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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
Somatization Disorder
Undifferentiated Somatoform Disorder
Pain Disorder
Hypocondriasis
Conversion Disorder
Body Dysmorphic Disorder
Somatoform Disorder Unspecified
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Somatization Disorder
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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/