chapter 6 Flashcards
Somatic symptom disorder
- Symptoms no clear reason for pain
- avoid exercising
- Life revolves around symptoms
At least one somatic symptom disorder that disrupt life
Excessive thoughts, feelings, and behaviours related to the somatic symptoms by 1+ of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concern
Symptoms can change, but being symptomatic must last for at least 6 months
Mild: 1 symptom and criterion b met
Moderate: 2+ symptomes in criterion B met
Severe: 2+ symptoms in Criterion B are met AND there are multiple somatic
complaints OR 1 very severe somatic symptom
Illness anxiety disorder
Preoccupation with having or acquiring a serious illness
Less so worried about symptoms (often mild or absent) more focused on what they mean
Reassurance from dr not helpful, they have disease conviction
6+ months
What’s the difference between
Somatic Symptom Disorder and Illness Anxiety Disorder?
Somatic symptom worries about symptoms
Illness anxiety worries about what symptoms mean
What’s the difference between these disorders and
Panic Disorder?
Pts with PD also misinterpret physical sx which might kill them
Pd - fear short term catastrophes to do specifically with panic sx
Concerns lessen between attacks (know panic wont kill)
SSD fear long term process of illness/disease range of sx
Don’t believe physicians when they say their ok
Stats
Lifetime prevalence 1% -5%
Late age of onset
Most comen in unmarried women
Lower SES
Causes of somatic symptom and illness anxiety
- Enhanced awareness and sensitivity to illness cues
- Interpret ambiguous stimulus as dangerous
- develop following stressful life event
- Learn from family members
Treatment of ss and IA
Psychodynamic psychotherapy – uncovering unconscious conflicts
* Physician reassurance (short-term), psychoeducation (longer-term)
* Cognitive-behavioural therapy (CBT)/exposure therapy
o Challenge illness-related misinterpretations of physical sensations
o Create ”symptoms”
o Minimize reassurance/help-seeking behaviours
o Reduce stress and anxiety
o Relating to others (reducing supportive
consequences to symptoms alone)
* Use of gatekeeper physician
Functional neurological disorder (conversion disordr)
Unconscious conflicts expressed through (converted to) physical symptoms to
allow the individual to discharge anxiety without experiencing
Functional: severe dysfunction without organic cause
ex. paralysis blindness seizures, globus hystericus (lump in throat)
DSM5tr functional neurologic symptom disorder
1+ symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and
recognized neurological or medical condition
Malingering
Faking
Trying to get out of something (e.g., work, legal difficulties), or trying to gain
something (e.g., financial settlement).
* Fully aware of what they are doing and are clearly attempting to manipulate
Factitious disorder
People trying to look ill, making themselves ill or hurting themselves
Factitious disorder imposed by other
Purposefully producing symptomes in family member.
Stats of Functional Neurological Symptom Disorder (Conversion Disorder)
More common in neurological settings (prevalence = 30%) than mental health settings
* Primarily in women, developing in adolescence, culture-specific
Causes of Functional Neurological Symptom Disorder (Conversion Disorder)
Trauma
repression of conflict
anxiety becomes conscious and person converts it to physical symptoms
Stress
Social and cultural factors
* Less educated, lower SES (knowledge about disease and medical illness not well-developed
Treatment for SOMATIC SYMPTOM & RELATED DISORDERS
Functional Neurological Symptom Disorder (Conversion Disorder)
Identify source of stress; reduce stress
* Minimize help-seeking behaviours
* Identify and reduce secondary gains
* Cognitive-behavioural treatment (CBT)
- The most effective form of psychotherapeutic treatment for obsessive-compulsive disorder
involves ______
Exposure (as in CBT or ERP)
- Trichotillomania (aka ______ ______ disorder) and Excoriation (aka ______ ______ disorder)
are separate disorders that fall under obsessive compulsive and related disorders.
Hair pulling; skin picking
- In terms of pharmacological treatments for body dysmorphic disorder, this general class of
medications seems to be most effective.
SSRIs
- When it comes to the nature of obsessions in obsessive-compulsive disorder, one important
thing to keep in mind is that they are ______, meaning they are felt by the person to be
inconsistent with their morals, values, or self-concept, and they are experienced as distressing
and unwanted.
