Somatic Sxs and Related Dxs Flashcards
Somatic Dxs:
In the past, Somatic Dxs were about what?
What were the problems with this approach?
Medically Unexplained Sxs (MUS)
- Clients were invalidated (“it’s all in their heads”) and this impaired the therapeutic alliance.
- Some MUS were later found to have organic etiologies.
- The Dxs were defined by what it wasn’t (medically explained) vs. what it was.
Psychological factors affecting Medical Condition…
Medical condition + Psych factor which does ≥ 1 of the following…
- Influences ______ of the med condition
- Interferes with _____
- Represents additional __________
- Influences underlying _______
- course
- treatment
- health risks
- pathology
Somatic Sx Dx
Criteria:
A. ≥ 1 somatic Sxs that are ________ or result in significant ________ of ________
B. Excessive _______, ______, or _______ related to somatic Sxs (or associated health concerns) manifesting as ≥ 1 of the following…
- Disproportionate and _______ thoughts about seriousness of ______
- Persistently high level of ______ about health or Sxs
- Excessive _____ and _____ devoted to ______ or health concerns
C. State of being ______ is ________ ( > 6 months) though may be spread across > 1 Sx
A. distressing; disruption of daily life
B. thoughts, feelings, or behaviors
- persistent; Sxs
- anxiety
- time and energy; Sxs
C. symptomatic is persistent
Somatic Sx Dx
Specifiers:
- With _________ pain
- Persistent > ___ months
- ______
- predominant
- 6
- Severity
Somatic Sx Dx:
Explain the Somatosensory Amplification and Cognitive Distortion theory of Somatic Sx Dx etiology
Person is overly attentive to bodily sensations
Distorted cognitions about those Sxs
Self-perpetuating downward cycle
These three all involve both a perceptual and cognitive component.
Illness Anxiety Dx
Criteria:
A. Preoccupation with ______ or _______ a ________
B. Somatic Sxs are either…
C. High ______ about _______; easily _____ about personal health
D. Performs _______ health related behaviors
OR
E. Exhibits _______ avoidance
F. Illness preoccupation present ≥ ___ months: but the specific ______ that is feared may change over that time
A. having or getting a serious illness
B. Not present OR if present - preoccupation is excessive
C. anxiety; health; alarmed
D. excessive
E. maladaptive
F. 6; illness
Illness Anxiety Dx
Subtypes:
- Name this type: frequent use of medical care
- Name this type: medical care is rarely used
- Care-seeking type
2. Care-avoidant type
Somatic Sx Dx and Illness Anxiety Dx:
These are very similar disorders. Compare and contrast them
Somatic Sx Dx:
Disproportionate and persistent thoughts about seriousness of Sxs that person already has
Illness Anxiety Dx:
Preoccupation with having or getting a serious illness
______________________
Somatic Sx Dx:
Excessive time and energy devoted to these Sxs or health concerns
Illness Anxiety Dx:
Performs excessive health-related behaviors or exhibits maladaptive avoidance
Illness Anxiety Dx
Basic Info:
Illness concerns take a __________ AND _______ revolves around illness concerns
Prevalence
Sex Ratio
Onset and Course
Tx
prominent place in the individual’s life AND identity revolves around…
Prevalence: 1.3-10%
Sex Ratio: Equal
Onset and Course: Early/middle adulthood and chronic
Tx: CBT - 2x better than control group
How is the APA at odds with itself about coping with chronic illness and symptoms for Somatic Sx Dx/Illness Anxiety Dx?
Suggestions for coping with chronic illness look very similar to symptoms for SSD and IAD.
Suggestions like “facing diagnosis head on” vs. “thinking too much about it”
OR
“Distress is common following a chronic disease diagnosis and it is likely to trigger feelings of fear and grief” vs. “having persistent high level of anxiety about health or Sxs”
OR
“Actively face your illness, write down all your questions and take them to physician to discuss” vs. “spending excessive time or energy on health or Sxs”
Somatic Sx Dx/Illness Anxiety Dx and COVID
List some factors that increase anxiety for this with these disorders during the pandemic. There are 6 total
- Reduced social contact
- Lack of daily structure/routine
- Limited knowledge of disease info/misinformation
- Limited access/competition for health care/resources
- Quarantine when ill - focus turns inward
- Increase in generalized anxiety (jobs, close others, finances, etc.)
