Lecture 7: Somatic Symptom Disorders: Chapter 8 (vanaf 246) Flashcards
What is the main characteristic of somatic symptom and related disorders?
Excessive concerns about physical symptoms or health
What is hypochondriasis? How does this term relate to the DSM diagnoses?
Chronic worries about developing medical illness
It’s a popular used term and it overlaps to some degree with somatic symptom disorder and illness anxiety disorder (high levels of distress about health concern)
What are the 3 main DSM diagnoses in somatic symptom related disorders?
- Somatic symptom disorder (SSD)
- Illness anxiety disorder (IAD)
- Functional neurological disorder (conversion disorder)
What are 2 criticism of the diagnostic criteria for somatic symptom and related disorders?
- Threshold for when to diagnose somatic symptom and related disorders is very subjective (80% of population report having had a symptom in the past week that led to concern/impairment)
- Diagnosis is stigmatizing, what can interfere with applying diagnoses in clinical practice
Why are there no epidemiology numbers for somatic symptom and related disorders?
These disorders are defined differently than in the DSM IV (somatoform disorders)
What is the prevalence of somatic symptom disorder vs. illness anxiety disorder?
SSD is estimated to be 3x as common as IAD
What can you say about the behavior of people with somatic symptom and related disorders around medical health care? (3)
- Seek frequent medical treatment
- Dissatisfaction with doctors, because they can’t find a cure or explanation
- Risk of dependency on painkillers
What are the 4 defining symptoms of somatic symptom disorder?
- At least one somatic symptom that is destressing or disrupts daily life
- Excessive thought, distress and behavior related to somatic symptoms or health concerns
- Duration of at least 6 months
- Specify if predominant pain
What are 3 aspects of excessive thought, distress and behavior related to somatic symptoms or health concerns in somatic symptom disorder?
What is the minimum number needed to fit a criterium of somatic symptom disorder?
- Health-related anxiety
- Disproportionate and persistent concerns about seriousness of symptoms
- Excessive time and energy devoted to health concerns
At least one necessary
How long do somatic symptom disorder and illness anxiety disorder often exist in clients?
It’s chronic
less than 50% achieve full remission within 5 years
What are common comorbid disorders with somatic symptom/related disorders?
Anxiety, mood, personality disorders
How are people with somatic symptom and related disorders often viewed upon by outsiders? How does this reflect the way clients with these disorders see themselves?
Seems like person is using the health concern to avoid some unpleasant activity or to get attention or sympathy
Clients themselves: they experience their symptoms as completely medical and have authentic stress
What is somatization according to Briquet?
Symptoms being purely caused in the body and not psychologically
What is the difference between top-down and bottom-up processes?
Top-down: when expecting an image, more likely to perceive it
Bottom-up: seeing something and recognizing it (from sensory input to interpretation)
What is the difference between linear and parallel processing?
Linear: process goes one step at a time
Parallel: processes go together at the same time
What is malingering?
Intentionally faking psychological or somatic symptoms to gain from those symptoms
What is factitious disorder?
Falsification of psychological or physical symptoms without evidence of gains from those symptoms
What distinguishes malingering and factitious disorder from somatic symptom disorder, illness anxiety disorder and functional neurological disorder?
Malingering/factitious disorder are produced consciously
What type of disorder is the Munchhausen by-proxy syndrome?
Factitious disorder directed to another person
What is the difference between factitious disorder imposed on self vs. imposed on others?
Self: person presents self as ill, impaired or injured
Others: person fabricates or induces symptoms in another person and then presents that person to others as ill, impaired or injured
Why is factitious disorder such a weird disorder?
There is deceptive behavior with no obvious external reward present for it
What is the difference in focus between the DSM IV and DSM V concerning somatic symptom disorders?
DSM IV: physical symptoms have no physical cause
DSM V: focus on positive symptoms (somatic symptoms explained or not + psychological and behavioral factors)
How is conversion disorder now called in the DSM 5 TR?
Functional neurological disorder
What are 4 defining symptoms of illness anxiety disorder?
- Preoccupation with and anxiety about having acquired a serious disease
- Excessive illness behavior or maladaptive avoidance
- No more than mild somatic symptoms present
- Preoccupation lasts at least 6 months, no need for continuous presence during that time
Give some examples of excessive illness behavior and maladaptive avoidance
Excessive illness behavior: check for signs of illness, seeking reassurance
Maladaptive avoidance: avoiding medical care
What is the difference between illness anxiety disorder and OCD with fear of acquiring disease?
OCD: fear of acquiring disease
IAD: actual having the disease is fearful
What are the similarities between SSD and IAD?
Excessive thoughts and behavior regarding illness
Both require duration of 6 months
What is the main difference between SSD and IAD?
SSD: actual have 1 distressing somatic symptom
IAD: no more than mild somatic symptoms present
What are the 3 defining symptoms of functional neurological disorder (conversion disorder)?
- One or more symptoms affecting voluntary motor or sensory function
- Symptoms aren’t compatible with any recognized medical disorder
- Symptoms cause significant distress or functional impairment
What are some possible physical symptoms of functional neurological disorder?
Blindness, seizures, paralysis
No medical cause found
What is non-epileptic seizure disorder?
Type of conversion disorder/ functional neurological disorder that involves presence of seizure events when normal EEG pattern is recorded
What is aphonia?
Loss of voice other than for whispered speech
Why was the name of functional neurological disorder previously conversion disorder?
It was thought that anxiety and psychological conflict (Freud) were converted into physical symptoms
What is anosmia?
Loss of smell
What is MUS?
Medical Unexplained Symptoms
What is one thing you should not say to patients with somatic symptom or related disorders?
Don’t say it’s all between the ears!
What is glove anesthesia? Why is that not by any means a direct indication for functional neurological disorder?
