Somatic Symptom Disorders Flashcards
Somatoform disorders in the DSM 4
- hypochondriasis
- pain disorder
- somatization disorder
- undifferentiated somatoform disorders
DSM 4- Hypochondriasis
- Somebody who fears illness based on misinterpretation of symptoms.
- The term is now pejorative which is why we do not refer to it as hypochondriasis.
Dsm 4- Pain disorder
Pain that is psychological
DSM 4- Somatization disorder
- People with persistent medical complaints which have been going on for years.
- the person seeks medical attention and have problems fulfilling life roles.
- the pain is real- and they do truly feel that they have a disorder.
DSM 4- Undifferentiated disorder
- a person who has a mysterious physical symptom that cannot be explained or that has no physiological origin and symptoms last 6 months.
- involves real pain that may be due to psychological conditions ( stress , depression, trauma)
Somatic symptom disorders (SSD)
- disproportionate concern for 6 months about medical seriousness of symptoms
- DSM 5 says you can have these disorders while having a medical issue major difference
- No longer requires medically unexplained Sx - Emphasis on cognition, emotion, and behavior
- Common feature of these disorders is prominent somatic sensations/changes
o Somatic Sx Disorder
▪ Presence of 1+ somatic sx (specific or vague)
▪ High levels of anxiety about sx or
▪ Devotes excessive time to health
▪ Somatic concerns must persist for a t least 6 months
▪ Specifiers - With predominant pain replaces pain disorder
▪ Mild (1sx), Moderate(2sx), or Severe(3
DSM 5 classification of SSD
- The DSM 5 classification includes people with medical diagnoses and without medical diagnoses.
- the amount of symptoms were also reduced which was an arbitrary # in the DSM 4 (8)
- DSM 5 only requires a symptom count of 1 - this symptom count of 1 is suppose to reflect a spectrum
- DSM 5 also says minimum of several months (6) and the DSM 4 was several years.
Medicine sometime gets it wrong
Sometimes medicine gets it wrong. Sometimes people really do have an illness and they are unable to identify it. This occurs in 20% of the cases and you can’t be sure whether or not a doctor is correct.
ALSO- who is to say that you don’t feel pain ?
Remember - even if you have cancer or diabetes and your concerns are EXCESSIVE you can be diagnosed with SSD
Voigt (2012) - the predictive validity and clinical utility of DSM SSD
The journal article says that Psychological symptoms of SSD enhanced Predictive validity and clinical utility of DSM 5 SSD.
It also identifies more psychologically impaired I individuals than Somatform disorder
Dimsdale et al (2013) “ what’s wrong with Somatoform Disorder ?”
o “Somatoform Disorder (SD)” often mistaken for somatization, so “Somatic Symptom Disorder (SSD)” is more clear
o Undifferentiated SD so loose that 20% of population could be Dx
o Too many SDs in DSM-IV – a lot of overlap – DSM5 reduced this to two: SSD and Illness Anxiety Disorder
o Rarely diagnosed, even though shown to exist (Ex - .000002 out of 28 million was the encounter frequency for SD and Undifferentiated SD)
o SD based on MUS (medically unexplained symptoms)—Dangerous because:
▪ Absence of medical doesn’t make it psychiatric (reinforces mind-body dualism)
▪ Clinicians differ greatly in assessments
▪ Patients think MUS makes their complaints inauthentic (bad for the alliance)
- Why is it better to change to “Somatic Symptom Disorder?”
o Focuses on somatic symptoms AND emotions, thinking, and behavior
o Can be specified as mild, moderate, or severe, based on response to symptoms
o May or may not accompany medical conditions
o Less stigmatizing, as it does not emphasize absence of medical issue so symptoms not “inauthentic”
Clinical rating scale for somatic disorders
The Illness Attitude Scales
Somatic Symptom Disorder Prevalence rates
About 6-16% of the general population has this disorder.
