Somatic Symptom and Related Disorders Flashcards
1
Q
What are somatic symptoms and related disorders?
A
- Somatic symptom and related disorders are a group of mental health conditions in which individuals experience distressing physical symptoms or worry excessively about their health, despite no clear medical or physical explanation for the symptoms.
2
Q
What is Somatic Symptom Disorder (SSD)? What is the DSM/ ICD criteria for this?
A
- Somatic Symptom Disorder (SSD) is a condition in which an individual has one or more physical symptoms that they are excessively worried about, even if there may be some physical basis for the symptom(s).
- Common symptoms include pain, back, chest, and headache, as well as gastrointestinal distress. SSD is typically more than 6 months long and is known as “Bodily Distress Disorder” in the ICD-11.
- Somatic Symptom Disorder, DSM/ICD criteria include one or more upsetting and disruptive somatic symptoms, excessive thinking or anxiety about the symptoms, and significant time and attention spent on the symptoms.
o Symptoms must be present for at least six months, and in ICD-10, there must be no physical explanation for the disorder, and the person must not accept a doctor’s reassurance for at least two years
3
Q
What is Conversion Disorder? What is the DSM/ ICD criteria for this?
A
- Conversion Disorder is a condition in which an individual experiences a loss or alteration of physical function or sensation that cannot be explained by any known medical or neurological condition.
- Symptoms may include weakness, paralysis, blindness, or hearing impairment, and they may be related to stressors in a person’s life.
- Conversion Disorder, DSM/ICD criteria include one or more physical symptoms involving lost or altered motor or sensory functioning, incompatibility with known medical or neurological conditions, and the presence or absence of a psychological stressor. The condition may be acute or persistent, and the criteria may differ in ICD-10 and -11.
4
Q
What is Illness Anxiety Disorder and how is it diagnosed according to DSM and ICD criteria?
A
- Illness Anxiety Disorder, previously known as Hypochondriasis, is a mental health condition characterized by excessive fears or concerns about having an illness, despite medical reassurance for at least 6 months.
- The person may exhibit mild somatic symptoms and engage in excessive health behaviors or maladaptive avoidance.
- The DSM criteria for Illness Anxiety Disorder include being excessively worried about health, checking symptoms constantly or avoiding doctors and hospitals, and disproportionate concern about being or becoming ill.
- According to ICD criteria, the person is easily and excessively worried about health, has no or mild physical symptoms, and is disproportionately concerned if they do become ill.
5
Q
What is Factitious Disorder and how does it differ from Malingering?
A
- Factitious Disorder is a mental health condition in which an individual intentionally induces physical symptoms in themselves or exaggerates or simulates symptoms to produce signs of illness and convince others that they are sick.
- The goal is to receive medical attention, as the person has a deep psychological need for it. They often have knowledge about medical diagnoses and various hospitalizations, and may visit emergency rooms on weekends or evening shifts to be evaluated by junior clinical staff.
- Factitious Disorder differs from Malingering, which involves intentionally producing physical symptoms to obtain incentives such as avoiding military service or obtaining financial compensation.
6
Q
What are some common practices associated with Factitious Disorder?
A
- Some common practices associated with Factitious Disorder include faking elevated body temperature by heating up the thermometer, putting blood in urine to stimulate infection, taking blood thinners to produce hemophilia, and faking chest or abdominal pain.
- They may manipulate lab results and engage in doctor-shopping.
- The person may also provide false information to medical professionals, such as their medical history or symptomology.
7
Q
What are the possible risk factors for Factitious Disorder?
A
- Possible risk factors for Factitious Disorder include childhood trauma such as emotional, physical, or sexual abuse, a serious illness during childhood, loss of a loved one through death, illness, or abandonment, past experiences during a time of sickness and the attention it brought, a poor sense of identity or self-esteem, personality disorders, depression, and a desire to be associated with doctors or medical centers.
8
Q
How does Factitious Disorder imposed on another differ from Factitious Disorder imposed on self?
