Somatic Symptom and Related Disorders

Question 1

Somatic Symptom Disorder Diagnostic Criteria

Answer 1

A. ≥1 somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviours related to the somatic symptoms or health concerns manifested by ≥1 of:
1. Disproportionate and persistent thoughts about the seriousness of symptoms
2. Persistently high level of anxiety about health symptoms.
3. Excessive time/energy devoted to these symptoms.

C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically >6 months)

Question 2

Somatic Symptom Disorder Specifiers

Answer 2

Specify if:
* With predominant pain

Specify if:
* Persistent: Severe symptoms, marked impairment, and long duration (>6 months)

Specify current severity:
* Mild: Only 1 symptom in Criterion B.
* Moderate: ≥2 symptoms in Criterion B.
* Severe: ≥2 symptoms in Criterion B, plus there are multiple somatic complaints (or one very severe complaint)

Question 3

Differentiation between Somatic Symptom Disorder and Psychological factors affecting other medical condition

Answer 3

• Distress in SSD may or may not be associated with a medical condition but must be disproportionate/excessive
• PFAOMC requires the presence of a medical condition, as well as psychological factors that adversely affect its course or affect treatment

Question 4

Differentiation between SSD and Illness Anxiety Disorder

Answer 4

If the individual has extensive worries about health but no or minimal somatic symptoms, it may be more appropriate to consider illness anxiety disorder.

Question 5

Illness Anxiety Disorder Diagnostic Criteria

Answer 5

A. Preoccupation with having or acquiring a serious illness
B. Somatic symptoms are not present, or if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., family history), the preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status
D. The individual performs excessive health-related behaviours (e.g., repeatedly checking for signs of the illness) or exhibits maladaptive avoidance (e.g., avoids doctors appointments/hospitals)
E. Preoccupation present for >6 months, but the specific illness that is feared may change over that time period.
F. Not better explained by another mental disorder

Question 6

Illness Anxiety Disorders Specifiers

Answer 6

Specify whether:
* Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.
* Care-avoidant type: Medical care is rarely used.

Question 7

Differentiation of Illness Anxiety Disorder from normal health anxiety or Adjustment Disorders following a serious medical diagnosis

Answer 7

• Nonpathological anxiety is usually time limited and less severe
• If health anxiety is clinically significant and causes functional impairment, adjustment disorder may apply
• If disproportionate anxiety lasts ≥6 months, illness anxiety disorder may apply.

Question 8

Functional Neurological Symptom Disorder (Conversion Disorder)

Answer 8

A. ≥1 symptoms of altered voluntary motor or sensory function
B. Clinical findings provide evidence of incompatibilty between the symptoms and the medical condition
C. Not better explained by another medical or mental disorder.
D. Causes clinically significant distress/functional impairment

Question 9

Functional Neurological Symptom Disorder Specifiers

Answer 9

Specify symptom type:
* With weakness or paralysis
* With abnormal movement (e.g., tremor, dystonia, myoclonus, gait disorder)
* With swallowing symptoms
* With speech symptoms
* With attacks or seizures,
* With anesthesia or sensory loss
* With special snesory symptom (e.g., visual, olfactory, hearing)
* With mixed symptoms

Specify if:
* Acute episode: Symptoms present <6 months
* Persistent: ≥6 months

Specify if:
* With psychological stressor
* Without psychological stressor

Question 10

Differentiation between Functional Neurological Symptom and Recognized neurological disease

Answer 10

Differentiated based on thorough neurological examination to determine whether the an underlying disorder explains the symptom

Question 11

Psychological Factors Affecting Other Medical Conditions Diagnostic Criteria

Answer 11

A. A medical symptom/condition (other than a mental disorder) is present.
B. Psychological or behavioural factors adversely affect the medical condition in one of the following ways:
1. Factors have influenced the course of the condition as shown by a close temporal association between the factors and the development, exacerbation, or delayed recovery from the condition
2. The factors interfere with treatment of the medical condition (e.g., poor adherence)
3. The factors constitute additional well-established health risks for the individual.
4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.

C. Factors in Criterion B are not better explained by another mental disorder.

Question 12

Psychological Factors Affecting Other Medical Conditions Specifiers

Answer 12

Specify current severity:
* Mild: Increases medical risk (e.g., inconsistent adherence with antihypertension treatment)
* Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating asthma)
* Severe: Results in medical hospitalization or ER visit
* Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attacks symptoms)

Question 13

Factitious Disorder Imposed on Self Diagnostic Criteria

Answer 13

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with the identified deception.
B. The individual presents themselves to others as ill, impaired or injured.
C. The deceptive behaviour is evident even in the absence of obvious external rewards.
D. The behaviour is not better explained by another mental disorder

Question 14

Factitious Disorder Specifiers

Answer 14

Specify:
* Single episode
* Recurrent episodes

Question 15

Factitious Disorder Imposed on Another Diagnostic Criteria

Answer 15

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with the identified deception.
B. The individual presents another individual (victim) to others as ill, impaired or injured.
C. The deceptive behaviour is evident even in the absence of obvious external rewards.
D. The behaviour is not better explained by another mental disorder

Note: The perpetrator, not the victim, receives the diagnosis

Question 16

Differentiation of Factitious Disorder from deception to avoid legal liability

Answer 16

• Protection from liability constitutes an external reward, so violates Criterion C
• With such presentations, the diagnosis is only given if the deception exceeds what is needed to achieve protection from liability

Question 17

Differentiation of Factitious Disorder from malingering

Answer 17

• Malingering is usually for personal gain (e.g., money, time off, etc.), so violates Criterion C
• However, they are not mutually exclusive; motives may be multiple and shifting