5. Somatic Symtpom Disorders Flashcards
Definition: patient’s suffering seems to be out of proportion to the actual severity of the physical problem
chronic “benign” pain
True or false: because somatiform disorders are not real pain, they only need CBT for treatment
FALSE: you absolutely need to reule out medical causes
True or false: somaticizing patients rarely ever have psychological concerns.
FALSE: some may acknowledge psychological concerns but may not see connection between somatic symptoms and precipitating stress conditions
What is the differential for somatic symptom and related disorders?
- Adult anxiety disorders
- Stress/trauma disorders
- OCD
How do you treat somatic symptom and related disorders?
- Do no harm (encourage healthy living)
- Take good psycho-social history (know the patient and screen for depression and anxiety)
- Consider somaticizing from beginning (but also rule out medical causes)
- CBT
- CAM
What is mind-body dualism?
real pain v. psychiatric problem (all pain is real pain)
When does somatic symptom disorder present?
before 30 yo (early)
What gender more commonly gets somatic symptom disorder?
women
What are risk factors for somatic symptom disorder?
- Rural areas
- Lower level of education
- Chaotic life circumstances
- Abuse history (often related to recent stress and h/o physical abuse and/or sexual molestation)
How does somatic symptom disorder differ from illness anxiety disorder?
- SSD will have patient with multiple, vague and shifting somatic symptoms (dramatically described) that are medically unexplained or marginally explained
- Illness anxiety disorder patients will have primary concerns of being ill and patients often have NO symptoms or minimal symptoms and ONE PREOCCUPATION at a time
What is Alexithymia? What disorder is it commonly seen in?
Alexithymia is the inability to express feelings (ex. hurt, fear, anger) in words. It is seen in somatic symptom disorder.
Comorbid depression is often seen in what somaticizing disorder?
SSD
What are some symptoms complained of by SSD patients?
nervousness back pain weakness joint pain dizziness extremity pain fatigue nausea HA dyspnea chestpain constipation/bloating
How do you treat SSD?
- offer routine visits to show concern and availability
- may respond to CBF
What is the old name for illness anxiety disorder?
hypochondriasis
What is the definition of illness anxiety disorder?
obsessional preoccupation with (or fear of) having a serious illness
How long must you have the preoccupations to be diagnosed with illness anxiety disorder?
lasts 6 months or more (where you cannot reassure the patient)
How might you treat illness anxiety disorder?
CBT
Definition: alteration or loss of physical functioning without explanatory pathology
conversion disorder
True or false: conversion disorder is NOT consciously feigned
TRUE (psychological problems that are “converted” into medical problems)
Who gets conversion disorder?
common in children
- many have model for symptom
- some are their own model (ex. pseudoseizures)
When do conversion disorders usually start?
under overwhelming stress (ex. funerals, family arguments)
What do patients with conversion disorder present with?
neurological symptoms (ex. paralysis, tunnel vision, seizures, numbness) but DOES NOT follow neuronal pathways
True or false: conversion disorder commonly causes extreme anxiety in patients
FALSE: may lead to distress and impairment but may not cause much anxiety in the afflicted patient
What treatments work for conversion disorder?
- hypnosis or psychotherapy
- may require physical therapy
Definition: patient engages in deception and manufactures medical or psychiatric symptoms
factitious disorder
Definition: patient engages in purposeful self-injury, infliction, or feigning of illness
malingering
What is the gain in factitious disorder?
primary gain (no external reward or gain, just want to get admitted and create interest and concern with the unusual and puzzling medical condition)
What is the gain in malingering?
secondary gain (obvious potential rewards–like escaping punishment/work or achieving financial or other compensation)
Who gets facitious disorders?
females > males; more commonly people with health-care related jobs
Who participates in malingering?
prisoners
soldiers
anti-social personality disorder
What type of disorder is Munchausen’s?
factitious disorder
What type of treatment is used for facitious disorder?
empathetic interviewing?
Definition: disruption, loss or absence of usual integration of memory, consciousness, and personal identity
dissociation
True or false: dissociation is always abnormal
FALSE: dissociation can be a normal, protective response to trauma or intense and recurrent fear OR a pathological state when dissociation occurs repeatedly and out of context
What is the presentation of dissociative disorders?
specific medical (cognitive) symptoms related to overwhelming anxiety states
Definition: sudden amnesia related to traumatic exposures
dissociative amnesia
Definition: sudden unexpected travel with inability to recall one’s past (often patient does not know own identity and is admitted as “John Doe”
dissociative fugue
Definition: feeling like one is “on the outside looking in” or an observer of ones’ own actions
depersonalization disorder
Definition: “multiple personality disorder” where a patient assumes one of several identities or “alters” when stressed
dissociative identity disorder
What is the risk factor for dissociative identity disorder?
childhood trauma
