Somatoform, Eating and Sexual Dysfunction Disorders

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jknell
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196971
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Somatoform, Eating and Sexual Dysfunction Disorders
Updated:
2013-01-31 18:35:16
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MBB II
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MBB II
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  1. Somatoform Disorder
    Physical symptoms that are due to psychological rather than medical illness

    • 1. Somatization disorder
    • 2. Hypochodriasis
    • 3. Pain Disorder
    • 4. Body Dysmrophic Disorder
    • 5. Conversion Disorder


    ** NOT: malingering or factitious disorders

    • Epidemiology:
    • -1% of general population
    • -women > men
    • -usually before 30

    • Diagnosis:
    • 1. pain (@ least 4 sites)
    • 2. at least 2 GI sx
    • 3. at least 1 sexual or reproductive sx
    • 4. at least one neuro sx
    • That cannot be explained by a medical condition or substance

    • Treatment:
    • -reassurance, education
    • -not make detailed inquiries about sx
    • -rarely used meds (SSRIs in BMD)
  2. Hypochondriasis
    -4% of primary care patients

    • -preoccupation with fears of having or the idea that they have a SPECIFIC disease
    • -persists despite medical evaluation and reassurance

    -usually at least 6 months
  3. Pain Disorder
    -pain in one or more anatomical sites that is the predominant focus of the clinical presentation

    -psych factors have an important role in onset, severity and exacerbation of the pain
  4. Body Dysmorphic Disorder
    • Epidemiology:
    • -1-3%
    • -men = women
    • -onset in adolescence, early adulthood

    Preoccupation with an imagined defect in appearance
  5. Conversion Disorder
    • Epidemiology:
    • -women > men
    • -onset: late childhood, early adolescence
    • -may be acute, chronic or recurrent

    • Diagnosis:
    • -symptoms or deficits that affect voluntary motor or sensory function
    • -often preceded by stressors
  6. Anorexia Nervosa
    • -body weight <85%
    • -intense fear of gaining weight
    • -disturbance in 1+:
    •      -body weight or shape experienced
    •      -undue influence of image on self value
    •      -deny seriousness of low body weight
    • -absence of 3 consecutive periods

    "restrictive type"

    • Course:
    • -onset in adolescence/puberty
    • -mainly female (10:1)
    • -deny disorder and resist tx
    • ->30% develop major depressive sx
    • -50% recover
    • -30% chronically ill
    • -10% die

    • Treatment
    • 1. Restore nutritional state
    • -usually inpatient
    • -antidepressants show some efficacy
    • 2. Relapse Prevention
    • -outpatient
    • -difficult to gain weight (dysphoria with meals, lack of hunger mechanism with starvation)
    • **high rate of relapse
  7. Bulimia Nervosa
    • Episodes of Binging:
    • -larger amount of food than normal consumed withing a discrete period of time
    • -lack of control over episode

    • Episodes of Purging:
    • -self induced vomiting
    • -misuse of laxatives
    • -diuretics
    • -enemas

    • -At least 2x/week for 3 months
    • -self value unduly influence by body image

    • Treatment:
    • -outpatient
    • -antidepressants (more helpful than in anorexia)
  8. Paraphilia
    • -sexual deviation
    • -at least 6 months of recurrent, arousing fantasies, urges or behaviours involving objects, humiliation or non-consenting individuals

    Occur almost exclusively in men

    • Causes:
    • -unknown
    • -brain function/learned behaviour/sx of other disorder

    • Treatments:
    • -psych/behaviour therapy
    • -decrease T (reduce sex drive)
    • -leuprolide (GnRH agonist)
    • -SSRIs
  9. Exhibitionism
    -exposing genitals to unsuspecting stranger
  10. Voyeurism
    -observing unsuspecting person disrobe or have sex
  11. Fetishism
    -using non-living objects such as underwear or shoes
  12. Transvestic fetishism
    -cross dressing
  13. Frotteurism
    -touching or rubbing against non-consenting person
  14. Masochism
    -the act of being beaten, humiliated, bound or other suffering
  15. Sadism
    -sexual excitement from psychological or physical suffering of a victim
  16. Pedophilia
    -sex with pre-pubertal child
  17. Gender Identity Disorder
    "transexualism"

    Strong and persistent cross-gender identification

    • -stated desire to be the other sex
    • -passing as the other sex
    • -desire to live of be treated as the other sex
    • -conviction that they have the typical feelings and reactions of the other sex

    • Usually begins in childhood:
    • 1/30000 males
    • 1/100000 females
  18. Sexual Dysfunction Disorder
    • -Hypoactive Desire
    • -Aversion
    • -Female Arousal
    • -Male Erectile
    • -Male Orgasmic
    • -Female Orgasmic
    • -Premature Ejaculation
    • -Male or Female dyspareunia
    • -Vagnismus

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