Eating Disorders PDF

EATING DISORDERS BULIMIA NERVOSA 1) Pica Disorder  Recurrent episodes of binge eating 2) Rumination disorder  Recurrent compensatory behaviors to prevent weight...

EATING DISORDERS BULIMIA NERVOSA 1) Pica Disorder  Recurrent episodes of binge eating 2) Rumination disorder  Recurrent compensatory behaviors to prevent weight 3) Avoidant/restrictive Food Intake Disorder gain, for example, vomiting 4) Anorexia nervosa  The binge eating and inappropriate compensatory 5) Bulimia nervosa behaviors both occur, on average, at least once a 6) Binge-eating disorder week for 3 months.  Body shape and weight are extremely important for PICA DISORDER self-evaluation  Persistent eating of nonnutritive, nonfood substances BINGE EATING DISORDER over a period of at least 1 month  Inappropriate to the developmental level of the  Recurrent binge eating episodes individual (A minimum age of 2 years is suggested for  Binge eating episodes include at least three of the a pica diagnosis) following:  The eating behavior is not part of a culturally o eating more quickly than usual supported or socially normative practice o eating until over full o eating large amounts even if not hungry o eating RUMINATION DISORDER alone due to embarrassment about large food quantity  Repeated regurgitation of food over a period of at o feeling bad (e.g., disgusted, guilty, or depressed) least 1 month. after the binge  Regurgitated food may be rechewed, reswallowed, o No compensatory behavior is present or spit out.  Marked distress regarding binge eating is present  The repeated regurgitation is not attributable to an  The binge eating occurs, on average, at least once a associated gastrointestinal or other medical condition week for 3 months (e.g., gastrosophageal reflux, pyloric stenosis).  The binge eating is not associated with the recurrent  The eating disturbance does not occur exclusively use of inappropriate during the course of other eating disorders AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER ETIOLOGY 1. Social Dimensions  Avoidance or restriction of food intake manifested by 2. Biological Dimensions clinically significant failure to meet requirements for 3. Psychological Dimensions nutrition or insufficient energy intake through oral intake of food TREATMENT  The disturbance is not better explained by lack of available food or by an associated culturally 1. Drug treatment (Anti-depressants) sanctioned practice. 2. Short-term Cognitive-Behavioral Therapy  The eating disturbance does not occur exclusively 3. Family Therapy during the course of other eating disorders 4. Interpersonal Psychotherapy 5. Hospitalization (Anorexia Nervosa) ANOREXIA NERVOSA 6. Self-help Approaches  Restriction of food that leads to very low body weight body weight is significantly below normal  Intense fear of weight gain or persistent behavior that interferes with weight gain, even though at a significantly low weight.  Body image disturbance or persistent lack of recognition of the seriousness of the current low body weight  SEXUAL RESPONSE CYCLE MALE HYPOACTIVE SEXUAL DESIRE DISORDER The Human Sexual Response Cycle  Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for A dysfunction is an impairment in one of the sexual activity. The judgment of deficiency is sexual response stages. made by the clinician  The symptoms in Criterion A have persisted for a Phases of Sexual Response minimum duration of approximately 6 months 1. Desire Phase  The symptoms in Criterion A cause clinically  Also referred to libido or excitement. Beginning of significant distress in the individual sexual arousal ERECTILE DISORDER 2. Arousal Phase  There is a subjective sense of sexual pleasure.  On at least 75 percent of sexual occasions for 6 Penis of males erect (tumescence) while vagina months: of females begin to lubricate (vasocongenstion) o Inability to attain an erection, or 3. Plateau Phase o Inability to maintain an erection for  It is a brief period of time before the orgasm as completion of sexual activity, or the body prepare for orgasm o Marked decrease in erectile rigidity 4. Orgasm Phase interferes with penetration or pleasure  It refers to the climax in layman’s terman, an intense and pleasurable experience, male ORGASMIC DISORDERS ejaculates the seminal fluid while both male and FEMALE ORGASMIC DISORDER female heart rate reach the maximum 5. Resolution  On at least 75 percent of sexual occasions for 6  It is the last phase where arousal decrease and months: muscle starts to relax, breathing, blood pleasure,  Marked delay, infrequency, or absence of and heart rate go back to normal orgasm, or  Markedly reduced intensity of orgasmic sensation SEXUAL DYSFUNCTIONS EARLY EJACULATION