Somatic Disorders Flashcards
Brakoulias article
- DSM-5 replaces hypochondriasis with somatic symptom disorder and illness anxiety disorder
- Diagnostic validity of somatic symptom disorder and illness anxiety disorder is not well supported
- Clinical utility: new diagnoses more accurately describe the disorder and are likely less stigmatizing
- Non-formal diagnostic term of “health anxiety”
Stone et al. article
- Conversion disorder DSM-IV: symptoms such as weakness, seizures, or abnormal movements not attributable to a general medical condition or to feigning and that are associated with psychological factors
- Name “conversion disorder” has not been widely accepted; Authors suggest the term “functional neurological disorder”
- DSM-IV exclusion of feigning: proving the absence of feigning is nearly impossible
- Hard to identify psychological factors and to determine whether they are etiologically relevant
- Authors suggest incorporating physical diagnostic features observed in conversion disorder in the criteria
- “In summary, we suggest that conversion disorder be renamed ‘functional neurological disorder’ and that the requirement for the exclusion of feigning and identification of associated psychological factors be relegated to the accompanying text. We suggest that discriminating clinical features be given greater prominence”
Rief and Martin article
- DSM-5 changed “somatoform disorders” to “somatic symptom and related disorders”
- Review evidence for validity of somatic symptom disorder (SSD)
- SSD: if somatic complaint is distressing this fits criterion A; before, needed to distinguish medically explained from medically unexplained condition
- More research needed on medically unexplained and medically explained conditions
FINISH READING…
Somatic Symptom Disorder
A) 1+ somatic symptom that is distressing or disrupts daily life
B) Excessive thoughts, feelings, or behaviors related to somatic symptoms. One of following…
- Disproportionate and persistent thoughts about seriousness of symptoms
- High level anxiety about health/symptoms
- Excessive time and energy devoted to symptoms
C) Although any one symptom may not be continuously present, state of being symptomatic may last more than 6 months
Somatic Symptom Disorder specifiers
- With predominant pain
- Persistent (more than 6 months)
- Mild/Moderate/Severe
Illness Anxiety Disorder
A) Preoccupation with having or acquiring a serious illness
B) Somatic symptoms are not present or are only mild. If medical condition is present, preoccupation must be excessive
C) High level of anxiety about health
D) Performs excessive health-related behaviors or exhibits maladaptive avoidance (e.g., avoids doctors)
E) Illness preoccupation for 6+ months
F) Not better explained by another mental disorder
Illness Anxiety Disorder specifiers
- Care-seeking type: frequently seeks medical care
- Care-avoidant type: medical care rarely used
Conversion Disorder
A) Altered voluntary motor or sensory function
B) Incompatibility between the symptom and recognized neurological or medical conditions
C) Not better explained by another medical or mental disorder
D) Sig distress or impairment or symptom warrants medical evaluation
Conversion Disorder specifiers
- With weakness or paralysis
- With abnormal movement (e.g., tremor, gait)
- With swallowing symptoms
- With speech symptoms
- With attacks or seizures
- With anesthesia or sensory loss
- With special sensory symptom
- With mixed symptoms
- Acute episode / Persistent (more than 6 months)
- With/without psychological stressor
Psychological factors affecting other medical conditions
A) Medical symptom/condition present
B) Psychological or behavioral factors adversely affect the medical condition in one of following ways…
- Close temporal association between psych factors and onset/exacerbation of medical condition
- Factors interfere with treatment of condition
- Factors constitute additional well-established health risks for individual
- Factors influence underlying pathophysiology, precipitating or exacerbating symptoms
C) Not better explained by another mental disorder
Factitious Disorder
A) Falsification of physical or psychological symptoms, or induction of injury or disease, associated with identified deception
B) Present self to others as ill, impaired, or injured
C) Deceptive behavior even in absence of obvious external rewards
D) Not better explained by another MD
- Specify: single episode, recurrent episodes
Factitious Disorder Imposed on Another
Same as factitious disorder but imposed on another
Why do people fake illness?
Pro’s of the sick role
- Attention
- Sympathy
- Care from others
- Make yourself look/feel better through self-deception
Malingering
- Feigning symptoms specifically for personal gain
Information processing/somatic amplification theory
- Individuals experience heightened affectivity and dispositional arousal
- Overly attentive to somatic cues/catastrophic thinking
- Better explains people who fear rather insist; behaviors they engage in reduce anxiety (temporarily)
