Somatic Symptom and Related Disorders Flashcards
describe diagnostic criteria for somatic symptom disorder (SSD)
- ≥ 1 distressing/disruptive somatic symptom
- at least one indicator of excessive thoughts/feelings/behaviors about the symptoms such as:
- disproportionate thoughts about the seriousness of the symptom
- high levels of anxiety about the symptom or health
- excessive time/energy devoted to the symptom
the diagnosis of SSD focuses on the abnormal behaviors/thoughts/feelings in response to ______
the diagnosis of SSD focuses on the abnormal behaviors/thoughts/feelings in response to the distressing somatic symptoms
The focus is NOT on whether there is a medical explanation for the somatic symptoms. The person COULD have a medical explanation for the symptom and still have SSD.
describe diagnostic criteria illness anxiety disorder (IAD)
- preoccupation with having/acquiring a serious illness
- somatic symptoms are NOT present, or, if present, the symptoms are mild:
- a normal physiological sensation
- a benign, self-limited dysfunction
- bodily discomfort not usually indicative of disease
- patient performs excessive health-related behaviors or maladaptively avoids heatlh-care
contrast SSD vs IAD
- SSD: patient has a distressing physical complaint with “excessiveness” in response to that distressing physical complaint
- IAD: patient does NOT have a distressing physical complaint but nonetheless worries about one’s health
describe delusional disorder (DD), somatic type
- a schizophrenia spectrum disorder characterized by a persistent fixed, false belief about body/health
- in DD, the belief is held with delusional intensity (100% certainty)
- in SSD and IAD, the belief is less strongly believed
describe body dysmorphic disorder (BDD)
- an obsessive-compulsive related disorder characterized by excessive concern about a perceived flaw in one’s appearance
- in BDD, the concern relates to one’s apperance whereas in SSD and IAD, the concern relates to somatic symptom or health
describe the physiological basis of SSD and IAD
- physiological features: overactivity of key brain regions (ant. cingulate, insula, somatosensory cortex) that are involved in processing the “unpleasantness” of bodily sensations
- cognitive biases: over-attentiveness to, and negative interpretations about, somatic symptoms
what are the behavioral consequences of SSD and IAD?
- assume the sick role (lay in bed), which can lead to feeling more ill
- get reinforced for sick role behavior (attention, obtaining tangible reward, getting out of unpleasant tasks)
what are treatments for SSD and IAD?
- cognitive-behavioral therapy to:
- reduce stress (to avoid intensifying symptoms)
- reduce excessive attention to bodily cues
- correct cognitive distortions about physical symptoms
- reinforce “non-sick role” behavior
describe diagnostic criteria for conversion disorder (functional neurological syndrome)
- altered voluntary motor or sensory function
- evidence of incompatability between the symptom and neurological condition
- they SHOULD be able to move their legs, but they claim they can’t
describe the onset and course of conversion and its etiology and treatment
- onset and course:
- typically sudden, after a major stressor
- often indifferent reaction to their disability
- usually short duration without recurrence
- etiology: psychological distress is converted into neurological symptoms
- treatment: psychoterhapy (goal is to elucidate and address the emotional basis of the symptom)
describe factitious disorder
- a person fakes/induces physical or psychological symptoms, in self or others, in the absence of obvious “external” rewards
- satisfaction is from gaining medical attention and being in the sick role (“primary gain”)
describe the 2 types of factitious disorders
- factitious disorder imposed on self (Munchausen’s syndrome)
- person feigns symptoms in oneself
- factitious disorder imposed on another (Munchausen’s syndrome, by proxy)
- person feigns symptoms in another individual
name hints to factitiousness
- unexplained persistent/recurrent symptoms
- inconsistent medical history
- dramatic presentation of history & symptoms (pseudologia fantastica)
- symptoms influenced by observations
- insistence on particular treatment
- grid abdomen
describe the treatment for factitious disorder
- treatment
- usually won’t seek psychiatric help, even when caught
- goal is to stsop further unnecessary medical care and prevent iatrogenic problems
- report “by proxy” cases to Child Protective Services
- differential = malingering