A
- Factitious Disorder imposed on another involves interfering with the health of someone else, such as doing things to make them ill or convincing children that they are sick. This is a crime and can cause psychological problems in the child as they perceive the mother as good and caring but may also be aware that the behavior is harmful.
- Factitious Disorder imposed on self involves intentionally inducing physical symptoms in oneself or exaggerating or simulating symptoms to produce signs of illness and convince others they are sick.
9
Q
What are other Specified Somatic Symptoms and Related Disorders?
A
- Examples:
o Brief somatic symptom disorder <6 mo
o Brief illness anxiety disorder <6 mo
o Pseudocyesis- a false belief of being pregnant that is associate with objective signs and reported symptoms of pregnancy - symptoms are present and cause distress or impairment, but do not meet the full diagnostic criteria for other somatic disorders.
10
Q
What is the biological perspective on somatic symptoms?
A
- The biological perspective includes brain chemistry, brain structure and function, genetics, and evolution.
- Antidepressants and antipsychotics are commonly prescribed for somatic symptoms.
- Antidepressants are particularly beneficial and SSRIs are preferred for hypochondriasis while SNRIs are preferred for pain symptoms.
- Herbal remedies such as St. John’s Wort can be used for somatization.
- Antipsychotics can also reduce somatic symptoms.
- More research is needed in this area, and trial-and-error may be used to find the most effective treatment.
11
Q
what about the structural functional perspective and evolutionary perspective within biology?
A
- Enhanced frontal lobe and limbic system activity
- Inconclusive
- Somatic symptoms might induce empathy in others and others might be more willing to help- hence increasing the chances of survival of the person
12
Q
What is the psychodynamic approach to somatic symptoms? What is the treatment for this?
A
- The psychodynamic approach suggests that unconscious conflicts are expressed indirectly as physical/somatic symptoms.
- Therapy aims to help the patient bring the underlying meaning of the somatization into conscious awareness and deal with resulting emotions.
- Case studies such as Mr. A., a man who experienced seizures without a biological basis, illustrate the effectiveness of this approach.
13
Q
What is the cognitive-behavioral approach to somatic symptoms? What is the treatment for this?
A
- The cognitive-behavioral approach focuses on how somatic symptoms are interpreted. This approach includes somatic amplification, perceiving bodily sensations as intense, aversive, and disturbing, as well as inaccurate beliefs about the prevalence of disease, contagion, the meaning of bodily symptoms, and the course and treatment of illness. Behavioral perspectives also consider the impact of rewards.
- Treatment techniques:
o Relaxation training (teach techniques to calm oneself- teach muscle
relaxation)
o Changing automatic thoughts (about what it means to have physical
symptoms)
o Changing attention away from physical symptoms
o Work on inaccurate beliefs about
Prevalence of disease and contagion
Meaning of bodily symptoms
Course and treatment of illness
o Work on avoidance
o Strategies to reduce stress
o Biofeedback electrical signals from the body is used to make the person aware of and control physiological processes
they learn to relax their muscles with this technique
o Learn that the physiological reactions can be controlled
o Mindfulness meditation be aware of the feelings and physiology but do not try to suppress them, do not be judgemental hence you will not label them, be
fixated on them, or react negatively to them
14
Q
What is the Humanistic perspective on somatization? What is the proposed treatment?
A
- The Humanistic perspective suggests that physical and psychological symptoms are interconnected.
- People who have somatization have difficulty expressing their emotional conflicts verbally, so they express these conflicts physically.
- Body-oriented psychotherapies aim to help clients reconnect with their emotions and gain a better understanding of bodily sensations.
15
Q
What are some Sociocultural Perspectives on somatization?
A
- There are various Sociocultural Perspectives on somatization.
- Conceptualizations of dissociations and somatization vary by country, with different prevalence and meaning.
o For example, somatization is more common among the Chinese population, and it can be a culturally influenced means of communicating psychological distress. In different cultures, experiences of dissociation are defined as possessions.
