Somatic Symptom Disorder

Question 1

Biofeedback

Answer 1

A relaxaton technique by which patients are trained to induce physiologic changes (usually induction of alpha waves on an EEG or vasodilation of peripheral capillaries) that results in a relaxation response

Question 2

Somatic symptom disorder with predominant pain

Answer 2

One of several somatic symptom and related disorders in DSM-5

All share the predominance of somatic symptoms associated with significant stress and impairment

Question 3

Diagnostic criteria for Somatic Symptom Disorder with Predominant Pain

Answer 3

One or more somatic symptoms that are distressing or result in a significant disruption in 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 levels of anxiety about health or symptoms
• Excessive time and energy devoted to these symptoms or health concerns

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

Predominant pain is a specifier if somatic symptoms predominantly involve pain.

Question 4

Treatment of somatic symptom disorder

Answer 4

Validation of symptoms and education about psychological factors that can contribute is vital.

Tricyclics and SSRIs have shown to be helpful (depression and analgesic effects)

Conventional analgesics are not generally helpful.

Biofeedback can be helpful, especially in headaches and muscle tension. Hypnosis and nerve stimulation are also used. Other relaxation techniques can also help.

Question 5

Somatic symptom and related disorders vs malingering vs factitious disorder

Answer 5

Question 6

Somatic symptom disorder vs conversion disorder

Answer 6

“In conversion disorder, the presenting symptom is loss of function (e.g., of a limb), whereas in somatic symptom disorder, the focus is on the distress that particular symptoms cause.”

Question 7

Fibromyalgia

Answer 7

Fibromyalgia is characterized by chronic generalized myalgia, paresthesia, and/or stiffness lasting > 3 months, multiple tender points on examination (typically at the points of muscular attachments to bone), and no signs of systemic inflammation or systemic disease on laboratory analysis (e.g., normal CBC, ESR, CRP, and TSH) or imaging