I. Disorders Involving Sexual Interest, Desire, and Arousal  Tendency to ejaculate during partnered sexual A. Female Sexual interest/arousal disorder activity within 1 minute of sexual activity on at B. Male Hypoactive sexual desire disorder least 75 percent of sexual occasions for 6 months C. Erectile disorder DELAYED EJACULATION DISORDER II. Orgasmic Disorders o Female orgasmic disorder  Marked delay, infrequency, or absence of o Early ejaculation orgasm on at least 75 percent of sexual occasions o Delayed Ejaculation Disorder for 6 months III. Genito-pelvic pain/ penetration disorder GENITO-PELVIC PAIN/PENETRATION DISORDER DISORDERS INVOLVING SEXUAL INTEREST, DESIRE,  Persistent or recurrent difficulties for at least 6 months AND AROUSAL with at least one of the following: FEMALE SEXUAL INTEREST/AROUSAL DISORDER o Inability to have vaginal/ penetration during intercourse A. Diminished, absent, or reduced frequency of at least o Marked vulvovaginal or pelvic pain during vaginal three of the following for 6 months or more: penetration or intercourse attempts o Marked fear or anxiety about pain or penetration  Interest in sexual activity o Marked tensing of the pelvic floor muscles during  Erotic thoughts or fantasies attempted vaginal penetration  Initiation of sexual activity and responsiveness to  Specify whether: partner's attempts to initiate o Lifelong  Sexual excitement/pleasure during 75 percent of o Acquired sexual encounters  Sexual interest/arousal elicited by any internal or ETIOLOGY external erotic cues  Genital or nongenital sensations during 75 Psychological Contributions percent of sexual encounters  Distraction   Negative thought processes  The individual experiencing the arousal and/or acting on the urges is at least 18 years of age Biological Contributions SEXUAL MASOCHISM DISORDER  Chronic illness  Vascular disease  Over a period of at least 6 months  Recurrent and intense sexual arousal from the act of Sociocultural Contributions being humiliated, beaten, bound, or otherwise made  Negative experiences such as rape/abuse to suffer, as manifested by fantasies, urges, or behaviors TREATMENT  The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, Psychosocial Approach occupational, or other important areas of functioning  Therapeutic program to facilitate SEXUAL SADISM DISORDER communication, improve sexual education, and eliminate anxiety  Over a period of at least 6 months  Both partners participate fully  Recurrent and intense sexual arousal from the physical or psychological suffering of another person, Medical Approach as manifested by fantasies, urges, or behaviors  Almost all interventions focus on male erectile  The individual has acted on these sexual urges with a disorder including drugs such as Viagra nonconsenting person, or the sexual urges or  Treatment is combined with sexual education and fantasies cause clinically significant distress or therapy to achieve maximum benefit impairment in social, occupational, or other important areas of functioning PARAPHILIC DISORDERS FETISHISTIC DISORDER 1. Exhibitionistic Disorder 2. Voyeuristic Disorder  Over a period of at least 6 months  Recurrent and intense sexual arousal from either the 3. Sexual Masochism Disorder use of nonliving objects or a highly specific focus on 4. Sexual Sadism Disorder nongenital body parts), as manifested by fantasies, 5. Fetishistic Disorder urges, or behaviors 6. Frotteuristic Disorder  The fantasies, sexual urges, or behaviors cause 7. Transvestic Disorder clinically significant distress or impairment in social, 8. Pedophilic Disorder occupational, or other important areas of functioning EXHIBITIONISTIC DISORDER FROTTEURISTIC DISORDER  Over a period of at least 6 months  Over a period of at least 6 months  Recurrent and intense sexual arousal from the  Recurrent and intense sexual arousal from touching or exposure of one's genitals to an unsuspecting person, rubbing against a nonconsenting person, as as manifested by fantasies, urges, or behaviors manifested by fantasies, urges, or behaviors.  The individual has acted on these sexual urges with a  The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or fantasies cause clinically significant distress or impairment in social, occupational, or other impairment in social, occupational, or other important areas of functioning important areas of functioning VOYEURISTIC DISORDER TRANSVESTIC DISORDER  Over a period of at least 6 months  Over a period of at least 6 months  Recurrent and intense sexual arousal from observing  Recurrent and intense sexual arousal from an unsuspecting person who is naked, in the process crossdressing, as manifested by fantasies, urges, or of disrobing, or engaging in sexual activity, as behaviors. manifested by fantasies, urges, or behaviors  The fantasies, sexual urges, or behaviors cause  The individual has acted on these sexual urges with a clinically significant distress or impairment in social, nonconsenting person, or the sexual urges or occupational, or other important areas of functioning fantasies cause clinically significant distress or impairment in social, occupational, or other PEDOPHILIC DISORDER important areas of functioning.  