Somatoform And Dissociative Disorders

1. The DSM mentions psychological factors in the diagnosis of pain disorder.

True

False

The DSM, which stands for the Diagnostic and Statistical Manual of Mental Disorders, does indeed include psychological factors in the diagnosis of pain disorder. This means that when diagnosing someone with a pain disorder, mental health professionals take into account psychological factors such as the individual's thoughts, emotions, and behaviors that may be contributing to their experience of pain. By considering these psychological factors, clinicians can gain a more comprehensive understanding of the disorder and develop appropriate treatment plans.

Explanation

The DSM, which stands for the Diagnostic and Statistical Manual of Mental Disorders, does indeed include psychological factors in the diagnosis of pain disorder. This means that when diagnosing someone with a pain disorder, mental health professionals take into account psychological factors such as the individual's thoughts, emotions, and behaviors that may be contributing to their experience of pain. By considering these psychological factors, clinicians can gain a more comprehensive understanding of the disorder and develop appropriate treatment plans.

2. Typical examples include partial paralysis, blindness, deafness, and pseudoseizures

Somatoform disorder

Conversion disorder

Pain disorder

Major depressive disorder

Conversion disorder is a somatoform disorder characterized by the presence of physical symptoms that cannot be explained by any underlying medical condition. These symptoms often resemble neurological or other medical conditions, such as partial paralysis, blindness, deafness, and pseudoseizures. The symptoms are believed to be a result of psychological distress or conflict, and are not intentionally produced or feigned. Therefore, conversion disorder is the most appropriate explanation for the presence of these physical symptoms without any identifiable medical cause.

Explanation

Conversion disorder is a somatoform disorder characterized by the presence of physical symptoms that cannot be explained by any underlying medical condition. These symptoms often resemble neurological or other medical conditions, such as partial paralysis, blindness, deafness, and pseudoseizures. The symptoms are believed to be a result of psychological distress or conflict, and are not intentionally produced or feigned. Therefore, conversion disorder is the most appropriate explanation for the presence of these physical symptoms without any identifiable medical cause.

3. In dissociative fugue,

Inability to recall previously stored information that cannot be accounted for by ordinary forgetting

The person manifests at least two or more distinct identities that alternate in some way in taking control of behavior.

In dissociative fugue, the person not only experiences amnesia and inability to recall previously stored information, but they also leave their home surroundings and become confused about their identity, sometimes assuming a new one. This suggests that dissociative fugue involves a more severe disruption of memory and identity, leading to a complete disconnection from one's familiar environment and a profound confusion about one's sense of self.

Explanation

In dissociative fugue, the person not only experiences amnesia and inability to recall previously stored information, but they also leave their home surroundings and become confused about their identity, sometimes assuming a new one. This suggests that dissociative fugue involves a more severe disruption of memory and identity, leading to a complete disconnection from one's familiar environment and a profound confusion about one's sense of self.

4. Chris is a shy, anxious-looking, 31-year-old carpenter who has been hospitalized after making a suicide attempt. . . . He asks to meet with the psychiatrist in a darkened room. He is wearing a baseball cap pulled down over his forehead. Looking down at the floor, Chris says he has no friends, has just been fired from his job, and was recently rejected by his girlfriend. "It's my nose . . . these huge pockmarks on my nose. They're grotesque! I look like a monster. I'm as ugly as the Elephant Man! These marks on my nose are all that I can think about. I've thought about them every day for the past 15 years, and I think that everyone can see them and that they laugh at me because of them. That's why I wear this hat all the time. And that's why I couldn't talk to you in a bright room . . . you'd see how ugly I am." The psychiatrist couldn't see the huge pockmarks that Chris was referring to, even in a brightly lit room. Chris is, in fact, a handsome man with normal-appearing facial pores. [Later Chris says,] "I've pretty much kept this preoccupation a secret because it's so embarrassing. I'm afraid people will think I'm vain. But I've told a few people about it, and they've tried to convince me that the pores really aren't visible. . . . This problem has ruined my life. All I can think about is my face. I spend hours a day looking at the marks in the mirror. . . . I started missing more and more work, and I stopped going out with my friends and my girlfriend . . . staying in the house most of the time. . . ." Chris . . . had seen a dermatologist to request dermabrasion, but was refused the procedure because "there was nothing there." He finally convinced another dermatologist to do the procedure but thought it did not help. Eventually he felt so desperate that he made two suicide attempts. His most recent attempt occurred after he looked in the mirror and was horrified by what he saw . . . "I saw how awful I looked, and I thought, I'm not sure it's worth it to go on living if I have to look like this and think about this all the time."

