Hovland- Somatic Symptom Disorders

Question 1

Why do somatic symtom disorders occur?

Answer 1

1. social support for those who are isolated
2. allows us to rationalize failures in roles
3. more able to be nutured
4. as children we learn that being ill is a way to be nurtured
5. used as power over others
6. cry for help
7. physical less stigmatizing
8. secondary gain

Question 2

What are the characteristics of excessive sx reporters?

Answer 2

• older, low SES, unemployed
• also have higher mortality

Commonly have somatic symptom disorders

Question 3

What is the criteria for diagnosing SSD?

Answer 3

1. One or more somatic sx that disrupt life.
2. Excessive thought/feelings and anxiety about symptoms
3. State of being symptomatic is persistent > 6 months

Question 4

What is Illness anxiety disorder?

Answer 4

Preoccupation with acquiring or having a serious illness
Somatic sx are NOT present
High level of anxiety about health status
Individual performs excessive health-related behaviors or maladaptive avoidance
Preoccupation w/ illness evident for 6 mos

care seeking type and care avoiding type

Question 5

What is conversion disorder?

Answer 5

• School age-35, rural areas, 1-3% prevalence
• can occur after CNS injury
• may reflect local mores about how to portray distress
• sx in first degree female relatives are up to 14x greater than general population

Question 6

What is the diagnostic criteria for conversion disorder?

Answer 6

One or more sx or deficits in voluntary motor or sensory function that suggests a neurological or other general medical condition.
Can’t be accounted for by other diagnosis.

Question 7

What is the prevalence of conversion disorders?

Answer 7

• F> M
• Lower SES/IQ/education
• increased risk if conversion disorder has occurred in other family members
• 1-3% of pts that see neurologists

Question 8

What are theoretical explanations for conversion disorder?

Answer 8

• inability to communicate emotions or pyschosocial distress
• mechanism to cope with acute stress
• learned behavior
• socially acceptable under some circumstances

Question 9

What are examples of conversion disorders?

Answer 9

Blindness, paralysis, non-epileptic seizures, anesthesia, amnesia, dementia, swallowing problems, motor tics, hallucination

Question 10

PNES

Answer 10

Psychogenic non-epileptic seizures

common sx of conversion disorders, triggered by psych problems

Question 11

How is morbidity related to PNES?

Answer 11

Morbidity is often an iatrogenic manifestation of unnecessary diagnostic/therapeutic interventions aimed at establishing a diagnosis.

Question 12

What is malingering?

Answer 12

• Production of false or grossly exaggerated sx
• motivated by external incentives
• may represent adaptive behavior
• Suspect when: medicolegal context of presentation, discrepency between disability and obj findings, lack of cooperation during diagnostic evaluation, often occurs in context of APD

Question 13

How do you separate malingering from factitious disorder?

Answer 13

Malingering- deliberate feigning of physical sx (includes external motivations for maintianing behavior)
Factitious- sick role, deliberate feigning of physical sx to obtain medical tx

Question 14

What is factitious disorder?

Answer 14

• Intentional feigning of physical sx
• illness w/ no medical explanation
• external incentives are absent

Question 15

How do you treat factitious disorder?

Answer 15

1. treat comorbid psychiatric issues w/ med and psychotherapy
2. Pscyhotherapy may allow for relationship not contingent upon new physical sx