Somatic Sx Dx/Illness Anxiety Dx and COVID
Describe the controversy associated with recovering from COVID and how it relates to Somatic Sx Dx
When convalescent individuals are recovering from COVID, how far does the occupation with Sxs and recovery have to go before we label it Somatic Sx Dx?
Factitious Dx Imposed on Self
Criteria:
A. Falsification of physical or psychological signs or Sxs, for the purpose of ________
B. The individual presents himself or herself to others as _____, _____, or ______
C. The _______ is happening despite the absence of __________
A. deception
B. ill, impaired, or injured
C. deceptive behavior; absence of obvious external rewards
Factitious Dx Imposed on Self
Specifiers and Prevalence:
_____ vs. _______
Prevalence
Single vs. Recurrent
Prevalence: 1.3-6%
Factitious Dx Imposed on Self:
What’s a possible etiology of this Dx?
Didn’t receive enough care as a child. Something they missed out on and are now looking to fill as an adult.
Factitious Dx Imposed on Another:
In what ways is Factitious Dx Imposed on Another different from Factitious Dx Imposed on Self?
Person presents another as ill, injured, or impaired.
Another name is Munchausen by Proxy
Victim is typically a small child (most often < 5 years old)
Perpetrators often have some medical knowledge or background, are more likely female, and are frequently friendly with medical staff
Factitious Dx
Etiology and Tx:
Individual benefits from “__________”
Tx: Change ______ so benefits come in other ways
sick role
Tx: change incentives
Factitious Dx and Malingering Dx:
Explain the difference and similarity between these two Dxs (What are the motivations for causing Sxs and what is the mechanism for illness production?)
Motivation for causing Sx:
Factitious - Sick role (unconscious)
Malingering - Secondary Gain ($, get out of punishment, etc.)
Mechanism for Illness production:
For both, the mechanism is conscious
Conversion Dx
Criteria:
A. ≥ 1 Sx of ________ or _______ function
B. Clinical findings provide evidence of _______ between the ______ and recognized _______ or ________
C. The Sx or deficit causes: 1. 2. OR 3.
Note: This Dx does require an _______
A. altered voluntary motor or sensory function
B. incompatibility; Sx; neurological or medical conditions
C. 1. Distress 2. Functional impairment OR 3. Warrants medical evaluation
Note: This Dx does require an MUS (medically unexplained Sx)
Conversion Dx
Specifiers:
Acute = < \_\_\_\_ months Persistent = ≥ \_\_\_\_\_ months
With or without Psychological Stressor:
Name some of the psychological stressors. There are 8, with two of them being the most common
acute = < 6 months persistent = ≥ 6 months
- weakness or paralysis
- abnormal movement
- Swallowing Sxs
- Speech Sxs (slurred speech, etc.)
- Attacks or seizures
- Sensory Loss
- Special sensory Sx
- Mixed Sxs
Most common are Sensory Sxs and Limb weakness
Conversion Dx Basic Info: Gender Ratio Onset: Etiology: Treatment:
Gender Ratio: 2-3x more in females
Onset: Non-epileptic attacks - in 30s; motor Sxs - in 40s
Etiology: person transforms psych issues into physical ones because they are thought to be more acceptable to person
Treatment:
- modest effects for types of Txs
- primary impact is on comorbid depression and anxiety
Somatic Sx and Related Disorders Overview:
- Which Dxs have a biological cause? There are 2
- Which Dxs do not have a biological cause or the response to the cause is not in proportion to the Sxs? There are 2
- Which Dxs are consciously aware that they are causing Sxs? There are 2
- Psych Factors Affecting Other Medical Condition; Somatic Sx Dx
- Illness Anxiety Dx; MUS - Conversion Dx
- Factitious Dx Imposed on Self; Factitious Dx Imposed on Other
