Somatic Symptom Disorder, Conversion Disorder, Factitious Disorder

Somatic Symptom Disorder

occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. These intense thoughts interfere with daily life. The person with SSD is not faking about the symptoms.

CD: Motor

paralysis usually in one limb and selective for specific functions.

Munchausens's Syndrome by proxy

A dangerous variant of factitious disorder, it is factious disorder imposed on another. ( ex. Lacey spears in the book) Perpetrators appear extremely devoted to the victim and are highly resistant to admitting the truth.

General model of somatic symptom disorders.

1. Attentional focus on the body and awareness to bodily changes. 2. Somatic sensations viewed as symtoms, attibute it to an illness. 3. Worry and catastrophizing about the meaning of symptoms. 4. Excessively seeking medical attention.

SSD criteria

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns. C. Persistent more then 6 months

"la belle indifference"

According Freud people with CD showed very little of the anxiety and fear expected of a person with paralyzed arms or vision loss. ( only present in about 20%)

CD TX

Behavior modification- approach in which specific exercises are prescribed in order to increase movement or walking. Hypnosis have been used as well.

SSD tx

Cognitive behavior therapy, aimed at treating the persons anxiety and depression.

FD: DSM

DSM-5 added it to the category of somatic symptoms and related disorders.

Behavioral Explanation of CD

Focus on reinforcement for the "sick role" and avoidance. ( being sick or disabled is more socially acceptable)

CD Theories : Conversion hysteria

Freud believed that symptoms were an expression of repressed sexual energy- that is the unconscious conflict that a person felt about his or her repressed sexual desires. Converted to a bodily disturbance so the person wouldnt have to deal with the conflict.

DSM combined what 3 disorders to form SSD?

Hyponchondriasis (idea they have a serious undiagnosed medical condition) Somatization disorder Pain disorder

Factitious disorder vs Malingering

Malingering, the person tends to have tangible external rewards ( avoiding work, military service or prosecution). Factitious disorder no extrernal rewards gained.

CD: Prevalence

More common in women Very rare now ( more common in hx)

Conversion Disorder

Presence of neurological symptoms in the absence of a neurological diagnosis. Pattern of symptoms not associated with neurological disease. ( Pt not faking the symptoms)

Primary vs Secondary gain

Primary gain = reducing anxiety from conflict Secondary gain = sympathy and support from others. ( Freud believed that those with the condition could not live in a mature relationship, and that those with the condition were unwell in order to achieve a "secondary gain", in that they are able to manipulate their situation to fit their needs or desires.)

FD: Prevalence

Very difficult to determine.

CD: seizures

Without EEG abnormalities, excessive thrashing and writhing during seizures, rarely injured by falls. (not true seizures)

Factitious Disorder

a condition in which a person acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms. ( falsifying physical and psychological signs and symptoms)

CD: Sensory

blindness, deafness, anesthesias