Ficticious disorder

Conversion disorder

OCD

BDD

The correct answer is BDD (Body Dysmorphic Disorder). Chris's preoccupation with the perceived flaws in his appearance, specifically the pockmarks on his nose, his excessive mirror checking, and his avoidance of social situations are all consistent with the symptoms of BDD. Despite being told by others that the flaws are not visible, Chris remains convinced of their existence and believes that they are the cause of his unhappiness and social difficulties. This disorder often leads to significant distress and impairment in functioning, as seen in Chris's case.

Explanation

The correct answer is BDD (Body Dysmorphic Disorder). Chris's preoccupation with the perceived flaws in his appearance, specifically the pockmarks on his nose, his excessive mirror checking, and his avoidance of social situations are all consistent with the symptoms of BDD. Despite being told by others that the flaws are not visible, Chris remains convinced of their existence and believes that they are the cause of his unhappiness and social difficulties. This disorder often leads to significant distress and impairment in functioning, as seen in Chris's case.

5. Pain disorder is diagnosed more frequently in men than in women and is very frequently comorbid with anxiety and/or mood disorders, which may occur first or may arise later as a consequence of the pain disorder

True

False

The given statement is false. Pain disorder is not diagnosed more frequently in men than in women. It is actually more commonly diagnosed in women. Additionally, the statement suggests that anxiety and/or mood disorders are very frequently comorbid with pain disorder, but it does not specify whether these disorders occur first or arise later as a consequence of the pain disorder.

Explanation

The given statement is false. Pain disorder is not diagnosed more frequently in men than in women. It is actually more commonly diagnosed in women. Additionally, the statement suggests that anxiety and/or mood disorders are very frequently comorbid with pain disorder, but it does not specify whether these disorders occur first or arise later as a consequence of the pain disorder.

6. This 38-year-old married woman, the mother of five children, reports to a mental health clinic with the chief complaint of depression, meeting diagnostic criteria for major depressive disorder. . . . Her marriage has been a chronically unhappy one; her husband is described as an alcoholic with an unstable work history, and there have been frequent arguments revolving around finances, her sexual indifference, and her complaints of pain during intercourse. The history reveals that the patient . . . describes herself as nervous since childhood and as having been continuously sickly beginning in her youth. She experiences chest pain and reportedly has been told by doctors that she has a "nervous heart." She sees physicians frequently for abdominal pain, having been diagnosed on one occasion as having a "spastic colon." In addition to M.D. physicians, she has consulted chiropractors and osteopaths for backaches, pains in her extremities, and a feeling of anesthesia in her fingertips. She was recently admitted to a hospital following complaints of abdominal and chest pain and of vomiting, during which admission she received a hysterectomy. Following the surgery she has been troubled by spells of anxiety, fainting, vomiting, food intolerance, and weakness and fatigue. Physical examinations reveal completely negative findings.

Hypochondriasis

Somatization disorder

Conversion disorder

DID

The correct answer is somatization disorder because the patient has a long history of physical complaints and seeking medical attention without any identifiable physical cause. She has a pattern of experiencing multiple physical symptoms in different body systems, such as chest pain, abdominal pain, backaches, and anesthesia in her fingertips. These symptoms are often associated with emotional distress and are not explained by any known medical condition. This pattern of somatic symptoms and seeking medical care is consistent with somatization disorder.

Explanation

The correct answer is somatization disorder because the patient has a long history of physical complaints and seeking medical attention without any identifiable physical cause. She has a pattern of experiencing multiple physical symptoms in different body systems, such as chest pain, abdominal pain, backaches, and anesthesia in her fingertips. These symptoms are often associated with emotional distress and are not explained by any known medical condition. This pattern of somatic symptoms and seeking medical care is consistent with somatization disorder.

