IX - Somatoform Disorders

Question 1

Somatoform vs Anxiety Disorders

Answer 1

Somatoform - primarily body. Anxiety - lots of things. If there is an individual preoccupied with disease but does not have somatic complaints, illness anxiety disorder. Somatoform - preoccupied with somatic symptoms; if person with anxiety has somatic symptoms, less intense. However, they can be comorbid.

Question 2

Somatic Symptom vs Somatoform disorders

Answer 2

Same thing but Somatoform is DSM-IV and Somatic is DSM-V. Change in name because Somatic symptom disorders encapsulate several previously separate disorders. Conditions that involve physical symptoms as well as abnormal thoughts, feelings, behaviors in response. Medically unexplained symptoms key (though less emphasis in DSM-V). Not intentionally faking

Question 3

Malingering

Answer 3

Producing or exaggerating physical symptoms for incentives like insurance money

Question 4

Factitious Disorder

Answer 4

Person intentionally produces psychological or physical symptoms for benefits of “sick role”

Question 5

DSM-IV Somatoform Disorders

Answer 5

5 patterns:

Hypochondriasis, somatization disorder, pain disorder, conversion disorder, body dysmorphic disorder

Question 6

DSM-V Somatic Symptom Disorder changes from DSM-IV

Answer 6

Hypochondriasis, somatization disorder, pain disorder all eliminated. Less emphasis on medically unexplained part of IV - doctors like this (though such symptoms still key part of some disorders)

Question 7

DSM-V Somatic Symptom and Related Disorders

Answer 7

Somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder, psychological factors affecting medical conditions, other specified and unspecified somatic symptoms and related disorders

Question 8

Somatic symptom disorder

Answer 8

(A) 1+ somatic symptoms that are distressing or significantly disrupt daily life
(B) Excessive thoughts, feelings, behaviors related to symptoms/health concerns with disproportionate/persistent thoughts of seriousness, high anxiety, and/or excessive time and energy devoted to.
(C) Though a single symptom may not continuously present, the state of being symptomatic is persistent and usually lasts 6+ months.

Question 9

DSM-V Illness Anxiety Disorder

Answer 9

(A) Preoccupation with having or acquiring serious illness
(B) Somatic symptoms not present or mild. If family history, worry is disproportionate
(C) High anxiety and alarm about health
(D) Excessive health-related behaviors or avoidance
(E) Preoccupation 6+ months (does not have to stay the same one)
(F) Not better explained by another disorder such as somatic symptom, panic, GAD, BDD, OCD.

Question 10

DSM-V Factitious Disorder

Answer 10

(A) Falsification of physical/psychological symptoms, or induction of injury or disease
(B) Presents self as ill, impaired, or injured
(C) Deceptive behavior evident even in absence of obvious external incentives
(D) Not better explained by another disorder such as delusional or psychotic disorder.

Question 11

DSM-V Conversion Disorder

Answer 11

(A) Altered voluntary movement or sensory function
(B) Clinical incompatibility between symptom and neurological/medical condition
(C) Not better explained by another medical or mental disorder
(D) Symptom causes clinically significant distress or impairment

Question 12

DSM-IV Hypochondriasis

Answer 12

Preoccupied with getting serious disease or have idea they already have one. Preoccupied with bodily functions, physical abnormalities, misinterpretation of bodily functions. Not reassured by medical evaluation - “doctor shopping.” Chronic if untreated. Often comorbid w/ mood disorders, panic disorder, somatoform

Question 13

Causes of DSM-IV Hypochondriasis

Answer 13

Closely related to anxiety disorders. Cog-beh: misinterpretation of bodily sensations, past experience with illness may lead to dysfunctional assumptions, which lead to excessive attention. Seek confirming evidence. See selves as weak. Secondary reinforcement includes sick role, which is developmentally acquired.

Question 14

CBT for DSM-IV Hypochondriasis

Answer 14

Assess patient’s beliefs, selective focusing, response prevention

Question 15

DSM-IV Somatization Disorder

Answer 15

Many different complaints of physical ailments lasting several years, not adequately explained by medical assessment. Characterized by combo of pain (4), gastrointestinal (2), sexual (1), pseudoneurological (1). This pissed doctors off b/c unnecessarily specific. Leading to treatment or significant life impairment. Symptoms not feigned.

Question 16

Somatization Disorder vs Hypochondriasis

Answer 16

Many similarities but only people with hypochondriasis think they have organic disease. Usually only one or a few primary symptoms, while somatization with multiple.

Question 17

DSM-IV Somatization Causes

Answer 17

Specific etiology unclear. Perceptual amplification of bodily symptoms - catastrophize. Elevated stress hormones, lessened habituation to psychological stressors. Interaction of neurotic personality with cognitive and learning variables.

Question 18

DSM-IV Somatization Disorder Treatment

Answer 18

Very difficult to treat - combo of medical management and CBT may be helpful. Integration between physician and psychologist good here. Medical management also good for integration and avoiding unnecessary testing/meds

Question 19

DSM-IV Pain disorder

Answer 19

Persistent and severe pain in 1+ areas of body. Medical condition may contribute but psychological apparently plays important role. Similar to somatization but with only pain symptoms. More common in women. Often comorbid with anxiety or mood disorder

Question 20

DSM-IV Pain Disorder Subtypes

Answer 20

(1) Pain disorder associated with psychological factors

(2) “” with both psychological factors and general medical condition

Question 21

Conversion Disorder - DSM-IV

Answer 21

Symptoms or deficits affecting sensory or motor functions - paralysis, blindness, deafness, pseudoseizures. 4 categories: sensory symptoms/deficits, motor symptoms/deficits, seizures, mixed presentation Psychological factors must be judged to play important role - onset/exacerbation of symptoms correlate with emotional stressors. Freud believed repressed sexual energy -> symptoms. Diagnosis can be very difficult - symptoms often diff from organic, selectively dysfunctional, affected by hypnosis or abrupt awakening. Limited knowledge of treatment

Question 22

Comversion disorder - DSM-IV - primary and secondary gains

Answer 22

Primary gain - escape or avoidance of stressful situation

Secondary gain - external circumstances such as attention, financial comp