Term
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Definition
nDSM-IV-TR defines malingering as "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."
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Term
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Definition
Symptom
Malingering Conscious Conscious
Factitious Disorder Conscious Unconscious
Somatoform Disorder Unconscious Unconscious
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Term
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Definition
-Dissociative identity disorder, psychosis, suicidality, and posttraumatic stress disorder.
-Forensic mental health clinicians are most likely to encounter malingered psychosis, malingered PTSD, and malingered amnesia/cognitive deficits.
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Term
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Definition
-A broad group of illnesses with bodily signs and symptoms as the predominant focus, influenced by the psyche
-Concept of mind/body interactions, with signals from the brain (?mechanism) indicating a problem
-Not based on theoretical construct or laboratory findings-no significant substantiating data, yet vigorous and sincere complaints “not imaginary”
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Term
Somatoform Disorders Examples |
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Definition
-Conversion disorder
-Hypochondriasis
-Somatization disorder
-Body dysmorphic disorder
-Pain disorder
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Term
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Definition
Conversion disorder is the somatoform disorder most likely to be mistaken for malingering. In this disorder, individuals present with pseudoneurological deficits of voluntary motor or sensory function that typically fail to follow known anatomical pathways. Other conversion symptoms include aphonia, urinary retention, blindness, deafness, paralysis, mutism,hallucinations, and seizures.
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Term
Conversion Disorder
Epidemiology |
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Definition
-Ratio of women to men
-Range of 2/1 to 10/1 in adults
-Increased female predominance in children
-Symptoms in women more common on left side of body
-Women with conversion symptoms more likely to subsequently develop somatization disorder
-Association in men between conversion disorder and antisocial personality disorder
-Men with conversion disorder often involved in occupation or military accidents
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Term
Conversion Disorder
Comorbidity |
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Definition
-Common Axis I psychiatric conditions:
-Depressive disorders (increased suicide risk)
-Anxiety disorders
-Somatization disorders
-Conversion in schizophrenia reported but considered uncommon, yet ¼ to ½ admissions to a psychiatric unit for conversion disorder have significant mood disorder or schizophrenia
-Personality Disorders
-5 to 21% histrionic
-9 to 40% passive-aggressive/dependent
-Antisocial
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Term
Conversion Disorder
Etiology |
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Definition
-Biological Factors
-Brain imaging
-Hypometabolism of dominant hemisphere
-Hypermetabolism of nondominant hemisphere
-Neuropsychological tests
-Subtle cerebral impairments in verbal communication, memory, vigilance, affective incongruity, and attention
-Increased incidence with head trauma/organicity
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Term
Conversion Disorder
Clinical Features
Sensory symptoms
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Definition
-Anesthesia and paresthesia common, especially in extremities (although all sensory modalities can be involved)
-Distribution of the neurological deficit inconsistent with either central or peripheral neurological disease (e.g. stocking-and-glove anesthesia, and hemianesthesia beginning precisely along the midline)
-Possible involvement of organs of special sense (deafness, blindness, tunnel vision)
-Unilateral or bilateral
-Intact sensory pathways by neurological exam
(e.g. conversion disorder blindness: ability to walk around without collision or self-injury, with pupils reactive to light, and normal cortical evoked potentials.)
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Term
Conversion Disorder
Clinical Features
Motor Symptoms |
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Definition
-Abnormal movements (gait disturbance, weakness/paralysis)
-Movements generally worsen with calling of attention
-Possible gross rhythmical tremors, chorea, tics, and jerks
-Astasia-abasia (wildly ataxic/staggering gait, gross irregular/jerky truncal movements, thrashing/waving of arms-rare falls w/o injury)
-Paralysis/paresis involving one, two, or all four limbs (w/o conformation to neural pathways)
-Reflexes remain normal
-No fasciculations/muscle atrophy (except chronic conversion)
-Normal electromyography
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Term
Conversion Disorder
Clinical Features
Seizure Symptoms |
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Definition
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Pseudoseizures
-Differentiation from true seizure difficult by clinical observation alone
-1/3 of those with pseudoseizures have coexisting epileptic disorder
-Tongue biting, urinary incontinance, and injuries after falling can occur (although generally absent)
-Pupillary and gag reflexes retained
-No postseizure increase in prolactin concentration
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Term
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Definition
-Inappropriate cavalier attitude toward serious symptoms
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Term
Conversion Disorder
Course and Prognosis |
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Definition
-Initial symptoms resolve within a few days to < a month in 90 to 100% (95% remit spontaneously, usually by 2 weeks)
-75% have no further episodes, with 20-25% recurring within a year during periods of stress
-25 to 50% present later with neurological disorders or nonpsychiatric medical conditions affecting the nervous system
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Term
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Definition
Frequently used in all dissociative disorders
Repression:
Disturbing impulses are blocked from consciousness
Denial: external reality is ignored
Dissociation:
Separation & independent functioning of 1 group of mental processes from others-(mental contents exist in parallel consciousness)
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Term
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Definition
-Most common dissociative disorder
-One or more episodes of inability to recall important personal information (traumatic or stressful, that is too extensive to be explained by ordinary forgetfulness)
-Reality testing remains intact
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Term
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Definition
Sudden unexpected travel away from home or ones customary place of work, with inability to recall one’s past.
Confusion about personal identity or assumes new identity (partial or complete)
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Term
Dissociative Identity Disorder |
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Definition
-The presence of 2 or more distinct identities or personality states (each with its own pattern of relating to the environment and self)
-At least 2 states recurrently take control of the persons behavior
-Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness
-Not due to substances (alcohol) or GMC (complex partial seizures)
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Term
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Definition
-Most severe and chronic dissociative d/o
-Original personality is generally amnestic of & unaware of the other personalities
-Being told of behavioral episodes by others that are not remembered by pt
-Being recognized by others or called by another name the pt does not recognize
-Discovery of writings, drawings etc. or objects (identification cards, clothing) among the patients belongings that are not recognized by the patient or cannot be accounted for
-Hx of witnessing a death or trauma or severe emotional, sexual or physical abuse as a child (incest) usually before 5yrs),poor support
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Term
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Definition
-Severe psychological & physical abuse (mostly sexual) in childhood leads to a profound need to distance ones self from horror and pain.
-This leads to an unconscious splitting off of different aspects of the original personality, with each personality expressing a necessary emotion or state (rage, sexuality, competence, playfulness) that the original personality dare not express
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Term
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Definition
Treat co-morbid disorders
-Intense insight-oriented psychotherapy-attempt to integrate split personalities into one whole
-Help pt understand that original reasons for dissociation (overwhelming rage, fear & confusion secondary to abuse) no longer exist
& affect states can be expressed by one whole person without the self being destroyed
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Term
Depersonalization Disorder
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Definition
-Feeling that the body or personal self is strange
- Persistent or recurrent experiences of feeling detached from & as if one is an outside observer of, one’s mental processes or body (e.g. like feeling like one is in a dream)
-reality testing intact
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Term
Depersonalization Disorder NOS
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Definition
Ganser’s syndrome: Prisoners with personality disorders giving approximate answers to questions-eg. 2+2=5 or talking past the point usually with other symptoms like amnesia, perceptual disturbances .
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