7. Mrs. Chatterjee, a 26-year-old patient, attends a clinic in New Delhi, India, with complaints of "fits" for the last 4 years. The "fits" are always sudden in onset and usually last 30 to 60 minutes.A few minutes before a fit begins, she knows that it is imminent, and she usually goes to bed. During the fits she becomes unresponsive and rigid throughout her body, with bizarre and thrashing movements of the extremities. Her eyes close and her jaw is clenched, and she froths at the mouth. She frequently cries and sometimes shouts abuses. She is never incontinent of urine or feces, nor does she bite her tongue. After a "fit" she claims to have no memory of it. These episodes recur about once or twice a month. She functions well between the episodes. Both the patient and her family believe that her "fits" are evidence of a physical illness and are not under her control. However, they recognize that the fits often occur following some stressor such as arguments with family members or friends. . . . She is described by her family as being somewhat immature but "quite social" and good company. She is self-centered, she craves attention from others, and she often reacts with irritability and anger if her wishes are not immediately fulfilled. On physical examination, Mrs. Chatterjee was found to have mild anemia but was otherwise healthy. A mental status examination did not reveal any abnormality . . . and her memory was normal. An electroencephalogram showed no seizure activity. (Adapted from Spitzer et al., 2002, pp. 469–70.)

Pain disorder

Somatoform disorder

Conversion disorder

DID

The given scenario describes a patient who experiences sudden fits that are preceded by a warning and are accompanied by unresponsiveness, rigidity, thrashing movements, closed eyes, clenched jaw, frothing at the mouth, crying, and shouting. The patient does not have any memory of the fits and they occur about once or twice a month. The family believes that the fits are evidence of a physical illness but also recognize that they often occur following stressors. The patient's physical examination and mental status examination are normal, and there is no seizure activity on the electroencephalogram. These symptoms are consistent with Conversion disorder, which is characterized by the presence of physical symptoms that cannot be explained by a medical condition and are thought to be caused by psychological factors.

Explanation

The given scenario describes a patient who experiences sudden fits that are preceded by a warning and are accompanied by unresponsiveness, rigidity, thrashing movements, closed eyes, clenched jaw, frothing at the mouth, crying, and shouting. The patient does not have any memory of the fits and they occur about once or twice a month. The family believes that the fits are evidence of a physical illness but also recognize that they often occur following stressors. The patient's physical examination and mental status examination are normal, and there is no seizure activity on the electroencephalogram. These symptoms are consistent with Conversion disorder, which is characterized by the presence of physical symptoms that cannot be explained by a medical condition and are thought to be caused by psychological factors.

8. Somatization disorder (according to the DSM-IV-TR) requires __ gastrointestinal symptoms to present for diagnosis.

Four

Two

One

No

According to the DSM-IV-TR, somatization disorder requires the presence of at least two gastrointestinal symptoms for diagnosis.

Explanation

According to the DSM-IV-TR, somatization disorder requires the presence of at least two gastrointestinal symptoms for diagnosis.

9. Pain disorder requires 2 or more pain sites for clinical diagnosis.

True

False

One is fine

Explanation

One is fine

10. DSM-IV-TR criteria for Conversion disorder DOES NOT include:

Seeming lack of concern (known as la belle indifférence)

Symptom or deficit cannot be fully explained by a general medical condition.

One or more symptoms affecting voluntary motor or sensory function that suggest a neurological or other medical condition.

Psychological factors judged to be associated with the symptoms because they were preceded by conflicts or other stressors.

The DSM-IV-TR criteria for Conversion disorder include symptoms or deficits that cannot be fully explained by a general medical condition, one or more symptoms affecting voluntary motor or sensory function that suggest a neurological or other medical condition, and psychological factors judged to be associated with the symptoms because they were preceded by conflicts or other stressors. However, it does not include the symptom of seeming lack of concern, also known as la belle indifférence. This means that individuals with Conversion disorder may not display a lack of concern towards their symptoms, unlike what is commonly observed in other psychological disorders.

Explanation

The DSM-IV-TR criteria for Conversion disorder include symptoms or deficits that cannot be fully explained by a general medical condition, one or more symptoms affecting voluntary motor or sensory function that suggest a neurological or other medical condition, and psychological factors judged to be associated with the symptoms because they were preceded by conflicts or other stressors. However, it does not include the symptom of seeming lack of concern, also known as la belle indifférence. This means that individuals with Conversion disorder may not display a lack of concern towards their symptoms, unlike what is commonly observed in other psychological disorders.