Causes. And Treatment Of Somatic Symptom Related Disorders

Question 1

What’s the common feature. Of somatic symptom related disorders?

Answer 1

The common feature of these disorders is the prominence of somatic/health-related symptoms associated with significant distress or impairment

Question 2

What are the physiological factors of somatic symptom and physiological factors?

Answer 2

Physiological Factors
• Overactivity of key brain regions (ant. cingulate, insula, somatosensory cortex) that are involved in processing the “unpleasantness” of bodily sensations

• May amplify perception of pain

Question 3

How does cognitive bias lead to somatic symptom and related disorders?

Answer 3

Cognitive Biases

• Over attentiveness to somatic symptoms
• Negative interpretations about somatic symptoms
• May exacerbate anxiety and physical discomfort

Question 4

How can behavioral consequences lead to somatic symptom and related disorders?

Answer 4

Behavioral Consequences: 
The person
may:
• Conform to the sick role (e.g., lay in bed)
▪ May lead to feeling more ill

• Get reinforced for sick role behavior
▪ Get attention from others
▪ Obtain tangible reward
▪ Avoid unpleasant tasks
▪ Derive satisfaction from being in the sick
role (in the case of Factitious disorder)

Question 5

What are the psychological consequences that lead to somatic symptom disorder and related diseases?

Answer 5

Psychological Consequences:
The person may be transforming psychological
distress into physical symptoms to avoid dealing with the mental distress

• Example: In conversion disorder, the pseudoneurological symptom often:
▪ Occurs after a major psychological stressor
▪ Is symbolically related to the stressor
▪ Is not distressful (la belle indifference reaction

Question 6

How do we treat symptom somatic disorders and related disorders?

Answer 6

Patients may resist the change in focus from physical health to mental health– the transition needs to be done tactfully

➢ Cognitive-behavioral therapy to:
•Reduce stress (to avoid intensifying symptoms)
•Reduce excessive attention to bodily cues
•Correct cognitive distortions about physical symptoms •Reinforce “non-sick role” behavior
•Elucidate and address any emotional basis to the
symptom (conversion disorder

Special note about treatment of Factitious Disorder
• Diagnosis is often overlooked— consider hints such as:
▪ Unexplained, persistent/recurrent symptoms
▪ Dramatic presentation of history and symptoms
(“pseudologia fantastica”)
▪ Insistence on treatment
▪ Presence of a grid abdomen
• When identified, the goal is to stop further unnecessary medical treatment
•Report “by proxy” cases to Child Protective Services

Question 7

What are the causes of symptom somatic and related disorders?

Answer 7

Psychological

Behavioral consequences

Cognitive biases

Physiological