Module 8: OCD & Somatic Disorders Flashcards
Describe Obsession.
- Recurrent intrusive thoughts/urges/images causing distress or anxiety
- Attempts are made to ignore, suppress, or neutralize their actions
Describe Compulsion.
- The compelling feeling to perform repetitive behaviors or mental acts according to rules or in response to an obsession
- Aimed at reducing anxiety
Obsessive Compulsive Disorder (OCD) diagnostic criteria?
A. Presence of obsessions, compulsions, or both
B. Time-consuming, distressing, or causing functional impairment
Degree of insight is highly important for prognosis
OCD treatment?
Pharmacologic:
- SSRIs (ex. Luvox/fluvoxamine)
- TCAs (ex. Anafranil/clomipramine)
Therapy (CBT based):
- Exposure/response
- Habit reversal training
- Relaxation techniques
Goal: reduce amount of time spent on rituals
Describe Somatization.
Manifestation of psychological distress as physical symptoms and/or function changes
- Ex. Pain, nausea, dizziness
Disorders related to Somatic Symptom Disorder?
- Functional Neurological Symptom Disorder (Conversion Disorder)
- Illness Anxiety Disorder (Hypochondriasis)
- Factitious Disorder (Munchausen’s)
Describe Somatic Symptom Disorder.
- Excessive thoughts/feelings/behaviors related to physical symptoms
- Somatic symptom (e.g. pain, fatigue, dyspnea, nausea) that is distressing or disruptive
- No clear causative underlying condition
- Individuals with SSD tend to “provider shop,” moving from one to another until they find one who will give them new medication, hospitalize them, or perform surgery.
- They report the same symptoms repeatedly
- Perceive themselves as “sicker than the sick”
Somatic Symptom Disorder (SSD) clinical course?
- Likely chronic (long-term), with episodes that come and go from several months to years
- If untreated, can lead to daily limited function
- Coexists with other mental health disorders
Why is Somatic Symptom Disorder (SSD) difficult to manage?
Its symptoms tend to change, are diffuse and complex, and vary and move from one body system to another
Somatic Symptom Disorder (SSD) co-morbidities?
- depression
- anxiety
Describe Illness Anxiety Disorder (Hypochondriasis).
- Intense fear of having or acquiring serious disease
- They spend time and money on repeated examinations looking for feared illnesses.
- Anxious behavior related to health may be:
- Care seeking
- Care avoidance
- Somatic symptoms not really present
- It is important to understand that the lack of physical sensation and movement is real for the patient
Illness Anxiety Disorder clinical course?
- Often chronic, with symptoms that fluctuate or remain steady
- Symptoms can last for months or years, followed by equally long periods of remission
Illness Anxiety Disorder co-morbidiites?
- Most are diagnosed with SSD
- Anxiety
- Preoccupation
Describe Functional Neurological Symptom Disorder (Conversion Disorder).
- Severe emotional distress or unconscious conflict is expressed through physical symptoms
- Altered/loss of motor or sensory function
- No clear neurologic basis or medical condition
- Causes severe distress or functional impairment
- Laboratory test results are typically negative
- It is important to understand that the lack of physical sensation and movement is real for the patient.
Conversion Disorder symptoms?
- Neurologic symptoms (impaired coordination, paralysis, aphonia)
- Loss of touch, vision problems, blindness, deafness, hallucinations
- Seizures
Conversion Disorder clinical course?
- Symptoms can develop quickly, often after a stressful event. They can be chronic, but episodes are usually short.
- The symptoms follow the person’s own perceived conceptualization of the problem.
- Ex. if the arm is paralyzed and will not move, reflexes and muscle tone may still be present.
Describe Factitious Disorder(Munchausen’s).
- Intentional injury or illness of self or imposed on other
- Actions are deceptive (exaggerated, misrepresented, induced)
- Motivation: desire to be a patient or develop dependent relationship
- Malingering is a behavior motivated by desire for secondary gain (money, shelter, etc)
Factitious Disorder symptoms?
Pseudologia fantastica:
- Pathological lying
- They tell fascinating but false stories of personal triumph.
- Tales contain a mix of truth and falsehood
Self-produced physical symptoms:
- seizure disorders
- wound-healing disorders
- abscess processes
- feigned fever
Self-produced psychological symptoms:
- hallucinations
- delusions
- amnesia
What happens when Factitious Disorder is exposed?
- When the interventions do not work and the fabrication is discovered, the health care team feels manipulated and angry.
- When the patient is confronted with the evidence, they become enraged and often leave that health care system, only to enter another.
- Eventually, the person is referred for mental health treatment.
- The course of the disorder usually consists of intermittent episodes.
Factitious Disorder clinical course?
- Can be chronic and is difficult to treat
- Requires careful assessment and a sensitive, non-confrontational approach
- Address underlying psychological needs and encourage healthier coping mechanisms
- Early intervention can improve outcomes and reduce the need for deceptive behaviors
