Somatic Symptom and Related Disorders Flashcards
What characterizes Somatic Disorders?
Excessive concerns about physical symptoms or health:
- Tendency to seek frequent medical treatment.
- Often see several physicians for a given health concern.
- May try many different medications.
- Hospitalization and surgery are common experiences.
What are the problematics of diagnosing Somatic Disorders?
- Conditions are remarkably varied.
2. Patients often find these diagnoses stigmatizing.
What is comorbid with Somatic Disorders?
Anxiety Disorders, Mood Disorders, and Personality Disorders
What are the 5 types of Somatic Disorders?
- Somatic Symptom Disorder
- Illness Anxiety Disorder (previously called Hypochondriasis)
- Conversion Disorder (also called pseudo-neurological disorder)
- Malingering
- Factitious Disorder
What is the main difference between the two groups of somatic disorders:
- Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder
- Malingering, Factitious Disorder
The first includes real subjective suffering and symptoms, while the second does not.
What is the difference between Malingering and Factitious Disorder?
In Malingering, somatic symptoms are faked in order to gain something external (e.g., not attending an exam), while in Factitious Disorder they are faked in order to gain from being a patient, an internal gain.
Both can happen by-proxy.
What characterizes Somatic Symptom Disorder?
Excessive thought, distress and behavior related to somatic symptoms.
What characterizes Illness Anxiety Disorder?
Unwarranted fears about a serious illness in the absence of any significant somatic symptoms.
Patients are easily alarmed about their health, may be haunted by visual images of becoming ill or dying, may react with anxiety when they hear about illnesses in their friends or in the community, and their fears will be easily calmed.
What characterizes Conversion Disorder?
Neurological symptoms that cannot be explained by medically disease or culturally sanctioned behavior.
What are the 4 DSM-5 criteria for diagnosing Somatic Symptom Disorder (1 of them is a specification that should be mentioned)?
- At least one somatic symptom that is distressing or disrupts daily life.
- Duration of at least 6 months.
- It should be specified if the symptom is predominantly pain.
- Excessive thoughts, distress, and behaviors related to somatic symptom(s) or health concerns, as indicated by at least one of the following:
- Health-related anxiety
- Disproportionate and persistent concerns about the seriousness of symptoms
- Excessive time and energy devoted to health concerns
According to DSM-5, may the somatic symptoms be medically explained when diagnosing Somatic Symptom Disorder?
Yes! That’s the big change from DSM-IV. Somatic Symptom Disorder may be diagnosed regardless of whether the symptoms are medically explained or not.
What are the 5 DSM-5 criteria for diagnosing Illness Anxiety Disorder?
- Preoccupation with and high level of anxiety about having or acquiring a serious disease.
- Excessive behaviors (e.g., checking for signs of illness, seeking reassurance) or maladaptive avoidance (e.g., avoiding medical care).
- No more than mild somatic symptoms are present (otherwise, diagnosed as Somatic Symptom Disorder).
- Not explained by other mental disorders.
- Preoccupation lasts at least 6 months.
What are the 3 DSM-5 for Conversion Disorder?
- One or more symptoms affecting voluntary motor or sensory function.
- The symptoms are incompatible with recognized medical disorders.
- Symptoms cause significant distress or functional impairment or warrant medical evaluation.
What is the prevalence of Conversion Disorder?
Less than 1%
Is there a gender difference in diagnosis of Conversion Disorder?
Yes, it is more present in women.
What is comorbid with Conversion Disorder?
Other somatic disorders.
When does the onset of Conversion Disorder usually happen?
Adolescence or early adulthood, and it is usually rapid.
What are some somatic symptoms that appear in Conversion Disorder?
- Partial or complete paralysis of arms or legs
- Seizures or coordination problems
- Vision impairment or tunnel vision
- Anesthesia (Insensitivity to pain)
- Aphonia(Whispered speech)
Are Somatic Symptom Disorders heritable?
Doesn’t seem like it.
** What are the 2 brain regions that show heightened activity correlated with Somatic Symptom Disorders?
- Anterior insula and anterior cingulate cortex - brain regions activated by unpleasant body sensations.
- Somatosensory cortex - brain region involved with processing bodily sensations.
What mental phenomena may increase Somatic Symptom and related disorders?
Anxiety, depression, and stress hormones.
What are 2 cognitive factors of Somatic Symptom Disorders?
- Attention to bodily sensations - automatic focus on physical health cues.
- Interpretation of those sensations - overreact with negative interpretations.
What are 2 behavioral factors of Somatic Symptom Disorder?
- Assuming the sick role, which intensifies poor health.
2. Safety behaviors (e.g., help-seeking) - prevents extinction of fear, maintains focus on potential health concerns.
What are the 2 vicious circles of mechanisms involved in Somatic Symptom Disorders?
- Medical symptoms and mental states lead to physiological symptoms and emotional arousal > this leads to attention to body, attribution of symptoms to serious illness, and health anxiety > leading back to physiological and mental conditions.
- Health anxiety leads to help seeking and avoidance, leading to a social response > leading back to medical and mental conditions.
(Look at Meinlschmidt’s flow chart)
What are the social and cultural factors of Conversion Disorders?
- People rural areas more likely to have.
- People from lower socio-economic status more likely to have.
- social factors shape the way symptoms unfold.
What is the psychodynamic explanation of the etiology of Conversion Disorders? and the neuroscientific one?
- Psychodynamic perspective - physical symptom is a response to an unconscious conflict.
- Neuroscientific perspective - much of our perceptual processing may operate outside of our consscious awareness.
What are obstacles of treating patient with somatic symptom and related disorders? What might help?
Most people with somatic symptom-related disorders want medical care, not mental health care. Referral to mental health may be viewed as invalidating.
A reminder of the mind–body connection can enhance their willingness to consider psychological treatment.
Has training medical professional to treat somatic disorders been successful?
Not so much to the patients, yes for the professionals themselves.
What are the 7 CBT strategies for treating somatic disorders?
- Identify and change triggering emotions.
- Change cognitions about symptoms.
- Change behaviors to improve social interactions.
- Train people to pay less attention to their body.
- Help people resume healthy activities (physical mainly) and rebuild life.
- Involve family members to reduce attention given to somatic symptoms.
- Mindfulness.
How is the concept of “predictive coding” relevant to Conversion Disorders?
Predictive coding claims the brain doesn’t only process but also predicts information. Prediction may be fulfilled by changing the environment. Here - internal predictions may affect the body and cause the symptoms.
What treatment has been proved helpful to Conversion Disorder in randomized controlled trials?
Two small randomized controlled trials indicate beneficial effects of CBT for specific forms of conversion disorder:
- Explanation that medical tests had not revealed an explanation for symptoms
- Patients were reinforced for taking part in physical training to improve area of difficulty
- Treatment team ignored ongoing signs of conversion symptoms