Over a period of at least 6 months  Recurrent, intense sexually arousing fantasies, sexual  Present when a person feels trapped in a body that is urges, or behaviors involving sexual activity with a the "wrong" sex, which does not match his or her prepubescent child or children (generally age 13 innate sense of personal identity years or younger)  The individual has acted on these sexual urges, or the ETIOLOGY sexual urges or fantasies cause marked distress or interpersonal difficulty Biological Influences  The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A  Not yet confimed, although likely to involve prenatal exposure to hormones ETIOLOGY  Preexisting deficiencies TREATMENT o In levels of arousal with consensual adults o In consensual adult social skills Sex reassignment surgery: removal of breasts or penis;  Treatment received from adults during childhood genital reconstruction  Early sexual fantasies reinforced by masturbation o Requires rigorous psychological preparation and  Extremely strong sex drive combined with financial and social stability uncontrollable thought  Psychosocial intervention to change gender identity TREATMENT o Usually unsuccessful except as temporary relief until surgery Covert sensitization: Repeated mental reviewing of aversive consequences to establish negative associations with behavior Relapse prevention: Therapeutic preparation for coping with future situations Orgasmic reconditioning: Pairing appropriate stimuli with masturbation to create positive arousal patterns Medical: Drugs that reduce testosterone to suppress sexual desire; fantasies and arousal return when drugs are stopped GENDER DYSPHORIA  A marked incongruence between one's experienced / expressed gender and assigned gender, of at least 6 months' duration  Strong desire to be a member of the other gender or strongly expressing the belief that one is a member of the other gender  Strong preferences for playing with members of the other gender and for toys, games, and activities associated with the other gender  Strong feelings of disgust and personal distress about one's sexual anatomy  Strong desires to have physical characteristics associated with one's experienced gender  Strong preferences for assuming roles of the other gender in make believe or fantasy play  Strong preferences for wearing clothing typically associated with the other gender and rejection of clothing associated with one's own gender  DEPRESSIVE DISORDERS 4. Sleep disturbance 5. Psychomotor agitation or retardation 1. Disruptive Mood Dysregulation Disorder 6. Fatigue or loss of energy 2. Major Depressive Disorder 7. Feelings of worthlessness or excessive 3. Persistent Depressive Disorder (Dysthymia) guilt 4. Premenstrual Dysphoric Disorder 8. Diminished ability to concentrate 9. Recurrent thoughts of death DISRUPTIVE MOOD DYSREGULATION DISORDER B. The symptoms cause clinically significant distress or impairment in social, occupational, or other A. Severe recurrent temper outbursts manifested important areas of functioning. verbally and/or behaviorally that are grossly out C. The episode is not attributable to the of proportion. physiological effects of a substance or another B. Temper outburst are inconsistent with medical condition. developmental age. D. At least one major depressive episode is not C. Temper outbursts occur, on average, three to better explained by schizoaffective disorder and four times a week is not superimposed on schizophrenia, D. The mood between temper outbursts is schizophreniform disorder, delusional disorder, or persistently irritable or angry most of the day other specified and unspecified schizophrenia nearly every day, and is observable by others. spectrum and other psychotic disorders. E. Criteria A-D have been present for 12 or more E. There has never been a manic episode or a months. hypomanic episode. F. The Criteria A and D are present in two or more setting. PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA) G. Diagnosis should be made for the first time between 6-18 years A. Depressed mood for most of the day, for more H. The age of onset of symptoms should be before days than not for at least 2 years 10 years old. I. There has never been a distinct period lasting Note: