Psychological Disorders 2 - somatoform disorders Flashcards
What is somatic symptom disorder?
they are mental disorders characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause
- note one somatic symptom may not be persisently present, but the symptoms/symptom is persistent for 6+ months
*note to diagnose, you must exhaust all medical tests that might diagnose a physical disorder
what might be the clinical signs of someone with somatic symptom disorder?
- high levels of worry about illness
- appraise bodily symptoms as undully threatening
- fear medical seriousness of symptoms despite evidence to contrary
- health concerns may assume a central role in the person’s life
- fear any physical activity may damage the body
- individuals usually present to general medical services rather than mental health services
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What is conversion disorder?
one or more symptoms of altered voluntary motor or sensory function - clinical findings show incompatibility between symptoms reported and recognzied neurological or medical conditions
- symptoms cause significant distress or impairment in functioning
what might be the clinical findings of someone with conversion disorder?
- weakness or paralysis
- abnormal movement
- swallowing symptoms
- seizures
- sensory loss
- often the symptoms are associated with onset of stress or trauma
- often we see “la belle indifference” which is a lack of concern about nature or implications of symptom- more often in women
What is glove anaesthesia?
someone comes in with a loss of feeling to their hand -
if it is in a person with the history of depression/somatic disorder, consider the possibility of conversion disorder
what test can you do to check for psychological/physical reason for their symptoms?
Hoover’s sign
ask them to raise the effected leg and hold the ‘good’ leg at the heel - if they are really ‘trying’ to extend the leg, their heel should dig into your hand
In other words, if patient in picture complained of “Left leg weakness,” but didn’t push off with Right heel during the attempt, there was lack of effort.
What is Illness Anxiety Disorder?
Preoccupation with having or acquiring a serious illness
- physical symptoms are not present or if present are very mild
- high level of anxiety about health is debilitating
(preoccupation lasts for more than 6 months)
What is a factitious disorder?
two types
1) imposed on self
2) imposed on another
essential feature is the falsification of medical or psychological signs in oneself or others - can seek treatment for self or another following induction of illness or injry - can occur in absence of obvious external rewards (no money/rational excuse)
- on some level this is a person’s own psychological need for attention/reassurance etc.
what is malingering?
a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of secondary gain motives - these may include financial compensation (often tied to fraud), avoiding school, work or military service, obtaining drugs etc.
what are somatoform disorders often associated with?
- genetic - increased in first degree relatives
- early environment - parents with chronic illnesses/learned behaviour
- often when physical illness during childhood was the only way to get attention/benefits from sick role
- childhood neglect and sexual abuse
- increased risk of somatoform disorder
- alexithymia (inability to express emotions)
- can be associated with somatization
How are we to manage somatoform disorders?
- avoid iatrogenesis - which is over investigation - because often times the overinvestigation exxacerbates the issue
- sometimes SSRIs relieve symptoms - but more often psychological help
- the key is empathetic doctor-patient relationship- build trust and come to an understanding about what is going on
- educate patient about illness/normal bodily sensations - often CBT shown to help patients and correct beliefs about illness
