L9 - Somatic Stress Disorder

Question 1

Examples of some somatic stress disorders?

Answer 1

 Fibromyalgia
 Chronic Fatigue Syndrome
 Pseudoseizure in epilepsy
 Silicone breast implant illness
 Gulf War Unexplained illness
 Toxic mould and Sick Building Syndrome
 Idiopathic Environmental Intolerance (IEI) (Multiple chemical sensitivity)  Psychologically-based aspects of the post concussion syndrome

Question 2

What is somatic symptom disorder?

Answer 2

Somatic symptom disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviours regarding those symptoms.

To be diagnosed with SSD, the individual must be persistently symptomatic (typically at least for 6 months).

DOES NOT require symptoms to be medically unexplained

Question 3

Do symptoms need to be medically unexplained?

Answer 3

NO!!!

• symptoms may or may not be associated with another condition
• not appropriate to diagnose individuals with a mental disorder solely because a medical cause cannot be demonstrated

Question 4

DSM-5 somatic symptom and related disorders?

Answer 4

Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder (Functional Neurological Symptom Disorder)
Psychological Factors affecting other medical conditions
Factitious Disorder

**these people are not thought to be malingering.

Question 5

Criteria for somatic symptom disrder?

Answer 5

 A. One or more somatic symptoms…
 B. Excessive thoughts, feelings, or behaviours…including at least one of the following
 Disproportionate and persistent thoughts about the seriousness of one’s symptoms
 Persistently high level of anxiety about health or symptoms
 Excessive time and energy devoted to these symptoms or
health concerns
 C. the state of being symptomatic is persistent (typically > 6 months).

Question 6

illness anxiety criteria?

Answer 6

A. Preoccupation with having or acquiring a serious illness.

B. Somatic symptoms are not present or, if present, are only mild in intensity.

Specify whether:
Care‐seeking type
Care‐avoidant type

Question 7

“fashionable diseases?”

Answer 7

• vague, subjective, multisystem complaints
• lack of objective lab findings
• quasi-scientific explanations
• consistent with depression or anxiety
• the patient rejects psychological explanations for their symptoms preferring biomedical and somatic ones and they seek out healthcare professionals who share their belief systems and who are likely to recommend alternative medical treatments or explanations

Question 8

What might cause neuropsychological impairment in somatic stress disorder

Answer 8

• doesnt implicate neurological disease, likely due to structural changes from stress
• cog complaints are often an index of emotional distress-emotional distress

Question 9

Characteristics in SSD?

Answer 9

 Often self-diagnosed
 Symptom amplification/filling in the internet
questionnaire of symptoms
 Belief in serious illness with bad outcome- but not fatal
 Skepticism with mainstream medicine
 Shopping for professionals who believe
 Rejection of psychological explanations
 Biomedical explanation preferred
 Normal viewed as abnormal- “so tuned into their bodies”
 Sick role and disability- 27% of cases of Fibromyalgia in the US are on disability
 Self help groups ++
 Sensationalized media coverage
 Overlapping conditions: chronic fatigue, Fibromyalgia, silicone breast illness, IEI

Question 10

pseudoneurologic disease?

Answer 10

Neurologic symptoms without objective evidence of neurologic disease
 Often associated with neuropsychological deficits

Question 11

non-epileptic sezures?

Answer 11

• Intensive EEG video telemetry monitoring is necessary because episodes usually not observed and NES and ES seizures often appear similar.
• Psychological methods useful for description and to identify persons at risk, but cannot be used for diagnosis
• neuropsych deficits persist. associated with psychogenic illness.
• bad historians… deny verifiable stressors.

Question 12

neuropsychological of non epileptic seizures?

Answer 12

• difficult to distinguish between epileptic seizures on neuropsych measures . very similar.
• can differentiate using mMPI-2. (conversion V and hypochondriasis scale very high in NES.. lower in epileptic patients.
• not found to be malingering - cog symptoms may be psychological manifestation

Question 13

So what do we use to best predict and identify non-epileptic seizure

Answer 13

MMPI-2 hysteria scale… routine EEG and brief chronicity of seizure.

Question 14

Fibromyalgia?

Answer 14

• diagnosis made based on repoert of pain at at least 11 of 18 trigger points in response to 4kg pressure. must be bilateral and both above and below waist
• there are problems with diagnosis with examiner and patient reliability.
• assoiated with mild neuropsych deficits

Question 15

etiological of fibromyalgia?

Answer 15

• unproven - ??? psychiatric?
• neuroendocrine and gate control theory hypotheses.
• diagnosis is often associated with a history of abuse
• they usually feel too sick to go to work……….

Question 16

Chronic fatigue syndrome?

Answer 16

• assoc with acquired cog deficits, and mood and anxiety disorders.
• more subjective cog impairment than objective .
• motivational deficits in clinical sample, but not mostly non disabled research sample.

Question 17

Neuropsych profile of Chronic fatigue syndrome?

Answer 17

Complex processing deficit
Preservation of intellect and complex
problem solving
subjective>objective findings

Question 18

Idiopathic environmental intolerance?

Answer 18

aka multiple chemical sensitivity.
- associated with psychiatric disease.

• allergy like sensitivity to various common chemical odours, like cleaners, gasoline, perfume
• fatigue, confusion, dizziness and respiratory problems
• no cog differences from control
• in the lab, patients had low sensitivity and specificity with those chemicals

Question 19

likely etiological of idiopathic environmental intolerance?

Answer 19

• classical conditioning??? but can occur without history of an uncondition stimuli causing UCR

illness belief sytem

and psychiatric illness

Question 20

pROBLEMS with self report in somatic disorders?

Answer 20

not reliable!!!!!!!!

• overestimate their health premorbidly
• can deny abuse/trama history
• over report subjective complaints, not related to objective