In children and adolescents, mood can be more than 1 day during which the full symptom irritable and duration must be at least 1 year criteria, except duration, for a manic or B. Presence while depressed of two (or more) of hypomanic episode have been met the following: J. The behaviors do not occur exclusively during an 1. Poor appetite or overeating episode of major depressive disorder and are 2. Insomnia or hypersomnia not better explained by another mental disorder 3. Low energy or fatigue (e.g., autism spectrum disorder, posttraumatic 4. Low self-esteem stress disorder, separation anxiety disorder, 5. Poor concentration or difficulty making persistent depressive disorder). decisions K. The symptoms are not attributable to the 6. Feelings of hopelessness. physiological effects of a substance or another C. During the 2-year period of the disturbance, the medical or neurological condition individual has never been without criteria A and B for more than 2 months. MAJOR DEPRESSIVE DISORDER D. Criteria for MDD must be continuously present for two years. A. Five or more of the following symptoms s have E. There has never been a manic episode or been present during the same 2- week period hypomanic episode and criteria have never and represent a change from previous been met for cyclothymic order. functioning: depressed mood or loss of interest or F. The disturbance is not better explained by a pleasure must be included. persistent schizoaffective disorder, schizophrenia, 1. Feelings of sadness, emptiness, and delusional disorder, or other specified or hopelessness unspecified schizophrenia spectrum and other 2. Markedly diminished interest or pleasure psychotic disorder. in different activities 3. Significant weight loss or weight gain G. The symptoms are not attributable to the 7. Physical symptoms such as breast tenderness physiological effects of a substance or medical or swelling, joint or muscle pain, a sensation condition of bloating or gaining weight H. The symptoms cause clinically significant distress D. The symptoms cause clinically significant distress or impairment in social, occupational, or other or interference with work, school, usual social important areas of functioning. activities, or relationships with others E. The disturbance is not merely an exacerbation of Specify whether: the symptoms of another disorder F. Criterion A should be confirmed by prospective With pure dysthymic syndrome: Full criteria for a daily ratings during at least two symptomatic major depressive episode have not been met in at cycles. least the preceding 2 years. G. The symptoms are not attributable to the physiological effects of a substance or other With persistent major depressive episode: Full criteria medical condition for a major depressive episode have been met throughout the preceding 2-year period. BIPOLAR DISORDERS With intermittent major depressive episodes, with current episode: Full criteria for a major depressive Manic Episode episode are currently met, but there have been A. A distinct period of abnormally and persistently periods of at least 8 weeks in at least the preceding elevated, expansive, or irritable mood, 2 years with symptoms below the threshold for a full increased goal-directed activity or energy, major depressive episode. lasting at least 1 week and present most of the With intermittent major depressive episodes, without day, nearly every day current episode: Full criteria for a major depressive B. During the period of mood disturbance and episode are not currently met, but there has been increased energy or activity, three (or more) of one or more major depressive episodes in at least the following symptoms are present to a the preceding 2 years. significant degree and represent a noticeable change from usual behavior: PREMENSTRUAL DYSPHORIC DISORDER 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep (e.g., feels A. In the majority of menstrual cycles, at least 5 rested after only 3 hours of sleep). symptoms must be present in the final week 3. More talkative than usual or pressure to before the onset of menses, start to improve keep talking. within few days after the onset of menses and 4. Flight of ideas or subjective experience become minimal or absent in the week that thoughts are racing. postmenses. 5. Distractibility (i.e., attention too easily B. One or more of the following symptoms must be drawn to unimportant or irrelevant present: externalstimuli), as reported or observed. 1. Marked affective ability (e.g. mood swings, 6. Increase in goal-directed activity sadness, tearful, sensitivity) 7. Excessive involvement in activities that 2. Marked irritability or anger have a high potential for painful 3. Marked depressed mood consequences (e.g., engaging in 4. Marked anxiety or tension unrestrained buying sprees, sexual C. One or more must additionally be present to indiscretions, or foolish business reach a total of 5 symptoms. investments). 