6.1: functional somatic symptoms

Question 1

• Functional Somatic Symptoms (FSS):

Answer 1

Symptoms that are medically unexplained and lack identifiable structural, biochemical, or pathological causes.

o Includes conditions like:
 Irritable Bowel Syndrome (IBS)
 Chronic Fatigue Syndrome (CFS)
 Fibromyalgia
 Non-cardiac chest pain
 Tension headaches

Question 2

. Misunderstandings About FSS

Answer 2

• Common Misconceptions:
  o FSS symptoms are not real and purely psychological.
  o Patients are malingering, seeking attention, or exaggerating symptoms.
• Reality:
  o Symptoms are genuine, often disabling, and involve a combination of physiological, psychological, and environmental factors.

o Central sensitisation and altered pain processing provide biological explanations for FSS.

o Psychological factors (e.g., stress, hypervigilance) amplify symptom perception but are not sole causes.

• Impact of Misunderstanding:
  o Delayed diagnosis: Over-testing to rule out biomedical causes.
  o Patient frustration: Repeated referrals without a clear treatment plan.
  o Healthcare burden: Unnecessary investigations and consultations

Question 3

biopsychosocial model FSS

Answer 3

biological factors
- central sensitisation (more sensititve CNS to normal stimuli)
- dysregulation stress response- activity HPA axis
- neurochemical imbalance- decreased seretonin

psychological factors
- hypervigilance - overly aware of sensations
- negative affectivity- anxiety, depression, neuroticism increase symptom sensation
- maladaptive coping
- cognitive misattribution

social:
- cultural normsw- some cultures normalise FSS more than others
- gender- women report more FSS

Question 4

Neurobiological Model FSS

Answer 4

central sensitisation
- overactive CNS lowers pain threshold - spinal cord changes
- dysrefulation brain network- DMN hyperactivity increases self-referential thoughts ab symptoms,
- HPA axis - chronic stress alter pain pathway and fatigue responses

Question 5

Cognitive Perceptual Models

Answer 5

• Selective Attention:
  o Patients focus excessively on bodily sensations, amplifying benign symptoms.

o Attention is driven by anxiety, emotional distress, and prior illness experiences.

• Common-Sense Model of Illness (Leventhal):
  o Patients construct mental models of their symptoms based on:

 Identity: Labelling the illness (e.g., “I have IBS”).
 Cause: Attributing symptoms to stress or external factors.
 Consequences: Predicting how symptoms affect their life.
 Timeline: Whether the symptoms are acute, chronic, or cyclical.
 Control: Perceptions about treatment efficacy.

Question 6

Treatment FSS

Principles of treatment

Answer 6

• Focus on a biopsychosocial approach to address all contributing factors.
• Build a strong therapeutic alliance with patients:
  o Validate the reality of their symptoms.
  o Emphasise a non-judgmental understanding.
• Reduce unnecessary medical tests and procedures

Question 7

Treatment FSS

psychological interventions

Answer 7

1. Cognitive-Behavioural Therapy (CBT):
   o Targets maladaptive thought patterns and behaviours.

o Techniques include:
 Cognitive Restructuring: Identifying and challenging catastrophic thinking.
 Behavioural Activation: Increasing activity levels to break avoidance cycles.
 Stress Management: Relaxation, breathing exercises, and problem-solving strategies.

o Effectiveness:
 Proven to reduce symptom severity in IBS, CFS, and chronic pain.

2. Mindfulness-Based Stress Reduction (MBSR):
   o Encourages present-moment awareness to reduce rumination about symptoms.
   o Reduces emotional distress and improves quality of life.
3. Acceptance and Commitment Therapy (ACT):
   o Focuses on acceptance of symptoms and commitment to valued activities despite discomfort.

Question 8

treatment FSS

Physical Intervention

Answer 8

1. Graded Exercise Therapy (GET):
   o Structured, gradual increases in physical activity.
   o Prevents deconditioning and improves energy levels.
   o Note: Controversial for CFS; pacing strategies are often preferred.
2. Physiotherapy:
   o Useful for pain syndromes like fibromyalgia.
   o Involves gentle stretching, aerobic exercise, and posture correction

Question 9

Treatment FSS

Pharmacological Interventions

Answer 9

• Antidepressants:
  o SSRIs (e.g., fluoxetine) and SNRIs (e.g., duloxetine) are effective for comorbid depression and pain modulation.
  o Low-dose tricyclic antidepressants (e.g., amitriptyline) reduce pain sensitivity.
• Analgesics:
  o Opioids are avoided due to the risk of dependency and hyperalgesia.
  o Non-opioid analgesics like pregabalin are preferred

Question 10

Treatment FSS

educational and self-management

Answer 10

• Psychoeducation:
  o Educating patients on the biopsychosocial model reduces fear and catastrophic thinking.
• Self-Management Programmes:
  o Action plans to identify triggers, pace activities, and implement coping strategies.

Question 11

conclusion FSS

Answer 11

Functional somatic symptoms result from a complex interplay of biological, psychological, and social factors.

Explanatory models such as central sensitisation, cognitive misattribution, and the biopsychosocial model provide frameworks for understanding these symptoms.

Treatment requires a multimodal approach including CBT, mindfulness, physical therapies, and pharmacological interventions, tailored to validate patient experiences and improve functional outcomes.