CPch8.2 - Somatic Symptoms and Related Disorders Flashcards
Somatic Symptom and Related Disorders - Basics
What is the main symptom (aspect) of all Somatic Symptom and Related Disorders?
The main aspect is an excessive concern about physical symptoms or health, or worry about having a serious illness (hypochondriasis)
!!! Patients genuinely experience symptoms as completely medical and their distress is authentic (they’re not faking it to gain a reward or avoid a responsibility, see flashcard 23 for this)
What is the behavior of people that have Somatic Symptom and Related Disorders?
- They seek out frequently medical treatment (physicians, medications, surgeries, and in SSD, dependency on painkillers is also common)
- They’re often dissatisfied and angry at their doctors because they believe the treatment they receive isn’t good or isn’t working. Yet they just continue to seek out another treatment
When is the onset of symptoms? How long does it last?
- Anxieties about health develop in early adulthood
- Symptoms are chronic
With what other disorders are Somatic Symptom and Related Disorders comorbid?
Anxiety, Mood and Personality Disorders
What is some criticism for the Diagnostic Criteria of Somatic Symptom and Related Disorders?
- The threshold for when to diagnose can be very subjective -> 80% of people reporting and worrying about a symptom actually found an impairment/problem after a certain amount of time
- Patients find diagnoses of these disorders stigmatizing
Somatic Symptom and Related Disorders
What are the main Somatic Symptom and Related Disorders?
- Somatic Symptom Disorder (SSD)
- Illness Anxiety Disorder (IAD)
- Conversion disorder
~ Factitious disorder
(Malingering -> not a disorder)
(Somatic Symptom Disorder)
What is the definition of SSD?
Excessive anxiety, distress, energy and behavior focused on somatic symptoms. (In order for SSD to be diagnosed, distress and focus on symptoms must persist for at least 6 months)
What are the general criteria for SSD?
- At least one distressing symptom that disrupts daily life
- Excessive time and energy devoted to health concerns
- Excessive and disproportionate concerns about seriousness of symptoms
(Diagnosis can be made regardless of if the symptoms can be explained medically or not)
(medically unexplained symptoms: See flashcard 13/ or due to somatization (psychosomatic symptoms: psychological symptoms manifest in the body)
What is a general note on SSD?
If clinicians find out that psychological factors affect negatively medical symptoms, they make an alternative DSM Diagnosis (psychological factors affecting other medical conditions)
What is a big dilemma when it comes to diagnosing SSD?
2/3 of people being treated/receiving care for SSD say that they have never received a medical explanation for their symptoms. This is maybe because they do have a medical problem, but limits in knowledge or technology make it nearly impossible to diagnose a certain problem
(What if many people with SSD actually have a medical condition that just can’t be explained or found?)
(Illness anxiety Disorder)
What is the definition of IAD?
Excessive anxiety, distress, energy and behavior focused on the idea of having a serious disease, despite having no somatic symptoms.
(Such distress and focus must persist for 6 months)
What are the symptoms of IAD?
- Excessive care-seeking and maladaptive avoidance behaviors
- Have strong visual images of becoming ill or dying
- React with anxiety when hearing about others getting ill
(Conversion Disorder)
What is the definition of Conversion Disorder?
The person suddenly develops neurological symptoms, but without any indication of a medical problem/disorder being present and causing those symptoms
(symptoms indicate damage, organs and N.S. are fine)
What are the general criteria for Conversion Disorder?
- One or more symptoms must affect motor/sensory functions
- Symptoms are incompatible with medical disorder
- Symptoms cause significant distress/functional impairment which calls for the need of medical evaluation
(!!! Cause significant distress because of the nature of the symptoms, not because person is excessively stressed over symptoms like in SSD !!!)
What are some examples of the neurological symptoms arising from Conversion Disorder?
- Paralysis of limbs
- Seizures (non-epileptic ones)
- anesthesia
- Aphonia (loss of voice)
- Blindness
- Anosmia (loss of smell)
What must clinicians take into account when diagnosing Conversion Disorder?
- Clinicians must assess whether a patients syndrome has a neurological basis or not (e.g. “glove anesthesia”)
-> genuine physical problems are misdiagnosed as Conversion Disorder about 4% of the time
What has the DSM done in order to help clinicians make accurate diagnoses for Conversion Disorder?
DSM-5 has a guideline for clinicians to assess if symptoms are medically unexplained, and thus symptoms of Conversion Disorder
What is an example of the DSM-5 guideline for medically unexplained symptoms?
- Non-epileptic seizure disorder -> seizure-like events that happen at the same time a normal EEG pattern is recorded (use EEG to measure actual brain activity and compare with a patient’s syndrome)
What is Malingering (not a disorder)?
When somebody intentionally fakes a symptom in order to:
- avoid a responsibility
- Gain a reward
What is the definition of Factitious Disorder?
When somebody acts as if they have an illness by deliberately producing, feigning (faking), or exaggerating symptoms, but without having a malingering motive. They do it just to attain a patient’s role
What factor must be taken into consideration when diagnosing Factitious disorder?
Behavior of person with Factitious Disorder must not be explained by another disorder (rule out other possible disorders as cause for the behavior:(getting into patient’s role through various means)
What are the two types of Factitious Disorder?
