Somatic symptom and related disorders Flashcards
Understand the aetiology, clinical presentation and diagnosis of psychosomatic and somatoform disorders as described in DSM-5 - define the terms “somatic symptom disorder”, “medically unexplained symptoms”, “hypochondriasis now known as “illness anxiety disorder” and “conversion disorder”
Understand the concepts of illness behaviour and abnormal illness behaviour, sick role, primary and secondary gain
Discuss the management of patients presenting with medically unexplained physical symptoms for example chest pain, fatigue, abdominal symptoms, pseudo-seizures
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DSM criteria for somatic symptom disoder
One or more somatic symptoms that are distressing or result in significant disruption of daily life.
Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
- Persistently high level of anxiety about health or symptoms.
- Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of be- ing symptomatic is persistent (typically more than 6 months).
Specify if with predominant pain or persistent (>6 mo)
Severity classificalsion
- mild: only 1 of the symptoms specified in criterion B
- moderate: >2 symptoms specified in criterion B
- severe: >2 symptoms specified in criterion B, plus there are multiple somatic complaints or one very severe somatic symptoms
DSM criteria for illness anxiety disorder
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., strong family history is present), 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 behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doc- tor appointments and hospitals).
E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
F. The illness-related preoccupation is not better explained by another menta ldisorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmor- phic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.
SPECIFY
- care seeking type vs care avoiding type
DSM criteria for conversion disorder
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
SPECIFY SYMPTOM TYPE
- with weakness or paralysis
- with abnormal movement
- with swallowing symptoms
- with attacks or seizures
- with anaesthesia or sensory loss
- with special sensory symptom
- with mixed symptoms
SPECIFY IF:
- acute: <6 mo
- persistent: >6 mo
SPECIFY IF:
- with psychological stressor (specify stressor)
- without psychological stressor
DSM criteria for factitious disorder
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
Outline the difference in presentation/symptoms of
- somatic symptom disorder
- illness anxiety disorder
- conversion disorder
- factitious disorder
- malingering
