Chapter 11: Somatoform, Factitious, and Dissociative Disorders Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2 Somatoform Disorders  Convert anxiety into physical symptoms  Physical symptoms without organic disease  Reflect complex interactions between mind and body  May cause serious impairments in social and occupational functioning

3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Etiology of Somatoform Disorders  Biologic  Behavioral  Cognitive

4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Types of Somatoform Disorders  Somatization disorder  Pain disorder  Conversion disorder  Hypochondriasis  Body dysmorphic disorder

5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Somatization Disorder  Formerly called hysteria and Briquet syndrome  Frequently seeking and obtaining medical treatment for multiple, clinically significant somatic complaints  Diagnosis requires:  Involvement of multiple organ systems  Early onset and chronic course without development of physical signs or structural abnormalities  No clinical laboratory abnormalities commonly associated with general medical conditions

6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Pain Disorder  Pain in one or more anatomic sites with significant impairment in one or more areas of functioning  Psychologic factors may play an important role in the onset, severity, exacerbation, or maintenance of the pain

7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Conversion Disorder  Exhibits one or more symptoms that affect voluntary motor or sensory function  Causes significant distress in social, occupational, or other areas of functioning  Common forms include blindness, paralysis, seizures, deafness, or abnormal motor movements

8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Hypochondriasis  Fears having (or the idea of having) a serious medical problem  Misinterpretation of symptoms persist despite medical evaluation  Preoccupation with illness  Causes significant distress in everyday function

9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Body Dysmorphic Disorder  Preoccupation with an imagined defect in appearance  Slight anomaly has an excessive response  Causes significant distress in everyday functioning

10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Factitious Disorder  Intentionally produces physical or psychologic signs to assume the sick role  Behavior satisfies need for secondary gains

11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Types of Dissociative Disorders  Dissociative amnesia  One or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature  Dissociative fugue  Sudden, unexpected travel away from home or one’s customary place of work, with an inability to recall one’s past

12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Types of Dissociative Disorders, cont’d.  Dissociative identity disorder  Demonstrates two or more distinct identities or personality states  At least two of these personality states recurrently take control of the person’s behavior  Depersonalization disorder  Persistent or recurrent episodes of feelings of detachment or estrangement from one’s self

13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Treatment Modalities  Psychotherapy  Behavioral therapy  Cognitive behavioral therapy  Pharmacotherapy