Ego-dystonic
How are superstitious behaviours different from OCD behaviours??
Obsessive-Compulsive Disorder
Clinical Description
What are obsessions?
What are compulsions
Fear of unwanted and intrusive thoughts (obsessions)
* Repeated ritualistic actions or thoughts (compulsions) designed to neutralize
the unwanted thoughts
DSM-5-TR Criteria OCD
Presence of obsessions, compulsions, or both
Recurrent and intrusive thoughts attempts to ignore or suppress thoughts through action
Compulsions
Repetitive behaviours that the individual feels driven to do in response to obsession
Behaviour aimed at reducing distress but not connected to distress in realistic way or excessive
Obsessions and compulsions take at least 1 hour a day
Specifies of OCD
With good insight: recognize ocd thoughts aren’t true still can’t control
Poor insight: thinks ocd belifs are probably true
No insight: thinks ocd is true
Types of Obsessions and Compulsions
Symmetry/exactness/“just right”
* Forbidden thoughts or actions
* Cleaning/contamination
* Hoarding
* Certain kinds of rituals
Tic Disorder & OCD
Involuntary movements
* Co-occur with OCD
* Movements may not be tics but may still be compulsions
Pediatric autoimmune neuropsychiatric syndrome (PANS)
- Tics/OCD occurring after serious bout of strep throat
- More common in boys
- Noticeable clumsiness
- Remission during antibiotic therapy
OCD stats
1.6%–2.3 %: lifetime prevalence of OCD
* Obsessions and compulsions can be arranged on a continuum
* Female-to-male ratio increases in adulthood
* Onset in early adolescence to mid-20s
* Chronic when develops
(Barlow et al.; Cengage, 2024)
Causes
Biological
o Thoughts regulated by brain circuits
o Mild genetic risk – 32-40% heritable
o Brain models
Basal ganglia and frontal cortex structure
and function
o Neurotransmitters
Serotonin levels
Environmental/behavioural/psychological
o Early experiences
o “thought-action fusion”
o Thought suppression leads to compulsions
Treatment of ocd
Pharmacological
o SSRIs
- Psychological
- Exposure and response/ritual prevention (ERP)
o Expose to feared thoughts and situations and prevent the rituals
o Effective but very stressful - Cognitive-Behavioural Therapy (CBT)
o Cognitive restructuring
o Challenge harmful cognitions - Psychosurgery
- For those who do not respond to other treatments (lesions to cingulate
Body Dysmorphic Disorder
How it works
Brain
Preoccupation with some imagined defect in appearance, though looks
reasonably normal
o “Imagined ugliness”
o Repeated looking in mirrors
* Co-occurs with OCD
- Brain imaging study
- Abnormal brain functioning
- Similar in pts with BDD and OCD
Body Dysmorphic Disorder
DSM-5-TR Criteria
Preoccupation with 1+ defects or flaws in physical appearance that are not observable or appear slight to
others.
B. At some point, individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming,
skin picking, reassurance seeking) or mental acts (e.g., comparing their appearance with that of others) in
response to the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual
whose symptoms meet diagnostic criteria for an eating disorder.
Stats of bdd
Overall prevalence of BDD is 2.2%
* Caucasians, Asians, Hispanics
* Strong interest in art and design
* Onset in early adolescence
* High degree of stress, reduced
quality of life, and impairment
common
Treatment BDD
SSRI
CBT ERP
Does plastic surgery help BDD?
Up to ¼ of those who request plastic surgery have BDD
* Does not change or increases severity of BDD symptoms
Hoarding
Excessive acquisition of things, difficulty discarding anything, and living with
excessive clutter/gross disorganization.
Everything has = value… How can I get ride of anything?
Hoarding usually starts early in life
and gets worse over time
* Can be hazardous
* Patients usually present for tx after
age 50
* Treatment: CBT
Trichotillomania and Excoriation
Trichotillomania (hair-pulling disorder)
* Disorder has severe social consequences
* 1%–5% college students: more in females
Excoriation (skin-picking disorder)
* Afflicts 1%–5% of general population
* Scabs, scars, open wounds common
* Treatment: habit reversal training
(Barlow et al.; Cengage, 2024)
