Is he mentally ill?

Somatoform—pt. complains of bodily symptoms that suggest a physical defect or dysfunction, but no phys. basis

• Somatoform—pt. complains of bodily symptoms that suggest a physical defect or dysfunction, but no phys. basis

• Dissociative—disruptions of consciousness, memory, and identity. Individuals with these disorders may be unable to recall events, may forget identity, may assume a new identity.

Preoccupied with fears of a serious disease—not reassured by physician

• Preoccupied with fears of a serious disease—not reassured by physician

• Overreact to ordinary physical sensations or minor abnormalities—irregular heartbeat, sweating, coughing, sort spot, stomachache

• Not faking—sincere

• Vague and ambiguous symptoms are common

• Causes—

• Not well understood
• Clearly anxiety related—some researchers like term health anxiety
• Attentional bias for illness-related information
• Misinterpretations of bodily sensations are seen as causal by cog-beh types
• Role of secondary reinforcement

• Treatment

• Cog-beh
• SSRIs may be helpful

Formerly called Briquet’s Syndrome

• Formerly called Briquet’s Syndrome

• Multiple somatic complaints for which medical attention is sought, but have no apparent physical cause

• Most often seen in primary medical care—common complaints include headache, fatigue, abdominal, back and chest pain, genitourinary and sexual symptoms, heart palpitations, gastrointestinal sx, neurological sx

• 3-10 x more common in women

• Usually begins in adolescence

• More often in low SES

• Lifetime prevalence .2-2% in women, .2% in men

• Comorbid with anx disorders

• Causes—Similar to hypochondriasis—hyperattentive to bodily sensations

• Interaction of personality, cognitive, and learning variables

• TX-medical management and cog-beh

Subjectivity of pain

• Subjectivity of pain

• Diagnosed more commonly in women

• Comorbid with anxiety and mood disorders

• May allow individuals to avoid some unpleasant activity

• Diagnosed when onset, severity, and maintenance of pain causes distress with no pathology

• Can be either psych alone or psych and physical

• TX—cog-beh; relaxation training, support and validation that pain is real; reinforcement of “no pain” behaviors

Symptoms suggest neurological damage, but everything is found to be fine

• Symptoms suggest neurological damage, but everything is found to be fine

• Usually appear in stressful times. Primary and secondary gain.

• So named because energy of a repressed instinct was diverted into sensory-motor channels and blocked functioning. Thus anx and conflict are converted into physical sx

• AKA conversion hysteria

• La belle indifference in about 20-50% of cases

• 1-3% of those referred for tx. Prevalence in general pop is very low—may be only about .0005 percent

• 2-10X more common in women.

• Issues in diagnosis—sx do not conform clearly to the particular diseases simulated; selective nature of the dysfunction; sx may go away under hypnosis or narcosis

• Distinguishing from malingering and factitious disorder

• Malingering—fake an incapacity to avoid responsibility—under voluntary control
• Factitious disorder—fake illness to assume role of pt

• Tx of conversion—behavioral, hypnosis

Preoccupied with an imagined or exaggerated defect in appearance. Often leads to may visits to plastic surgeons. 70% or more of students indicate some dissatisfaction.

• Preoccupied with an imagined or exaggerated defect in appearance. Often leads to may visits to plastic surgeons. 70% or more of students indicate some dissatisfaction.

• Would you change something about your appearance if you could? 99% of women, 93 % of men say yes

• Social and cultural factors play a role.

• Most common—skin (73%), hair (56%), nose (37%), stomach (22%), breasts, chest, nipples (21%), eyes (20%)

• No official estimates of prevalence. No gender difference. Onset typically in adolescence.

• 50% comorbid with depression

• Over 75% seek non-psych help

• Related to OCD—similar brain structures implicated; same tx are effective (SSRIs, cog-beh helps in 50-80%)

Suddenly unable to recall important personal information, usually after a stressful situation.

• Suddenly unable to recall important personal information, usually after a stressful situation.

• Most often—for all events in a given period of time.
• More rarely—selected events in a period; continuous from traumatic event to present; total

• Behavior looks normal, but may be disoriented

• Usually person retains ability to read, write, play piano, have knowledge

• Comes and goes suddenly

• Not the same as with organic brain disorders or substance use—either a definite cause or fails slowly over time

• Fugue—new identities may be assumed; may last for days, weeks, or years

• Similar to conversion in that threatening information becomes inaccessible; suppression is involved in memory loss