1. Decreased interest in usual activities C. The mood disturbance is sufficiently severe to 2. Difficulty concentration cause marked impairment in social or 3. Lethargy, lack of energy occupational functioning 4. Marked change in appetite D. The symptoms are not attributable to the 5. Sleep disturbance physiological effects of a substance or other 6. Sense of being overwhelmed or out of control medical condition. Note: At least one lifetime manic episode is required BIPOLAR II for the diagnosis of bipolar I disorder. A. One hypomanic and one major depressive Hypomanic Episode episode has been met B. There has never been a manic episode. A. A distinct period of abnormally and persistently C. At least one hypomanic episode and at least elevated, expansive, or irritable mood, one major depressive episode are not better increased activity or energy, lasting at least 4 explained by schizoaffective disorder consecutive days and present most of the day, D. The symptoms of depression or the nearly every day. unpredictability caused by frequent alternation B. During the period of mood disturbance and between periods of depression and hypomania increased energy or activity, three (or more) of causes clinically significant distress or impairment the following symptoms are present to a significant degree and represent a noticeable CYCLOTHYMIC DISORDER change from usual behavior: 1. Inflated self-esteem or grandiosity. A. For at least 2 years, there are hypomanic periods 2. Decreased need for sleep (e.g., feels rested but did not meet the full criteria for hypomanic after only 3 hours of sleep). episode and depressive periods but did not 3. More talkative than usual or pressure to keep meet the full criteria for major depressive talking. episode. 4. Flight of ideas or subjective experience that B. The individual has not been without the thoughts are racing. symptoms for more than 2 months 5. Distractibility (i.e., attention too easily drawn C. Criteria for a major depressive, manic, or to unimportant or irrelevant external stimuli), hypomanic episode have never been met. as reported or observed. D. The symptoms in Criterion A are not better 6. Increase in goal-directed activity explained by schizoaffective disorder 7. Excessive involvement in activities that have E. The symptoms are not attributable to the a high potential for painful consequences physiological effects of a substance or another (e.g., engaging in unrestrained buying medical condition. sprees, sexual indiscretions, or foolish business investments). C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is not severe to cause marked impairment in social or occupational functioning F. The symptoms are not attributable to the physiological effects of a substance or other medical condition. BIPOLAR I ETIOLOGY A. One manic and one major depressive episode has been met which can be followed by Biological Factors hypomanic episode. B. At least one manic episode is not better 1. Familial and Genetic Influences explained by schizoaffective disorder and is not 2. Neurotransmitter Systems superimposed on schizophrenia, 3. Endocrine System schizophreniform disorder, delusional disorder, or 4. Sleep Disturbance other specified or unspecified schizophrenia spectrum and other psychotic disorder. Psychological Factors B. Deep Brain Stimulation  Chronic brain stimulation through an 1. Personal perception towards negative electrode was implanted under the skin to stressful life events deliver continual impulses of electrical 2. Striving to achieve stressful goals stimulation that could not be detected by 3. Learned Helplessness the patients 4. Negative cognitive styles  It has shown a therapeutic effect among depressed patients who have failed to Social Factors respond to other treatments C. Cognitive-Behavioral Therapy 1. Marital relations  It involves helping the individual examine 2. Gender Bias things that they think and they do 3. Social support  The way we think about the situations can affect the way we behave TREATMENT D. Interpersonal Therapy  It involves resolving the conflict with other A. Antidepressant Drugs people which serves as the causal factor of 1. Monoamine Oxidase Inhibitors the disorder  Iproniazid was the first antidepressant drug in the market  It increases the levels of monoamine such as norepinephrine and serotonin by inhibiting the activity of monoamine oxidase (MAO) that breaks down monoamine neurotransmitters  These MAO inhibitors have several side effects and the most