Somatic disorders, eating disorders Flashcards
Somatic symptoms and related disorders. General theme
- Share a common feature: prominence of somatic symptoms associated with significant distress and impairment. - It is not just the somatic symptoms, its the way they present and interpret them - abnormal thoughts feelings and behaviours in response to these symptoms. - Many factors can lead to these symptoms
Clinical présentation of somatic symptom disorder (SSD)
- Individual exhibits somatic symptoms that are distressing or disrupt daily life and devotes to these somatic symptoms excessive thoughts (disproportionate and persistent thoughts about the seriousness of one’s symptoms) - Excessive behaviours (excessive time and energy devoted to these symptoms or health concerns) - Individuals appraise their bodily symptoms as unduly, threatening, harmful or even catastrophic for their health, even when there is evidence to the contrary. - they may seek care from multiple doctors
Etiopathogenesis of SSD
Psychological factors: - Negative emotionality - heightened attention to bodily sensations - Attribution of bodily symptoms to possible illness rather than it being a normal phenomena - Depression and anxiety risk factors Social factors: - Childhood sexual/physical abuse or neglect, female sex, older age lower education, unemployment, stressful life events, concurrent chronic physical illness
Functional consequences of SSD
- Health related quality of life is impaired, both physically and mentally - In severe SSD the health and social impairment is marked and can lead to invalidism
Differential diagnosis of SSD
- Generalised anxiety disorder - Depressive disorders are commonly accompanied by somatic symptoms however core depressive symptoms of low mood and anhedonia differentiate them from somatic symptom disorder - Illness anxiety disorder - if the individual has extensive worries about health but no (or minimal) somatic symptoms - Delusional disorder. Somatic type
Hypochondriasis (Illness anxiety disorder) (IAD)
- Individual is preoccupied with having undiagnosed serious illness, although somatic symptoms are to present or minimal - The individual is very anxious about their health, is easily alarmed about illness e.g. hearing about someone else falling ill may trigger even a panic attack - Individual researches their suspected disease excessively, adopts maladaptive avoidance of situations (e.g. doesnt visit family, exercise) - Negative tests or physicians reassurance generally do not alleviate their worries. - They highly utilise medical services, goes to multiple docs, multiple tests - They are generally dissatisfied with their medical care
Development and course of IAD
The course is chronic and onset in adulthood - Specific illness that is feared may change over time and health-related anxiety usually increases with age
Etiopathogenesis of IAD
Psychosocial factors - childhood abuse, serious childhood illness, major life stress, serious but ultimately benign threat to the individual’s health are risk factors
Conversion disorder (functional neurological symptom disorder) - CD
- The individual has symptoms of altered voluntary motor or sensory function
Motor symptoms of CD
- Weakness or paralysis - Abnormal movements (e.g. tremor dystonic movement, myoclonus, gait abnormalities, abnormal limb posturing)
Sensory symptoms of CD
- Include altered, reduced, absent skin sensation (anaesthesia) - Visual, olfactory or hearing disturbance other symptoms include: - Swallowing symptoms - Absent speech - Altered articulation
Development and course of CD
Onset may be associated with psychological or physical stress and may occur throughout life course. - Symptoms can be transient
Etiopathogenesis of CD
Biological factors - Presence of neurological or somatic disease that causes either similar symptoms or is a risk factor for conversion disorder Psychosocial factors - Childhood abuse and neglect, maladaptive personality traits, stressful life events and receive of disability benefits are risk and negative prognostic factor for conversion disorder
Functional consequences of CD
Substantial distress, disability and impairment in social, academic/professional functioning
Differential diagnosis of CD
Neurological disease - That might better explain the symptoms is the main different diagnosis - Conversion disorder may co-exist with a neurological disease