28: Somatization - Streyffeler

Question 1

reasons for somatization

Answer 1

• emotional disturbances have physical effects upon the body
• physical symptoms may be perceived as a necessary ticket of admission to receive caring from the clinician
• physical distress carries less shame and connotation of weakness than emotional distress
• dysfunctions in neuroendocrine system have been linked to functional disorders, including chronic fatigue syndrome and some kinds of chronic pain
• psychiatric illness

Question 2

somatization -

Answer 2

experiencing and communicating of emotional distress as physical distress

Question 3

tips for working with pts with unexplained symptoms

Answer 3

• develop empathic, trusting relationship
• encourage strong relationship with one primary care provider
• accepts that symptoms are real, in sense of being a valid expression of distress
• acknowledge the pts suffering
• use descriptive terms to reflect back the symptoms; no need to dispute etiology
• may eventually note that stress tends to worsen symptoms

Question 4

diagnostic and treatment efforts should be guided by _____- rather than __

Answer 4

signs

symptoms

Question 5

clinical approach to medically unexplained symptoms

Answer 5

1. inability to find a physical cause for symptoms does not allow for a psychological diagnosis to be made unless affirmative evidence of pyschological dysfunction is found
2. discovering a medical explanation does not mean that psychiatric factors are absent, particularly if symptoms and impairment are more severe than would be expected
3. avoid investing energy in determining whether symptoms are medically vs. psychologically caused. both factors are typically relevant.
4. take a multidemensional approach, and look to how the pt reacts to the symptoms and the subsequent functional impairement as indicators of somatization
5. be mindful that most ppl somatize at times, and there is a continuum from normal to quite pathological

Question 6

criteria for somatic symptom disorder

Answer 6

• one or more somatic symptoms that are distressing or result in significant disruption of daily life
• excessive thoughts, feelings, or behaviors related to the symptoms
• symptoms may vary, but state of being symptomatic persists

Question 7

prevalence of somatic symptom disorder

Answer 7

5-7%

Question 8

criteria for illness anxiety disorder aka hypochondriasis

Answer 8

• preoccupation with health to the exclusion of everything else
• somatic symptoms are either not present or are mild
• high level of anxiety about health
• individual performs excessive health-related behaviors or else exhibits maladaptive avoidance
• illness preoccupation must be present at least 6 mo

Question 9

fixed belief that one is seriously ill that is impervious to reassurance

Answer 9

illness anxiety disorder

Question 10

criteria for conversion disorder

Answer 10

• one or more symptoms of altered voluntary motor or sensory function
• clinical findings show incompatibility between the symptom and recognized neurological or medical conditions
• symptom causes clinicall significant distress or impairment

Question 11

inexplicable fainting, paralysis, seizures, blindness, etc

Answer 11

conversion disorder

Question 12

factitious disorder v. malingering

Answer 12

factitious: intentional production of symptoms with goal to assume the sick role
malingering: lying to obtain outcome not sick role, not a psychiatric disorder