dangerous is the cheese effect which elevates blood pressure that increases the risk of stroke 2. Tricyclic Antidepressants  It blocks the reuptake of the norepinephrine and serotonin from synapses, thus increasing their levels in the brain  Imipramine was the first tricyclic antidepressant which initially thought to be an antipsychotic drug  They are safer alternative to MAO inhibitors 3. Selective Serotonin-Reuptake Inhibitors (SSRIs)  It blocks the reuptake of serotonin from synapses  Fluoxetine (Prozac) was the first SSRI in the market  It was immediately accepted by the psychiatric community because they have fewer effects than tricyclic antidepressant and MAO inhibitors and can also be applied in the wide range of psychological disorders  PROLONGED GRIEF DISORDER pursuing interests, or planning for the future). A. The death, at least 12 months ago, of a person 6. Emotional numbness (absence or marked who was close to the bereaved individual (for reduction of emotional experience) as a children and adolescents, at least 6 months result of the death. ago). 7. Feeling that life is meaningless as a result B. Since the death, the development of a of the death. persistent grief response characterized by one or 8. Intense loneliness as a result of the death. both of the following symptoms, which have D. The disturbance causes clinically significant been present most days to a clinically significant distress or impairment degree. In addition, the symptom(s) has E. The duration and severity of the bereavement occurred nearly every day for at least the last reaction clearly exceed expected social, month: cultural, or religious norms for the individual’s 1. Intense yearning/longing for the culture and context. deceased person. F. The symptoms are not better explained by 2. Preoccupation with thoughts or memories another mental disorder and are not attributable of the deceased person (in children and to the physiological effects of a substance or adolescents, preoccupation may focus another medical condition. on the circumstances of the death). C. Since the death, at least three of the following symptoms have been present most days to a clinically significant degree. In addition, the symptoms have occurred nearly every day for at least the last month: 1. Identity disruption (e.g., feeling as though part of oneself has died) since the death. 2. Marked sense of disbelief about the death. 3. Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by efforts to avoid reminders). 4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death. 5. Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with friends,  MODULE 5: Dissociative & Somatoform Disorders 1 DISSOCIATIVE DISORDERS ETIOLOGY 1) Dissociative Identity Disorder I. Environmental Factors 2) Dissociative Amnesia 3) Depersonalization/Derealization Disorder  Severe abuse during childhood  "Fantasy life" is the only escape  Process becomes automatic and then involuntary DISSOCIATIVE IDENTITY DISORDER II. Biological Factors A. Disruption of identity characterized by two or more distinct personality states (alters) or an experience of  Heredity possession. This disruption may be observed by others or reported by the patient. TREATMENT B. Recurrent gaps in recalling events or important Dissociative Identity Disorder (DID) personal information that are beyond ordinary forgetting.  Long-term psychotherapy may reintegrate DISSOCIATIVE AMNESIA separate personalities in 25% of patients  Treatment of associated trauma similar to PTSD A. Inability to remember important personal information, usually of a traumatic or stressful nature, that is too Dissociative Amnesia (DA) extensive to be ordinary forgetfulness  Usually self-correcting when current life stressor is B. Functional Impairment and significant distress. resolved  If needed, therapy focuses on retrieving the lost C. The amnesia is not explained by substances or memory medical condition Depersonalization/Derealization Disorder (D-DD) D. Not better explained another psychological conditions  Psychological treatments similar to those for panic Specify if: disorder  Stress associated with onset of disorder should be Dissociative fugue subtype: the amnesia is addressed associated with bewildered or apparently purposeful wandering CONTROVERSY DEPERSONALIZATION/DEREALIZATION DISORDERS  The scientific community is divided over the question of whether multiple identities are genuine experience A. Presence of persistent and recurrent experiences of or faked depersonalization and derealization  Studies have shown that false memories can be created by therapies A.1: Depersonalization – Experiences of detachment  Other tests confirm that various alters are from one's mental processes