Rebecca Sposato MS, RN

Somatoform DisordersA collection of syndromes where the body

experiences mental anxiety as a physical symptomSevere enough to cause distress and impairmentRule out medical causesSymptoms are not intentionally produced

Psychosomatic symptoms are still symptoms, they just need psychosomatic careRepression of a conflictAttempt to feel cared for in response to helpless

with unmet needs

SomatizationA collection of symptoms and impaired bodily

functions. DSM –IV requiresBegins before the age of thirty4 areas of pain: head, back, chest, joints etc 2 GI symptoms: nausea, cramping, bloating etc.1 sexual effect: ED, dyspareunia, irregular cycle1 pseudoneurological side effect: aphonia,

vertigo, paralysis, localized weakness, visual changes

Chronic and fluctuating disorder, rarely fully remits for extended period of time

HypochondriasisPreoccupation or fear of having a serious disease

based on a misinterpretation of symptom or clinical dataAnxiety persists beyond reassurance or normal

findingsCondition lasts over 6 monthsCauses distress and impairs social and occupational

abilities

Often includes the presence of “doctor-shopping” and a deteriorated doctor-patient relationship

Typically do not have better health habitsPrevalence of 3% of general population

Pain SyndromePrimary symptom is significant pain without

an obvious physiological etiologySevere enough to cause distress and impair

important areas of functionPsychological factors contribute to clinical

picture and features of painSymptom is not intentionally produced or

feigned to obtain a substance or other benefit

Body Dysmorphic DisorderExcess preoccupation and distress over

appearance of a normal or slightly flawed physical featurePerson engages in time consuming and

restricting habits in response to the flawAbout 10% dermatology and cosmetic surgery

patients have this disorder

Conversion DisorderDeficit of a voluntary motor or sensory

function in response to psychological conflict or stressorNot intentionally produced or feigned,

although a secondary gain is often present Deficits do not follow a natural pathology, but

the person’s concept of a conditionObjective clinical data does not support

presence of condition Normal EEG/EMG, reflexes, labs

Most symptoms will remit with time and treatment

Factitious DisordersIntentionally produce symptoms of illness in

order to assume the sick role. Subjective complaints

Dramatic yet vague descriptions of their illnessTamper with objective signsSelf inflicted injuriesExacerbate current medical condition

Evolving medical historyStrongly resistant to confrontation and

psychological evaluation

Factitious DisordersMunchausen by proxy: person will falsify a

disease in a dependent for one’s own psychological gainChild abuse

Malingering: a person is motivated to present as ill for a personal or material gain

Dissociative DisordersDisruption in the integration of

consciousness, memory, identity or perception that cannot be explained by injury or disease prcoesses

Dissociative AmnesiaInability to recall important personal information of

a stressful or traumatic nature that is too extensive to be explained by normal forgetfulnessLocalized: failure to recall the events adjacent to the

circumscribed period of time related to a stressful event

Selective: unable to recall some, but not all, specific features of a traumatic event

Generalized: memory loss covers most of life history Continuous: memory loss from specific time up to the

presentSystematized: memory loss is specific to category

Dissociative FugueSudden and unexpected travel away from

one’s residence and routine with inability to recall some or all of one’s pastLoss of personal identity May last hours to monthsNo other obvious pathology or mental

impairments

Dissociative Identity DisorderPresence of 2 or more distinct identities or

personality states that recurrently take control of behaviorAlternate identities have distinct and often

stereotypical personal traits and historiesPrimary identity is unable to recall memories

obtained when alternate identity is consciously present

Method of self protection resulting from extreme childhood abuse

Depersonalization DisorderRecurrent and intrusive episodes

characterized by a feeling of detachment from selfDescribes being removed from sensory input,

out of one’s body or mental processes or environment

Person has awareness of the episodes

About 1/3 adults will describe a single brief depersonalization episode when exposed to life threatening event