in Latin/Asian cultures
• Treatment
• Prognosis poor.why?
• Avoid catastrophizing medical symptoms
• Diet changes can help some (ex. IBS)
• Found in less than 1 of US population

5
Hypochondraisis

• Unrealistic exaggeration of health symptoms
• i.e. flu symptoms Anthrax
• Focus on health concerns
• Worry about future illness
• Preventative measures
• Ex. Excessive, diet, exercise, vitamines
• Unnecessary medication/surgery
• No treatment
• Prevalence less than 1

6
Conversion Disorder (Hysteria)

• Convert emotional distress to physical symptoms
  (usually neurological)
• Deafness, blindness, paralysis
• Reflexes still intact
• Beautific (or Euphoric) indifference
• Placebo treatments
• Very rare
• Mass psychogenic illnesses
• 1989 kids in H.S. auditorium
• Tarantella

7
Body Dysmorphic Disorder

• Obsessed with exaggerated disfigurations
• Weight, scars, imperfections, hair loss, etc.
• Often restrict social activities
• Treatment similar as to OCD
• Comorbid anxiety/depression common
• CBT treatment and SSRIs

8
Factitious Disorder

• Munchausen's Syndrome
• Medical Symptoms and attention
• By Proxy
• Waneta Hoyt Steinschneider

9
Malingering

• Purposeful falsification of medical/psychological
  symptoms for personal gain
• Why would one do that?
• Identifying malingering
• MFAST
• TOMM
• atypical responses

10
Dissociative Disorders

• Dissociative Symptoms
• Feelings of unreality, loss of appropriate
  emotion, disconnection with identity
• Fairly common, particularly under stress
• Psychological shock can involve dissociation
• Altered states experiments
• Many diagnoses are controversial

11
DID (MPS)

• Dissociation from parts of personality
• Controversial diagnosis (malingering, BPD, naïve
  therapists?)
• Popularized by Sybil
• Remains largely psychoanalytic in theory
• Response to early, repeated childhood trauma
• Controversial nature of trauma itself

12
DID Part 2

• The Core
• Secondary personality
• Helper personalities
• Amnesia, self-mutilation not uncommon
• Therapy reintegration of personalities
• Prevalence less than 1, more often in women

13
The controversy

• Media presentations of DID
• Dissociation or bad acting?
• Majority of cases diagnoses by tiny fraction of
  therapists
• Easy to Malinger
• Kenneth Bianci

14
Psychogenic (Dissociative) Amnesia

• Most common D.D.
• Reaction to stressful event
• Stress hormones (cortisol, adrenaline) interfere
  with encoding?
• Distinct from neurological amnesia due to injury
• No guarantee psychogenic amnesia will recover
• Anterograde (rare for psychogenic) vs. retrograde
  amnesia
• Also easy to malinger in criminal cases

15
Psychogenic (Dissociative) Fugue

• Person suddenly abandons identity
• May move and take up new identity
• Claims no memory of previous identity
• Often response to chronic stress
• Very rare
• Treated similarly as DID

16
Problems with the dissociative disorders

• Easy to malinger
• Linked closely with psychoanalytic theory
• Use of hypnosis in diagnosing them
• Linked with the repressed memory debate
• Validity of these diagnoses remains controversial
• Less than ¼ of psychologists/psychiatrists
  believe they are valid