When a person experiences little to no sensation in the part of the hand and lower arm that would be covered by a glove
This could also be caused by carpal tunnel syndrome
What percentage of people is misdiagnosed as conversion disorder instead of having a genuine physical problem?
4%
What are 3 defining symptoms of factitious disorder?
- Fabrication/induction of physical or psychological symptoms, injury, disease
- Deceptive behavior with absence of external rewards
- Imposed on self or others
When do symptoms of conversion disorder/ functional neurological disorder typically develop?
In adolescence and early adulthood
What is the expectation of prevalence of functional neurological disorder?
<1%
When does illness anxiety disorder usually develop?
Early adulthood
Which 2 tendencies are neurobiological and cognitive behavioral models based on when understanding the etiology of somatic symptom and related disorders?
- Excessive attention to somatic symptoms
- Disproportionate anxiety about one’s health
What are 3 brain regions that have a different than normal response in somatic symptom disorders? What is the function of these regions?
Increased activity in:
1. Rostral anterior insula
2. Anterior cingulate cortex
3. Somatosensory cortex
Regions are involved in experiencing events of physical and emotional pain
What are 3 cognitive behavioral factors that might explain somatic symptom disorders?
- Attention to somatic sensations
- Interpretation of cognitive sensations
- Avoidant behavior intensifies health anxiety
How do the attention to and the interpretation of somatic sensations make the matter worse for people with somatic symptom disorder?
They tend to interpret physical symptoms in the worst possible way. Small physical symptoms get blown up easily
What psychological factor might trigger the onset of somatic symptoms?
An increase of negative thoughts/ worries
E.g. Saying someone is exposed to some poison, whilst that person is not. The person however might experience serious symptoms though
How are some people with SSD reinforced for disengagement from work?
Because they receive disability payments etc.
What are some safety behaviors people with SSD can engage in?
Seek reassurance from doctors, family members and the internet or taking other steps to protect health (disinfecting etc.)
Which 2 perspectives might explain conversion disorder/functional neurological disorder?
- Psychodynamics
- Neuroscience
What does psychodynamic theory explain about conversion/functional neurological disorder?
Physical symptom is a response to an unconscious psychological conflict
What does neuroscience explain about conversion/functional neurological disorder?
Much of our perceptual processing may operate outside of our conscious awareness
E.g. unexplained blindness: vision relies on numerous brain regions. If those aren’t coordinated in an overarching conscious fashion, the brain may process some visual input in such a way that the person can do well on certain visual tests, but still lack a conscious sense of seeing
So if people aen’t processing visual inputs at higher level, they can truthfully claim they couldn’t see, even when tests suggest they can
What are 2 social/cultural influences on conversion / functional neurological disorder?
- More common in rural areas
- More common in low SES
What is an important obstacle to treatment of somatic symptom and related disorders? What can persuade them to accept mental health care (2)?
They want medical care, not mental health care
Mind-body connection reminders work well to increase their willingness + good doctor-patient relationship
Study figure 8.2 p. 253 (232)!
DO SELF CARE <3
What can be an intervention to decrease the unnecessary provisions of costly healthcare services?
Minimizing the use of diagnostic tests and medications
How can cognitive behavioral strategies help people with somatic symptom disorder/illness anxiety disorder? (3)
Help patients identify and change
1. Emotions that fuel somatic worries
2. Cognitions regarding their somatic symptoms
3. Behavior so they no longer assume the role of a sick person and get more empowerment from social interactions
How can cognitive techniques in terms of attention problems with SSD and IAD?
Help pay less attention to their bodies or identify/challenge negative thoughts about their bodies
How can behavioral techniques help people with SSD and IAD to resume healthy activities and rebuild a healthy lifestyle? (2)
It reduces safety behaviors
1. Assertiveness training
2. Social skills training
What should be the goal of behavioral techniques in treating SSD and IAD? (3)
- Don’t focus on what people can’t do
- Encourage them to start doing fun things again
- Regain their sense of control
How can treating anxiety and depressive disorders help with SSD/IAD complaints?
Often anxiety and depression trigger physiological symptoms and intensify distress about the somatic symptoms.
Treating it reduces the effect
How can a person struggling with thoughts like ‘I can’t cope with this pain’ be helped?
Help them to make more positive self-statements, such as I’ve been able to manage pain before, so I can do it today too
How can families help members that have SSD/IAD?
Family members should reduce the amount of attention (reinforcement) they give to somatic symptoms of the patient
What does CBT reduce in SSD/IAD? And behavioral therapy?
CBT: reduce health concerns, depression, anxiety
BT: safety behaviors
What can help for the treatment of somatic symptom disorder that is focused on pain?
Low dose anti-depressants, CBT, hypnosis, acceptance and commitment therapy (ACT)
What is acceptance and commitment therapy (ACT)?
Type of CBT. Therapist encourages client to adopt an accepting attitude toward pain, suffering and depression/anxiety and view these as a natural part of life
When might antidepressants help in treatment of SSD?
When pain is the main symptom
What is the best treatment so far for conversion/functional neurological disorder?
CBT
What are the 4 steps of CBT in treatment of conversion/functional neurological disorder?
- Therapist explains no medical condition is found
- Patient is hospitalized
- Patient is reinforced for taking part in the training
- Avoiding reinforcing conversion symptoms, treatment ignored signs of poor physical performance
What are 2 important aspects of CBT in functional neurological disorder?
- Reinforce taking part in physical training
- Don’t reinforce conversion symptoms
Describe the pain model of SSD. What are the 2 pathways?
Injury leads to painful experience
2 options:
1. Not catastrophize –> confrontation –> recovery
- Catastrophize –> fear of movement or injury –> avoidance –> disability, depression –> painful experiences (it’s a cycle then)
