Module 8: OCD & Somatic Disorders

Question 1

Describe Obsession.

Answer 1

• Recurrent intrusive thoughts/urges/images causing distress or anxiety
• Attempts are made to ignore, suppress, or neutralize their actions

Question 2

Describe Compulsion.

Answer 2

• The compelling feeling to perform repetitive behaviors or mental acts according to rules or in response to an obsession
• Aimed at reducing anxiety

Question 3

Obsessive Compulsive Disorder (OCD) diagnostic criteria?

Answer 3

A. Presence of obsessions, compulsions, or both
B. Time-consuming, distressing, or causing functional impairment

Degree of insight is highly important for prognosis

Question 4

OCD treatment?

Answer 4

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

Question 5

Describe Somatization.

Answer 5

Manifestation of psychological distress as physical symptoms and/or function changes

• Ex. Pain, nausea, dizziness

Question 6

Disorders related to Somatic Symptom Disorder?

Answer 6

• Functional Neurological Symptom Disorder (Conversion Disorder)
• Illness Anxiety Disorder (Hypochondriasis)
• Factitious Disorder (Munchausen’s)

Question 7

Describe Somatic Symptom Disorder.

Answer 7

• 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”

Question 8

Somatic Symptom Disorder (SSD) clinical course?

Answer 8

• 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

Question 9

Why is Somatic Symptom Disorder (SSD) difficult to manage?

Answer 9

Its symptoms tend to change, are diffuse and complex, and vary and move from one body system to another

Question 10

Somatic Symptom Disorder (SSD) co-morbidities?

Answer 10

• depression
• anxiety

Question 11

Describe Illness Anxiety Disorder (Hypochondriasis).

Answer 11

• 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

Question 12

Illness Anxiety Disorder clinical course?

Answer 12

• Often chronic, with symptoms that fluctuate or remain steady
• Symptoms can last for months or years, followed by equally long periods of remission

Question 13

Illness Anxiety Disorder co-morbidiites?

Answer 13

• Most are diagnosed with SSD
• Anxiety
• Preoccupation

Question 14

Describe Functional Neurological Symptom Disorder (Conversion Disorder).

Answer 14

• 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.

Question 15

Conversion Disorder symptoms?

Answer 15

• Neurologic symptoms (impaired coordination, paralysis, aphonia)
• Loss of touch, vision problems, blindness, deafness, hallucinations
• Seizures

Question 16

Conversion Disorder clinical course?

Answer 16

• 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.

Question 17

Describe Factitious Disorder(Munchausen’s).

Answer 17

• 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)

Question 18

Factitious Disorder symptoms?

Answer 18

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

Question 19

What happens when Factitious Disorder is exposed?

Answer 19

• 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.

Question 20

Factitious Disorder clinical course?

Answer 20

• 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