Somatic Symptom Disorders Flashcards
5 Types of Somatic Symptom & Related d/o
1) Somatic Symptom Disorder
2) Conversion Disorder
3) Illness Anxiety Disorder (fka - Hypochondriasis)
4) Psychological factors affecting other medical conditions
5) Factitious Disorder (Münchausen Syndrome)
1) One or more somatic symptoms that are distressing or result in significant disruption of daily life.
2) Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
~ Disproportionate & persistent thought about the seriousness of one’s symptoms
~Persistently high level of anxiety about health or symptoms
~Excessive time & energy devoted to these symptoms or health concerns
Somatic Symptom Disorder Diagnostic Criteria
Possible Etiologies of Somatic Symptom Disorder
1) anger suppression
2) Family enviornment (abuse)
3) Genetic
~women=somatic symptom
~men=antisocial personality
3 Classic Features of Somatic Symptom d/o
1) Multiple system complaints
2) Early onset, chronic course without physical signs
3) Diagnostic studies are normal
“Fashionable Diagnoses” associated with Somatic Symptom d/o
Fibromyalgia, chronic fatigue syndrome, Irritable Bowel Syndrome
Treatment of Somatic Symptom Disorder
-Single health care provider
-Regularly scheduled appointment
-Long term strategy
(NEVER tell patient “it’s all in your head”)
-Group therapy
-Meds not effective unless used for co-morbid psych dx
-Provider should think of patient’s c/o as emotional expressions, not medical complaints
Complications of Somatic Symptom d/o
- Failure to ID medical cause for s/s
- Use of unnecessary & invasive dx or surgical tx
- Adverse effects of multiple med
- Rx drug abuse
- Can lead to helpless and dependent lifestyle
- One or more symptoms of altered voluntary MOTOR or SENSORY function
- Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
Diagnostic Criteria for Conversion d/o
Conversion d/o is most commonly found in:
- Rural populations
- Lower IQ
- Less educated
- Lower socioeconomic groups
- Military with combat experience
co-morbidities of Conversion D/O
- MDD
- Anxiety d/o
- Schizophrenia
Common Examples of Conversion d/o
1) symptom that allows pt. to avoid confronting the problem
2) Vaginismus-unable to have sex after rape
3) Blindness-after patient observed traumatic experience
Psychodynamics associated with Conversion d/o
1) Primary gain: (ex.blindness prevents dealing with trauma)
2) Secondary gain: (pt. benefits from illness)
3) La belle indifference: lack of appropriate concern for severe symptoms
4) Identification: (patient may take on characteristics of person important to them)
DDx of Conversion d/o
- 25-50% go on to have a neurological dz
- It is most likely Conversion d/o if s/s disappear with hypnosis, or medication
- ONE specific s/s that violates laws of H&P
- 20-25% reoccur within first year
- Preoccupation with having or acquiring a serious illness
- Somatic symptoms are NOT present or, if present, are only mild in intensity.
- There is a high level of anxiety about health
- Individual preforms excessive health-related behaviors
- Men and women effected equally
Illness Anxiety d/0 (Hypochondriasis)
diagnostic criteria
- Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
- At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his/her appearance with that of others) in response to the appearance concerns
- Often claimed to be an expression of OCD
Body Dysmorphic d/o diagnostic criteria
