Somatic Symptom and Conversion Disorders Chapter 6

Factitious Disorder

Falsification of physical and psychological symptoms, induction of injury or disease, associated with identified deception

Illness Anxiety Disorder

"Hypochondriac"

Conversion Disorder

Symptoms are not part of a behavior or experience that is part of one's culture

Muchausen Syndrome

A factitious disorder (subtype) in which a person causes symptoms and claims he has a physical or mental disorder

Illness Anxiety Disorder

Autosuggestibility is common- reading or hearing about an illness can lead to fear of having that disease

Dissociative Fugue

Cannot recall their past, and sometimes their identity, and end up living and working far away from family and friends, often occurs after traumatic event

Illness Anxiety Disorder

Care-seeking type: medical care is frequent Care-avoidant type: medical care is rarely used

Depersonalization/Derealization Disorder

Causes great distress and significantly interferes with functioning, episodes do not occur because of another mental disorder (such as panic disorder), substance abuse, or other medical condition. Symptoms of depersonalization and dissociative fugue are similar

Conversion Disorder

Causes: experience of trauma, getting sick is acceptable, symptoms to escape uncomfortable situation

Illness Anxiety Disorder

Causes: over focus on common sensations (pains of living), more disease in family in general (observational/modeling), more illness concern in family, more attention for sick behavior

Muchausen Syndrome by Proxy (factitious disorder imposed on another)

Child often gets better after being separated from parent, usually mother who is the perpetrator, most common in children under 4 years old, mother's motivation is attention and sympathy

Factitious Disorder

Deception is evident with the absence of external rewards, does not do it to get out of a situation or to gain benefits

Malingering Factitious Disorder

Deliberate production of physical or psychological symptoms with some external motivation (external motivators are not present in just factitious disorder)

Factitious Disorder

Deliberately causes symptoms

Somatic Symptom Disorder

Difficult to treat, focus on reduction of medical visits, reducing secondary gain, no proven treatment, biofeedback to turn around some of the physical symptoms

Dissociative Identity Disorder (Multiple Personality Disorder)

Difficulty treating because of controversy of therapist possibly implanting repressed memories and causing further problems (patients suing abuser)

Somatic Symptom Disorder

Disproportionate and persistent thoughts about the seriousness of one's symptoms, persistently high levels of anxiety about health or symptoms, and (or), excessive time and energy devoted to these symptoms/health concerns

Dissociative Identity Disorder (Multiple Personality Disorder)

Each personality may have its own distinctive voice, behavior, memories, age, gender, handedness, allergies and eyesight

Illness Anxiety Disorder

Essential problem is anxiety

Malingering Factitious Disorder

Example: A person complains of back pain or says he hears voices to get out of work or military service, obtain financial compensation or drugs, or dodge criminal prosecution. Financial benefits of being disabled is a major motivator

Derealization

Experiences of unreality or detachment with respect to surroundings

Depersonalization

Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body or actions

Dissociative Trance Disorder

Extremely rare in western cultures, sudden changes in personality, possession by spirits, related to trauma, could be a relative that had passed away

Somatic Symptom Disorder

Family link, antisocial personality disorder is very high, evidence of weak behavioral inhibition, strong behavioral activation, and short term gain (attention)

Dissociative Amnesia

Forgetfulness is not caused by substance abuse or neurological, or other medical disorders

Dissociative Amnesia

Forgetting highly personal information (childhood experiences, family members, and even one's own name) often after a traumatic event

Dissociative Identity Disorder (Multiple Personality Disorder)

Formation of different personalities (alters), two or more distinct personalities within themselves, may adapt up to 100 identities or alters, distorted and unconscious identity, host identity is one who asks for treatment

Dissociative Amnesia

Generalized: unable to remember anything Localized or selective: failure to recall specific events or times

Illness Anxiety Disorder

High level of anxiety about health, and the individual is easily alarmed about the personal health status

Dissociative Identity Disorder (Multiple Personality Disorder)

