Académique Documents
Professionnel Documents
Culture Documents
Disorders
Toni Peters MSN, RN
Wright State University
Hypochondriasis
DSM-IV-TR
A. Preoccupation with fears of having, or the idea that one has, a serious
disease based on the persons misinterpretation of bodily symptoms.
B. The preoccupation persists despite appropriate medical evaluation and
reassurance.
C. The preoccupation is not of delusional intensity (Delusional Disorder)
and is not restricted to a circumscribed concern about appearance
(Body Dysmorphic Disorder).
D. The preoccupation causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
E. The duration of the disturbance is at least 6 months.
Hypochondriasis
DSM-IV-TR
F. The preoccupation is not better accounted for by
GAD, OCD, Panic DO, a MDE, Separation Anxiety, or
other Somatoform DO
Specify if:
With Poor Insight: if, for most of the time during the
current episode, the person does not recognize that
the concern about having a serious illness is excessive
or unreasonable
http://www.youtube.com/watch?v=4NFry20WoJ
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Conversion Disorder
DSM-IV-TR
A. One or more symptoms or deficits affecting voluntary motor or sensory function that
suggest a neurological or other general medical condition
B. Psychosocial factors are judged to be associated with the symptom or deficit because
the initiation or exacerbation of the symptom or deficit is preceded by conflicts or
other stressors
C. The symptom or deficit is not intentionally produced or feigned.
D. The symptom or deficit cannot, after appropriate investigation, be fully explained
by a known general medical condition or the direct effects of a substance, or as a
culturally sanctioned behavior or experience.
E. The symptom or deficit causes clinically significant distress or impairment in
functioning, or warrants medical evaluation.
F. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur
during the course of Somatization Disorder, and is not better accounted for by
another medical disorder.
than 6 months.
Conversion Disorder
Differential Diagnosis
Neurological Disease
Somatic Symptom Disorder
Factitious Disorder and Malingering
Dissociative Disorders
Body Dysmorphic Disorder
Depressive Disorders
Panic Disorder
Conversion Disorder
http://www.youtube.com/watch?v=jV0szS02PGE
Factitious Disorder
DSM-IV-TR
A. Intentional production or feigning of physical or
psychological signs or symptoms.
B. The motivation for the behavior is to assume the sick role.
C. External incentives for the behavior (i.e., economic gain,
avoiding legal responsibility, or improving physical
wellbeing, as in Malingering) are absent.
Specify:
With Predominantly Psychological Signs and Symptoms
With Predominantly Physical Signs and Symptoms
With Predominantly Psychological and Psychological Signs
and Symptoms
Factitious Disorder
DSM-5
A.
B.
C.
D.
Specify if:
Single episode
Recurrent episodes: two or more events of falsification of illness
and/or induction of injury)
Factitious Disorder
DSM-5 Factitious Disorder Imposed on Another
(previously Factitious Disorder by Proxy)
A. Falsification of physical or psychological signs or symptoms, or induction of
injury or disease, in another, associated with identified deception.
B. The individual presents another individual (victim) to others as ill, impaired,
or injured.
C. The deceptive behavior is evident even in the absence of obvious rewards.
D. The behavior is not better explained by another mental disorder, such as
delusional disorder or another psychotic disorder.
Note: The perpetrator, not the victim, receives this diagnosis.
Specify if:
Single Episode
Recurrent Episodes: two or more events of falsification of illness and/or
induction of injury
Factitious Disorder
Differential Diagnosis
Somatic Symptom Disorder
Malingering: intentional reporting of symptoms for personal
stress/anger
Environmental: lower education level, low socioeconomic
status, recent stressful life events, sexual abuse, parents
with somatic behaviors
Females more than males 5:1 (except Illness Anxiety DO)
Symptoms may begin in childhood, adolescence, or early
adulthood. New onset of unexplained somatic symptom
disorders in older adults should be concerning. Consider
medical illness or major depression with somatic symptoms.
effective
CBT
Individual/Family Therapy
Emotional support
Relaxation techniques
SSRIs (effectiveness not proven)
Avoid pain medications and benzodiazepines
risk of dependence or overdose
Questions
1. In DSM-IV-TR a patient with a high level of anxiety about having a disease and many
associated somatic symptoms would be given the diagnosis of hypochondriasis. What DSM-5
diagnosis would apply to this patient?
a) hypochondriasis
b) illness anxiety disorder
c) somatic symptom disorder
d) generalized anxiety disorder
e) somatoform disorder NOS
2. A young woman is hospitalized for evaluation of fits of movement in which she appears to lose
consciousness, rock her head from side to side, and move her arms and legs in a
nonsynchronous, bicycling pattern. The episodes occur a few times a day and last for 2 to 5
minutes. EEG during the episodes does not reveal any ictal activity. After a fit, her sensorium
appears clear. What is the most likely DSM-5 diagnosis?
a) epilepsy
b) malingering
c) somatic symptom disorder
d) conversion (functional neurological symptom disorder), attack-seizure subtype
e) factitious disorder
Questions
3. Which of the following is the key feature of factitious disorder in DSM-5?
a) somatic symptoms
b) conscious misrepresentation and deception
c) external gain associated with illness
d) absence of another medical disorder that may cause the symptoms
e) normal physical exam and laboratory tests
4. Why would you avoid prescribing pain medication or benzodiazepines
to a patient diagnosed with Somatic Symptom Disorder?
5. What three things must you rule out before considering a Somatic
Symptom or Related Disorder?
Videos
Hypocondriasis
http://www.youtube.com/watch?v=4NFry20WoJo
Conversion Disorder
http://
www.youtube.com/watch?v=jV0szS02PGE
Factitious Disorder
http://
www.youtube.com/watch?v=LLyH-98aaYY
Factitious Disorder by Proxy
http://
References
American Psychiatric Association (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Arlington, VA: American
Psychiatric Publishing.
American Psychiatric Association (2000). Diagnostic and statistical
manual of mental disorders (4th ed.). Arlington, VA: American
Psychiatric Publishing.
Banks, K. & Bevin, A. (2014). Predictors for somatic symptoms in
children. Nursing Children and Young People, 26(1), 16-20.
Dimsdale, J. E., & Levenson, J. (2013). Whats next for somatic
symptom disorder? American Journal of Psychiatry, 170, 13931395. DOI: 10.1176/appi.ajp.2013.13050589
References
Kroenke, K. (2007). Efficacy of treatment for somatoform
disorders: A review of random controlled trials.
Psychosomatic Medicine, 69, 881-888. Retrieved from
focus.psychiatryonline.org
Mayo Clinic Staff (n.d.). Conversion disorder. Retrieved from
http://www.mayoclinic.org/diseases-conditions/conversion-di
sorder/basics/tests-diagnosis/definition/con-20029533
Yates, W. R. (2014). Somatic symptom disorders. Retrieved
from http://emedicine.medscape.com/article/294908overview