Somatic Symptom Disorders Flashcards
Somatic Symptoms and related disorders
Expressing psychological distress as body distress
DSM-5 Disorders
Somatic symptom disorder
Conversion disorder
Illness Anxiety Disorder (hypochondriasis)
Psychological factors affecting other medical conditions
Factitious Disorder (Munchausen Syndrome)
Also: undifferentiated somatoform disorder and somatoform disorder NOS
Somatic symptoms and other disorders DSM-V
Disproportionate and persistent thought about 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
Somatic Symptom Disorder etiologies
Etiology unknown
Anger suppression, avoid responsibilities
Family environment - abuse
Genetic (women = somatic symptom disorder, men= antisocial personality disorder)
Somatic symptom disorder
3 classic features
- Multiple system complaints
- Early onset, chronic course without physical signs
- Normal diagnostic studies are normal
Somatic symptom disorder
Very high levels of worry about illness and tendency to appraise symptoms as unduly threatening, harmful and often think worst about their health
These are distressing and alter every day life
Clinical findings
Somatic symptoms disorder
- Long complex medical hx (thick chart sign)
- Numerous invasive dz or tx procedure
- Multi-system c/o
- Fashionable diagnosis (Fibromyalgia, chronic fatigue syndrome, IBS)
Somatic Symptom Disorder Treatment
Single health care provider
Regularly scheduled appointment
Long term strategy
Group therapy
Meds no effective unless co-morbid psych
Provider should think of complaints as emotional expression
Chronic
Complications of Somatic Symptom Disorder
Failure to ID cause for s/s
Use of unnecessary and invasive do or surgical treatment
RX drug abuse
Can lead to helpless and dependent lifestyle
Conversion disorder
DSM-V
One or more symptoms of altered voluntary motor/sensory function
Clinical findings provide evidence of incompatibility between symptom and recognize neurological/medical conditions
Symptom not better explained by another medical or mental disorder
Symptom or deficit causes clinically significant distress or impairment in social, occupational or other important areas of functioning
Conversion is commonly found in:
- Rural populations
- Lower IQ
- Less educated
- Lower SES
- Military combat experience
Comorbities with other psychological disorders
Conversion disorder
Etiologies
May follow acute trauma
Repression of unconscious, intra-psychic conflict
Conversion of anxiety into physical symptoms
Conversion disorder
Clinical findings
Mimics dysfunction in voluntary motor or sensory system (blind, deaf, mute)
Motor involvement (gait, weakness, paralysis)
Exam doesn’t correlate
Psychodynamics
Conversion disorder
Primary gain: blindness prevents dealing with trauma
Secondary gain: pt benefits from illness
La belle indifference: lack of appropriate concern for severe symptoms
Identification: patient may take on characteristics of person imp. To them
Differential Dx
Conversion disorder
Must rule out medical disorder
If s/s disappear by suggestion, hypnosis, amobarbital/lorazepam = conversion disorder
Difference b/t Conversion disorder and somatic symptom disorder
Conversion = 1 s/s/ that violates law of H and P
Somatic symptom = multiple s/s
Conversion disorder prognosis
Can recur (20-25% with in first yr
Need to make sure true dz is not overlooked
Failure to consider conversion disorder as do can lead to continued treatment
Conversion disorder treatment
Usually have spontaneous resolution
Meds (benzos for anxiety, antidepressants)
Psychological (insight, behavior therapies)
Illness anxiety disorder
Preoccupation with having or acquiring serious illness
Somatic symptoms NOT present or only mild
High level of anxiety about health and individual is easily alarmed
Excessive health related behaviors or maladaptive avoidance
Illness preoccupation present 6+ months
Illness preoccupation is not better explained by another mental disorder
Etiology behind Illness Anxiety Disorder
Several theories of etiology
Lower pain threshold and tolerance
Social learning
May be variant of other mental disorder
Defense against guilt, sense of innate badness, low self esteem
Clinical findings of illness anxiety disorder
No physical exam to correlate complaints
Patient focuses on fear and belief that disease is present more than symptoms
Continues in belief even when diagnostic studies are negative
Can have depression, anxiety
Illness anxiety disorder
Treatment
Treat psychiatric symptoms with appropriate meds
Behavior therapy
Reassurance from clinician
Problem: remaining objective and not missing real disease
Body dysmorphic disorder
Criteria
Preoccupation with 1+ defects or flaws in physical appearance that are not observable or appear slight
Repetitive behaviors or mental acts in response to appearance concerns
Preoccupation causes significant distress or impairment
Appearance preoccupation is not better explained by an eating disorder
BDD is a somatic expression of
OCD
Is listed in DSM-V as OCD related
MC concern is facial features
BDD presentation
Seek multiple plastic surgeries
Fear of humiliation due to imagined defect, may keep patient housebound
Spends hours per day looking in mirror
Long course, consists of freq. ups and downs, few times when patient is symptom free
BDD treatment
surgery is contraindicated
Meds: SSRI drugs are effective
Factitious Disorder
DSM-V
- Falsification of physical or psychological signs or symptoms, induction of injury or disease then patient presents to others as ill, impaired or injured
- Deceptive behavior is evident even in absence of obvious external rewards
- Behavior is not better explained by another mental disorder
- Inflicted in self or another (child)
Factitious Disorder clinical findings
Present with nausea, vomiting, pain
Put blood in feces or urine, artificially elevate temp
Multiple hospital admissions, surgeries
Munchausen by proxy (to kid)
Malingering
Factitious disorder
Exaggerates symptoms for external gain
Malingering is deliberate behavior for a known external purpose
Factitious disorder malingering
Strongly suspect in presence of:
Medicolegal presentation
Marked discrepancy between claimed distress and objective findings
Lack of cooperation during elevation and in complying with prescribed treatment
Presence of antisocial disorder
Common goal of people who malinger
In ER: obtaining drugs or shelter
In clinic: financial compensation
