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Munchausen & More

A Review of SomatizationBy Eli Bader


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Somatoform Disorder

Any of a group of psychological disorders

marked by physical complaints for which

no organic or physiological explanation is

found and for which there is a strong

likelihood that psychological factors are

involved

http://www.merriam-webster.com/medlineplus/somatoform


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Somatization Disorder

A somatoform disorder characterized by

multiple and recurring physical complaints

for which the patient has sought medical

treatment over several years without any

organic or physiological basis for the

symptoms being found

http://www.merriam-webster.com/medlineplus/somatoform


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Somatoform Disorders

Types


Undifferentiated Somatoform Disorder

Pain Disorder

Hypocondriasis

Conversion Disorder

Body Dysmorphic Disorder

Somatoform Disorder Unspecified


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Undifferentiated Somatoform Disorder

1+ medically unexplained symtom(s)

> 6 month duration


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Somatoform Pain Disorder

Pain in 1+ site(s)

Clinically significant stress or impairment

Symptomology is not intentionallyproduced or faked

Psychological factors judged important in

presentation No other accountable origin for pain


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Hypocondriasis

Preoccupation with fear/idea of having

serious disease without having one

Belief of diseased state is not dilusional

Preoccupation persists despite contrary

evalution

>6 Months Not accounted for by other diagnoses


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Conversion Disorder

Motor or sensory involvement suggestive

of neurological (or other medical)

impairment

Not accounted for by other diagnoses

Not intentionally produced of faked

Clinically relevant stress or impairment Cannot be accunted for by another

somatoform disorder


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Body Dysmorphic Disorder

Obsession with imagined or exaggerated

physical defect


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Unspecified

Catch-all for somatoform disorders that do

not fall under other criteria.


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Other Somatization Disorders

Factitious & Munchausen

Intentional faking of symptomology

Unknown reasoning

Malingering

Intentional faking of symptomology

For gain


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Differentiating Disorders

Somatoform Disorders

Factitious

Malingering

Somatoform Factitious Malingering

Physical - + +/-

Psychological + +/- +/-

Conscious - + +

Obvious Goal- - +


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Diagnosis Algorithm


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Diagnosis Algorithm Continued


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Treatment

Rule out medical & physiological causes

But limit workup to relevant potential causes

Psychotherapy

Cognitive Behavioral Therapy

Psychosocial interventions

Psychopharmocology

Treat accessory psychiatric disorders

Sedation if/as needed

Antidepressant usage: TCA or SSRI


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References

Lathrop, Thomas. Stedman's medicaldictionary. 28th. Philadelphia : Hubsta Ltd,2008. Print

www.uptodate.com American Psychiatric Association.

Diagnostic and Statistical Manual of

Mental Disorders, Fourth Edition, TextRevision (DSM-IV-TR), AmericanPsychiatric Association, Washington, DC2000

www.Drugs.com/professional
http://www.uptodate.com/http://www.drugs.com/professionalhttp://www.drugs.com/professionalhttp://www.uptodate.com/

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