Somatoform and Dissociative Disorders (cont\'d) Case Studies on Somatoform and D

Question

Somatoform and Dissociative Disorders (cont'd) Case Studies on Somatoform and Dissociative Disorders Check your understanding of somatoform and dissociative disorders by reading the information on the following 6 cases, and stating the most appropriate diagnosis for each person. Explain the rationale for each of your diagnoses. Some of these cases may not involve somatoform or dissociative disorders. In that case, indicate th at the person does not have a somatoform or dissociative disorder, and indicate why this would be the case. 1. Jackie is a 50 year old woman with a history of repeated serious medica complaints. She has had repeated surgeries, on average once a year. Some of her problems relate to documentable physical problems. For example, she had a mastectomy for breast cancer and she is diabetic. However, most of her complaints are not things for which a definite physical cause can be established. For example, recently she complained of abdominal pain which she felt was caused by adhesions from the previous surgery. She insisted on further surgery to correct this conditior. Without clothes, her body looks like it is covered with zippers; all are in fact scars from previous surgeries she has had. Myrtle is a 35 year old woman who comes to your office complaining of memory lapses. She has periods during the week where she cannot remember what she has done. However, she occasionally meets people who claim to have met her during these periods. Recently, a man called her home and asked to speak to "Myra" and claimed that he had met her at a singles bar. Myrtle has no recollection of having visited that bar. 2. Sam has had a nagging cough for several weeks. Although the cough is bothersome to Sam, it does not appear to the average observer to be serious. Sam, however, is really worried that he might have contracted tuberculosis. He has had 3 chest x-rays, ali of which were negative. (When the first x-ray came back negative, he thought it was an error, so he wen to another physician and got another x-ray, and so on.) He has also had a skin test for exposure to tuberculosis, which was also negative. He still believes that his cough is a symptom of a serious illness which has not been detected yet. He has been to a total of 11 physicians, so far, and none of them can find evidence of anything more serious than hayfever. 3. Garth does not like his job. Recently he began complaining of low back pain. He has been collecting disability payments for the past month. He continues to complain of back pain, and does not show any desire to 4. return to work

Explanation / Answer

Please note that that the diagnostic labels have been taken from DSM 5:

1. I would provide a diagnosis of a complex somatic symptom disorder because although the pain maybe exaggerated, the patient has at least some somatic symptoms.

2. I would provide a diagnosis of dissociative identity disorder, given that the patient is experiencing lapses in memery and is also meeting other people under a different identity.

3. I would provide a diagnosis of illness anxiety here as there is an unwarranted fear in the absence of any major somatic symptoms.

4. I would suspect a case of malingering here because there's no behaviour that indicates that the patient is trying to find a cure for his pain. In addition, there's a clear benefit for him to fake this pain.

5. I would provide a diagnosis of dissociative amnesia because there is a lack of any recollection of a traumatic incident.

6. I would provide a diagnosis of depersonalisation/derealization disorder as the episodes clearly indicate episodes of feeling far removed from reality.

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