- Factitious Disorder imposed on self (Munchausen Disorder): A person presents himself/herself to others as ill, impaired or injured (Miss Scott example)
- Factitious Disorder imposed on another (Munchausen Disorder by proxy): When a person fabricates/induces symptoms in another person, then presents that person to others as ill, impaired, or injured (Kathleen Bush and daughter example)
Etiology -SSD & IAD
What are some Neurobiological factors for SSD & IAD?
- Hyperactivity in brain regions responsible for evaluating the unpleasantness of body sensation (heat, pain etc.): ACC, rostral anterior insula
- Pain and Somatic Symptoms can be increased by Anxiety, Depression and stress hormones
~ Those with SS Disorders show elevated levels of anxiety, depression and trauma
~ ACC and anterior insula: activated when experiencing “emotional pain” (depression, sadness) -> amplify somatic symptoms even more
What has a study on people with SSD or IAD and control of ACC shown?
People who are learn to control their ACC are able to reduce some somatic symptoms and pain
What is the Cognitive-Behavioral Model of SS Disorders?
(See image on PowerPoint)
What are some other potential cognitive causes for SSD & IAD?
- People with health worries are overly focused on somatic symptoms and once they attend to those symptoms, they interpret them in the worst way possible
~ Once negative thoughts begin -> elevated levels of anxiety may increase somatic symptoms and distress over them (go back to flashcard on neurobiological factors) - (Increasing experimental research): Negative thoughts might even trigger/create the somatic symptoms (Wi-Fi sham experiment)
What are the behavioral consequences of people with SSD or IAD?
- Assume role of being sick (but not fake symptoms -> actually believe and feel that you’re sick) -> avoid work, social activities etc. Avoidant behavior in general in turn intensify bad health
- Many engage in safety behaviors, which consist of:
~ Seeking reassurance
~ Taking steps to protect health
What are the positives and negatives of safety behaviors?
+ Reduce anxiety, elicit attention or sympathy
- Counterproductive:
~ people believe they have warded off serious health problems just because they engaged in safety behaviors
~ Safety behaviors prevent focused exposure to initial somatic symptom, and thus prevent person from extinguishing fear of that symptom
(Experiment with safety behaviors and increased anxiety and worry about health)
Etiology for Conversion Disorder
What are some causes for Conversion Disorder according to the Psychodynamic theory?
Psychodynamic Theory suggests that the physical symptom is a response to an unconscious psychological conflict, which stops people from having conscious awareness
What are some causes for Conversion Disorder according to the Neuroscience?
People can be unaware of many of their own perceptual or motor processing:
- Blindness, maybe people can past test of sight, but higher level areas don’t function properly, so people can’t actually see, despite results from tests
- Tremors: people might be creating tremors themselves, but thee brain’s monitoring system might not be processing this fact. Then the person could experience the tremor as involuntary
What are some Socio-cultural causes for Conversion Disorder?
- Symptoms of Conversion Disorder are more common among people from rural Areas and with low SES
- “Mass hysteria”: group of people with close contact (schoolmates, coworkers etc.): One person gets e.g. a seizure/develops a specific symptom -> within a following period of time, a lot of other people will get the same symptom/seizure
Treatment - SSD & IAD
What is a major obstacle to treatment of Somatic Symptom and Related Disorders?
Patients seek out only medical healthcare and not mental:
- If clinician refers to the patient’s mental health, the patient gets offended because he thinks the clinician is saying that what the person is feeling is in his/her head
What must clinicians do when trying to help patients that suffer from Somatic Symptom and Related Disorders?
Remind patients of the mind-body connection. That will increase chances that they’ll seek out psychological help
(SSD & IAD): What must clinicians/doctors do when they’re treating somebody with Somatic Symptom and Related Disorders?
- Establish a strong doctor-patient relationship that increases trust and comfort of patient in doctor’s diagnosis
- Alert physicians when somebody uses too much of healthcare services in order to minimize the use of diagnostic tests and medication
What is the most effective therapeutic approach to treating Somatic Symptom and Related Disorders?
CBT (most effective in treating health concerns, depression, anxiety)
Steps in treating Somatic Symptom and Related Disorders with CBT:
1/. Identify and change emotions that trigger somatic concerns
2/. Identify and change cognitions regarding somatic symptoms
3/. Change behaviors so as to improve social interactions
What is Acceptance and Commitment Therapy (ACT)?
A therapy method that encourages the client to adopt a more accepting attitude towards pain, suffering, anxiety, depression etc.
What are some other ways to treat Somatic Symptom and Related Disorders?
- Treat depression and anxiety (best method is low-dose antidepressants)
- Mindfulness
- Other strategies to minimize how much attention a patient pays to his body
- Family interventions: teach family members how to give less attention (reinforcement) to patient’s symptoms through operant conditioning
- Internet-based guidance (with a bit of help from a clinician)
Treatment - Conversion Disorder
What is the most effective way for treating Conversion Disorder?
CBT:
- helps in obtaining lower rates of gait disturbance (disturbances in ability to walk)
- helps in making patients have lower rates of non-epileptic seizures
