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Somatoform, Factitious, and Dissociative Disorders

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When a client presents physical ailments for which no medical evidence confirms a condition, the client's pain may not simply go away. Rather, the pain may persist, further disrupting the client's life. In these cases, psychological evaluations may be used to determine if any psychological disorders exist. Specifically, somatoform disorders, factitious disorders, and dissociative disorders may be considered for the client's diagnosis. Additionally, psychologists may also evaluate whether other confounding factors, such as environmental and/or individual variables, influence a diagnosis.

Axes I through V diagnoses for the client in the case study and explain your rationale for assigning these diagnoses on the basis of the DSM-IV-TR. Then describe three confounding factors that may influence client diagnosis and why.

Male Client: All things considered, I'm doing pretty well. I own my own consulting firm. I help online businesses identify and build their customer base. The company keeps growing every year, so I'm kept pretty busy. I've got it made, really. I mean, I have more free time to play with than most people, a lot more. But to be honest, I'm not happy with my life right now. I wouldn't be here otherwise, right?

Psychologist: So tell me what's going on for you?

Male Client: Well I can't seem to keep a relationship going. I have so much good in my life right now, but just not that. I'll start going out with someone a couple of times, and they stop returning my calls. I used to think that it was just a run of bad luck, but now I know that it's me. I'm just not very attractive. I think that's what happened with my last real boyfriend. We were together for eight months, and never came right out and said it, but I know the reason he ended things - it was because I was just too fat. No matter what I do, I can't seem to get rid of this right here, my love-less handles.

Psychologist: Well, if sounds as if you exercise some, because you look in shape.

Male Client: I do. I should. I run five miles a day. I go to the gym a couple times a week and lift weights. I even take a hot yoga class. But it might look like I'm in shape, but trust me; I need to burn more weight.

Psychologist: You're what, 6 foot, 5'11"? How much do you weigh?

Male Client: 155, but 155 pounds of flab. Don't get me wrong. I know you might - I don't purge or anything. What goes in my belly stays there.

Psychologist: Tell me about your diet. What are your eating habits?

Male Client: I eat two meals a day, breakfast, lunch. That's it, no dinner. I drink a lot of protein mixes. I'll have a smoothie every now and then, but as long as its low fat. No alcohol, that's fattening. And definitely no pot. If you smoke that, you'll eat the whole grocery store.

Psychologist: When was the last time you had a physical?

Male Client: Three months ago. Everything was great. Blood pressure, cholesterol. I've never had a sick day in my life. Never seen a shrink, either. You know what my GP said last time I was there, putting my clothes back on? You're too skinny. You know what I said to him? Brother, you can never be too rich or too thin.

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Confounding factors- dealing with his body dysphoric disorder, his anorexia-even though he says he does not purge, and his homosexuality.

The patient states that ...