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Psych
Issues - Part 1:
Somatoform / Conversion Disorders &
Malingering / Factitious Disorders |
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Included in
this issue:
A.
Conversion Disorders/ Somatoform Disorders
-
Definitions/Overview
-
Resources & Articles
-
Case Studies
B.
Malingering/ Factitious Disorders
-
Definitions/Overview
-
Case Studies
-
Articles
-
Resources
 |
CONVERSION
DISORDERS/
SOMATOFORM DISORDERS |
Certain
conditions, such as the somatoform and factitious disorders, can
baffle even our most experienced clinicians. These disorders frequently
go unrecognized or are mis-diagnosed, and patients with these
conditions may be seen more often in the offices of non-psychiatric
physicians than in those of psychiatrists.
Either patients
are fully convinced that their problems are “physical”
instead of “mental” or they choose to present their
problems that way.
In
this newsletter, experienced clinicians will provide guidelines
to help identify the presence of the somatoform and factitious
disorders, as well as recommendations about their treatment.
DEFINITIONS
Conversion
Disorders: Physical symptoms caused by psychologic conflict,
unconsciously converted to resemble those of a neurologic disorder.
Conversion
disorder tends to develop during adolescence or early adulthood
but may occur at any age. It appears to be somewhat more common
among women. Isolated conversion symptoms that do not fully meet
the criteria of a conversion disorder or a somatization disorder
are commonly seen in nonpsychiatric medical practices
Dissociative
Disorders:
In dissociative and conversion disorders the predominant symptoms
are physical. The term conversion disorder implies that in the
affected person anxiety has been replaced by (or “converted
into?) physical symptoms.
Somatoform
or Somatization disorder is a type of conversion disorder. It
is used to denote a chronic condition characterised by a history
of numerous, variable and recurrent physical complaints that may
begin in early life and persist for many years. These physical
symptoms are not accounted for by physical disease.
Somatoform
disorders: A group of psychiatric disorders characterized
by physical symptoms that suggest but are not fully explained
by a physical disorder and that cause significant distress or
interfere with social, occupational, or other functioning.
Somatoform
disorder is a relatively new term for what many persons refer
to as psycho-somatic disorder. In somatoform disorders, either
the physical symptoms or their severity and duration cannot be
explained by an underlying physical condition. The somatoform
disorders include somatization disorder, undifferentiated somatoform
disorder, conversion disorder, hypochondriasis, pain disorder,
body dysmorphic disorder, and somatoform disorder not otherwise
specified.
Frequently
Asked Questions:
What is going on in the body?
What are the causes and risks of the condition?
What are the signs and symptoms of the condition?
What are the causes and risks of the condition?
What can be done to prevent the condition?
How is the condition diagnosed?
What are the long-term effects of the condition?
What are the risks to others?
What are the treatments for the condition?
What are the side effects of the treatments?
What happens after treatment for the condition?
How is the condition monitored?
It
has been postulated that the patient [with a conversion disorder]
derives primary and secondary gain. With primary gain,
the symptoms allow the patient to express the conflict that has
been suppressed unconsciously. With secondary gain,
symptoms allow the patient to avoid unpleasant situations or garner
support from friends, family, and the medical system that would
otherwise be unobtainable.
According
to socio-cultural theories, the direct expression of emotions
is impermissible for the paitent with a conversion disorder; somatization
takes its place.
In
behavioral models, conversion symptoms are viewed as a learned
maladaptive behavior that is reinforced by the environment.
Additional
Case Study Resources
REVIEW
PAST ISSUES
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"the
intentional production of false or grossly exaggerated physical
or psychological symptoms, motivated by external incentives
such as avoiding military duty, avoiding work, obtaining financial
compensation, evading criminal prosecution or obtaining drugs".
The
individual engaging in malingering is thought to be consciously
aware that he or she does not have the physical or mental
illness that is being presented.
An
opinion that a plaintiff has engaged in malingering must be
based, at least in part, upon objective psychological testing….
One psychological test that contains these special "validity"
scales is the Minnesota Multiphasic Personality Inventory.
The MMPI-2, as it is now known, has been described as the
"Cadillac" or "gold standard" of objective
psychological tests and is also a standard against which other
tests of malingering are measured.
DSM-IV
& DSM-IV-TR: Malingering:
This term applies to individuals who intentionally pretend
to have symptoms of mental or physical illness to achieve
financial or other gain or to avoid criminal conviction or
unwanted duty. They may also malinger to facilitate escape
from captivity or incarceration.
DSM-IV
& DSM-IV-TR: Factitious Disorders Patient's
with this mental disorder are so eager to assume the role
of a sick person that they intentionally feign or produce
symptoms. Sub classification is according to whether the symptoms
are predominately psychological, physical or combined.
Factitious
Disorder with Psychological Signs and Symptoms: Case Reports
and Proposals for Improving Diagnosis
Feigning
does not equal Malingering:
A Case Study
Malingering should be strongly suspected if any combination
of the following is noted:
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Medico-legal context of presentation (e.g., the person is
referred by an attorney to the clinician for examination)
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Marked discrepancy between the person’s claimed stress
or disability and the objective findings
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Lack of cooperation during the diagnostic evaluation and
in complying with the
prescribed treatment regimen
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The presence of Antisocial Personality Disorder.
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It’s
not Munchausen’s or “Psychosomatic”
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Presentations
of Malingered Psychiatric Symptoms
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You Usually
Can’t Tell by Interviewing
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Comparison
of malingering, factitious, and somatoform syndromes
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Detecting
Malingering Isn’t Hopeless
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Hypnosis,
Polygraphs, and Chemically-Augmented Interviews
Toni
Cesta, PhD, RN, FAAN
Director Case Management
St. Vincents Catholic Med'l Centers NY |
Elaine
Cohen, EdD, RN, FAAN
Dir Case Management and
Assoc Professor
Univ Colorado Health Sciences Center |
Tim
Field, PhD,
Author, Consultant, Educator and Vocational Expert |
CMSA's
2004
Case Manager of the Year
Major Melanie Prince, RN,
CCM |
Julie
Smart,
Ph.D, CRC, NCC, LPC, ABDA, CCFC
Professor & Director
Rehab Counselor Education Program
Utah State University |
Peggy
Rossi, BSN, MPA, CCM, CPUR
Director of Utilization and Case Mgmt
Catholic Healthcare West
California |
Vivian
Campagna, RN, CCM
Director Case Management
St. Clare's Hospital & Health Center,
New York, NY |
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Interested
in being part of our Advisory Board? Contact us
1-866-543-2273 |
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