75% of patients Dx in the DSM4 diagnosed with hypochondriasis will meet criteria for DSM 5 SSD
Illness anxiety disorder
-Preoccupation with acquiring a serious illness
- such as fear of having diabetes or contracting HIV
▪ Differs from SSD in that somatic sx not present or only minor
▪ Focus more on consequences of illness rather than sx
-
▪ Excessive behaviors to reduce anxiety
▪ Bodily checking, avoidance
▪ Care-seeking type - Frequently makes medical visits
▪ Avoidance type – Avoids medical care
▪ 6 month duration
Illness anxiety disorder versus somatic symptom disorder
- in SSD there is presence of physical symptoms (heart racing )
- if you have one physical symptom with your anxiety it isn’t illness anxiety disorder - it’s going to be somatic symptom disorder (SS) guaranteed difference ***
- in illness anxiety disorder you have severe anxiety of possibly having an illness- but you don’t experience any physical symptoms at the time. These individuals are not faking , they honestly feel and believe that they have it.
Mayou et al. (2005)
Shortcomings of Somatoform disorders
- Shortcomings of Somatoform Disorders as Diagnoses:
o The term is unacceptable to patients
o It is inherently dualistic – Can somatic symptoms really be divided into those reflecting
disease and those that are psychogenic?
o Do not form a coherent category – Only similar component of each of the disorders is
that they are not associated by a general medical condition
o Incompatible with other cultures
o Ambiguity about the stated exclusionary criteria
o Subcategories are unreliable
o Lack clearly defined thresholds - Diagnostic confusion due to overlap of od SDs -
Authors suggest:
o Abolishing the category and adopting a new term for somatic symptoms and
syndromes
o Elaborating on diagnoses with an additional multidimensional description
Conversion Disorder (DSM4) is now called
Functional Neurological Symptom Disorder
Functional Neurological Symptom Disorder
• Hallmark is – lack of correspondence b/t signs & sx and medical understanding of the possible neurological condition
Ex-May complain of epileptic seizures, but lacks electrical activity in the brain consistent with epilepsy – such inconsistency needed for dx, so neurological testing paramount for this dx
• Manifestation of changed voluntary motor or sensory functioning
• Motor Sx - paralysis, paresthesia, tremors, convulsions, odd postures or movements
• Sensory Sx – blindness, reduced hearing, unusual skin sensations, altered speech patterns
• Specifiers – with or without psychological stressor
• Acute episode – if less than 6 months
• Persistent – if more than 6 months
Treatment for health disorders
25% of hypochondriasis can be treated by CBT
focuses on:
- CBT and Exposure
- exploring the actual underlying reasons for somatic symptoms
- what purpose do the lumps serve?
- people who are considered to be sickly are unable to do things and incapable of carrying responsibilities.
- Family therapy of the individual
- what behaviors reinforce the symptoms?
- extinguishing patient’s nagging/complaining by teaching the family the importance of ignoring the family member.
Medication tx for health disorders
SSRIs can be given for health disorders (somatization disorders)
Antidepressant medication (like prozac) that is used to treat depression may also help with hypochondriac symptoms
Factitious Disorder Imposed on the Self (
- person acts as if they have an illness by deliberately producing , feigning, or exaggerating symptoms. *** BUT NOT TO GET ANYTHING OUT OF IT
- Deception must occur without external gain
- Can be given to those with a medical condition, but there are attempts to make it appear worse
• Specifier – recurrent episode – when they have shown deceptive behavior more than once
Factitious Disorder Imposed on Another (formerly by proxy)
• Same criteria as “self” but applied to a person other than victim who engages in deceptive behavior
• Ex – Parent tampers with child’s urine to misrepresent health status
o Dx given to parent
Body Dysmorphic Disorder (BDD)
- Used to be in the DSM IV, but is now in Obsessive Compulsive and related Disorders
- extreme concern about one or more perceived defects in one’s physical appearance. Feel that they are “hideous” and suffer from overwhelming distress and can have trouble focusing on anything besides their perceived defects.
Body Dysmorphic Disorder is associated with….
Associated with:
- diminished quality of life - social isolation - repeated hospitalizations - suicide
