10 13 2014 Somatization Flashcards
Somatization
behavior that results from bodily sensations or experiences
Somatic symptom disorder
Characterized by one or more physics symptoms accompanied by:
- disproportionate/ persistent thoughts about the seriousness of the disease
- Excessive time or energy devoted to addressing the symptoms
Patient is not faking it, they may be exaggerating or misinterpreting body sensation
* cultural expression of mood and anxiety (asian and hispanics are not allowed to complain of objective symptoms but they can complain for physical ailments
somatic amplification
seen with somatic symptom disorder
- decrease in the pain threshold
- very common for depressed patients
_greater tendency to report symptoms and indicate a disease
Alexthymia
A- not
lex- read
Thym- feelings
-unable to be aware of one’s own feelings
Complications of Somatic symptom disorder
- unnecessary tests
- unnecessary treatments : medication
- unnecessary surgeries
Illness anxiety disorder
same a somatic symptom disorder BUT without or mild somatic symptoms.
- preoccupation/ anxiety about an illness
Must persist for at least 6 months
Conversion disorder
Sudden, dramatic loss of sensory or motor function (blindness or paralysis) often associated with a stressful life event.
More common in unsophisticated adolescents and young adults
Patients appear relatively unworried ( “ la belle indifference”)
Psychological factors affecting other medical conditions
- Emotional or behavioral issues that negatively impact medical problem
- influencing course of illness
- interfering with treatment
- Adding a risk factor
- Influencing underlying pathophysiology
NOT DIAGNOSIS IF ANOTHER DIAGNOSIS CAN BE MADE (tobacco use disorder)
Fastitious Disorder (AKA Munchausen’s Syndrome)
Individual intentionally and falsely seeks medical attention either by faking an illness or causing harm to himself or herself to create an illness.
Persist despite lack of rewards.
Person knows that they are causing the illness.
Their goal is to be in the sick role.
Morbidity and mortality is a concern because of dire self-harm and complications of unnecessary medical and surgical interventions.
Fatitious disorder by proxy
Usually biological mother (parent/guardian) induce illness in a child.
- CHILD ABUSE!
Person tends to have borderline personality disorder and has a background in health care. Goal is to be the provider.
Treatment: remove child and give psychotherapy to the perpetrator
Pseudocyesis
fake pregnancy
may have all the symptoms but just are not pregnant.
Strategy for the treatment of Somatic symptom and related disorders:
- primary care physician is quarter back
- schedule visits regularly (don’t want patient to feel that the only way to see you is when they are sick)
- Focus evaluation on new symptoms
- Goal of treatment = improve function not cure
Educate patient on condition and address co-morbid psychiatric conditions ( depression and anxiety)
- be careful with medication because patients tend to be sensitive to side effects ( somatic amplification)
Malingering
faking an illness for secondary gain
- NOT a psychiatric disorder
What are risk factors for malingering?
- antisocial personality disorder
- medical-legal situations
Presence of medical or psychiatric diagnosis does NOT exclude malingering