If abuse of the kind that leads to DID (extreme) starts after age 9, the child is unlike to develop DID but rather will experience PTSD

Illness Anxiety Disorder

Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time

Illness Anxiety Disorder

Illness-related preoccupation is not better explained by another mental disorder

Somatic Symptom Disorder

Individuals enjoy the role of being a patient

Somatic Symptom Disorder

Many individuals are unemployed because disease and doctors visits become their full time job

Dissociative Amnesia

Memory loss can cause distress and impair one's ability to function on a daily basis

Muchausen Syndrome

Mimicking seizures, injecting fecal bacteria into oneself, common in women who visit obstetricians and gynecologists, may experience stressful life events or depression, aspects of borderline/ antisocial personality disorder, very rare, no specific treatment

Conversion Disorder

Motor or sensory problems that suggest a neurological or medical disorder, even though one has not been found

Conversion Disorder

Often experience "la bella indifference", which means that they are relatively unconcerned about their symptoms (indicated the psychological factors)

Muchausen Syndrome by Proxy (factitious disorder imposed on another)

Often refers to an adult who deliberately induces illness or pain on their child

Somatic Symptom Disorder

One or more somatic symptom that is distressing and result in disruption of daily life for more than 6 months (usually more than 1 symptom)

Dissociative Identity Disorder (Multiple Personality Disorder)

Onset in childhood, linked to extreme child abuse, 97% of cases are linked to unthinkable child abuse, coping mechanism to escape into fantasy world

Depersonalization/Derealization Disorder

Persistent experience of detachment from one's body as if in a dream state, maintain a sense of reality but may feel that they are floating above themselves, watching themselves go through the motions, or feel like they are in a movie

Conversion Disorder

Popularized by Freud, he called it "hysteria"

Illness Anxiety Disorder

Preoccupation with having some serious disease that may explain general bodily changes

Illness Anxiety Disorder

Preoccupied with bodily symptoms, misinterpretations of symptoms, convinced that there is a specific disease

Conversion Disorder

Psychological, not physical stressors trigger symptoms

Dissociative Identity Disorder (Multiple Personality Disorder)

Relationships between host personalities and sub personalities can be complex. 1) Two-way amnesiac: personalities are not aware of the existence of one another 2) One-way amnesiac: some personalities are aware of other personalities but awareness is not always reciprocated 3) Mutually aware: personalities are all aware of other personalities and may even communicate

Illness Anxiety Disorder

Risk factors: limited education, recent stressful life events, co-morbid depression/anxiety disorder

Somatic Symptom Disorder

Seems indifferent to diagnosis, persistent thoughts about seriousness of symptoms, but less upset about symptoms than you'd expect ("I'm dying")

Dissociative Identity Disorder (Multiple Personality Disorder)

Similar treatments to PTSD, more susceptible to suggestibility and hypnotism, no controlled research

Conversion Disorder

Sudden blindness, deafness, mutism, lost sense of touch, tremor, seizure-like activity, paralysis, etc.

Dissociative Identity Disorder (Multiple Personality Disorder)

Switch in alters can occur at any time, abrupt but not painful, average of 10 alters, 9:1 female to male ratio

Conversion Disorder

The terror of a trauma is too difficult to bear, so distress is "converted" into a sensorimotor disability that is easier to tolerate

Illness Anxiety Disorder

Thoughts about having an illness can resemble obsessive compulsive disorder, often have significant fears of contamination and of taking prescribed medication

Conversion Disorder

Treatment: address the traumatic event, remove the sources of secondary gain (attention), but no well established treatment

Illness Anxiety Disorder

Treatments: CBT or Wait List, (76% Reduction), evoke bodily sensations, modify illness perceptions, provide "appropriate" reassurance, more research is needed for treatments

Illness Anxiety Disorder

Unlike somatic symptom disorder, people with this disorder are very aware of bodily functions and complain about symptoms in great detail, often to help their doctor find a diagnosis