or body, as though one physiologically distinct is in a dream A.2: Derealization – Experiences of unreality of SOMATOFORM DISORDERS surroundings 1) Somatic symptom disorder B. Reality testing remains intact 2) Illness anxiety disorder 3) Conversion disorder (functional neurological C. Significant distress and functional impairment symptom disorder) 4) Factitious disorder D. Symptoms are not explained by substances, or by a medical condition SOMATIC SYMPTOM DISORDER A. One or more somatic symptoms that are distressing or result in significant disruption in daily life  MODULE 5: Dissociative & Somatoform Disorders 2 B. Excessive thoughts, feelings or behaviors related to the C. High level of anxiety about health seriousness of the somatic symptoms as manifested in at least 1 of the ff: D. These fears must lead to excessive care seeking or maladaptive avoidance behaviors  Persistent thoughts about the seriousness of the of one's symptoms E. Duration of at least 6 months  Persistently high level of anxiety about health or symptoms F. Not better explained by another mental disorder  Excessive time or energy devoted to these symptoms Specity whether: C. Duration of at least 6 months o Care-seeking type o Care-avoidant type Specify if: ETIOLOGY  With predominant pain (previously pain disorder) I. Environmental Factors Specify if:  Faulty interpretation of physical sensations  Intesified focus on sensation  Persistent: A persistent course is characterized  Increased anxiety by severe symptoms, marked impairment, and long duration (more than 6 months). II. Biological Factors Specify current severity:  Heredity  Mild: Only one of the symptoms specified in TREATMENT Criterion B is fulfilled.  Moderate: Two or more of the symptoms  Psychotherapy to challenge illness perception specified in Criterion B are fulfilled.  Counseling and/or support groups to provide  Severe: Two or more of the symptoms reassurance specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very CONVERSION DISORDER (FUNCTIONAL severe somatic symptom). NEUROLOGICAL SYMPTOM DISORDER) ETIOLOGY A. One or more symptoms affecting voluntary motor or sensory function I. Environmental Factors  People may experience partial or complete  Continual development of new symptoms paralysis of arms or legs; seizures and coordination followed by immediate sympathy and attention disturbances; a sensation of prickling, tingling, or creeping on the skin; insensitivity to pain; or II. Biological Factors anesthesia  Heredity B. The symptoms are incompatible with recognized medical disorder TREATMENT  When a patient reports a neurological symptom, it Cognitive-Behavioral Therapy (CBT) to provide is important to assess whether that symptom has a reassurance, reduce stress, and minimize help-seeking true neurological basis behaviors ETIOLOGY ILLNESS ANXIETY DISORDER I. Environmental Factors A. Preoccupation with fears of having a serious disease  Life stresses or psychological conflict B. No significant somatic symptoms present  Symptoms learned from observing real illness or injury  MODULE 5: Dissociative & Somatoform Disorders 3 II. Biological Factors  Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (CBT  Heredity and/or Family Therapy) TREATMENT Same as somatic symptom disorder, with emphasis on resolving life stress or conflict and reducing help-seeking behaviors FACTITIOUS DISORDER A. People with this disorder fake or manufacture physical or psychological symptoms, but without any apparent motive. B. The person presents himself to others as ill or injured C. Deceptive behavior is evident Factitious Disorder Subtypes Factitious disorder on self (Münchausen Syndrome) the person presents himself or herself to others as ill, impaired, or injured Factitious disorder imposed on another: the person fabricates symptoms in another person and then presents that person to others as ill, impaired, or injured ETIOLOGY  The exact cause of factitious disorder is not known  Researchers believe both biological and psychological factors play a role  Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses in themselves or family members that required hospitalization  Most patients with factitious disorder have histories of abuse, trauma, family dysfunction, social isolation, early chronic medical illness or professional experience in healthcare TREATMENT  The first goal of treatment is to change the person's behavior and reduce their misuse of medical resources  In the case of factitious disorder imposed on another, the main goal is to ensure the safety and protection of any real or potential victims  Once the first goal is met, treatment aims to resolve any underlying psychological issues that may be causing the behavior