Somatic Symptom Disorders Flashcards
DSM-5 diagnostic criteria for somatic sx disorder
i. 1+ symptoms that are distressing/result in disruption of daily life
ii. Excessive thoughts/feelings/behaviors related to somatic symptoms/associated health care concerns manifested by 1+ of:
1. Persistent thoughts about seriousness of symptoms
2. Persistently high-level anxiety about health/symptoms
3. Excessive time/energy devoted to symptoms/health concerns
iii. Any one somatic symptoms may not be continuously present but state of being symptomatic is persistent → >6 months
iv. Specify if:
1. With predominant pain: complaints are mostly pain
2. Persistent: severe symptoms, marked impairment, long duration (> 6 months)
3. Severity: mild (1 symptom), moderate (2+ symptoms), severe (2+ symptoms and multiple somatic complaints)
v. Suffering must be present and authentic (somatic symptoms w/o medical explanation not enough for diagnosis)
DSM-5 diagnostic criteria for illness anxiety disorder
i. Previously called hypochondriasis
ii. Preoccupation with having/acquiring serious illness
iii. Somatic symptoms not present or if present, only mild
1. If another medical condition present or there is a high risk of developing medical condition→preoccupation is excessive/disproportionate
iv. High level of anxiety about health, individual easily alarmed about personal health status
v. Performs excessive health-related behaviors or exhibits maladaptive avoidance (avoids doctors/hospitals)
vi. Illness preoccupation present for >6 months, but illness that’s feared may change over that timeframe
vii. Illness-related preoccupation not better explained by another mental disorder
viii. Specify if care-seeking or care-avoidant type
DSM-5 diagnostic criteria for factitious disorder imposed on self
i. Falsification of physical/psychological signs/symptoms or induction of injury/disease associated with identified deception
ii. Presents himself to others as ill/impaired/injured
iii. Deceptive behavior evident even in absence of obvious external rewards
iv. Behavior not better explained by another mental disorder (ex: delusional/other psychotic disorder)
v. Must specify single or recurrent episodes
DSM-5 diagnostic criteria for factitious disorder imposed on another
i. Falsification of physical/psychological signs/symptoms or induction of injury/disease in another (associated with identified deception)
ii. Individual presents with another individual to others as ill/impaired/injured
iii. Deceptive behavior evident even in absence of obvious external rewards
iv. Behavior not better explained by another mental (ex: delusional behavior) or another psychotic disorder
v. Perpetrator, not victim, receives diagnosis
vi. Must specific single or recurrent episodes
DSM-5 diagnostic criteria for body dysmorphic disorder
i. Preoccupation with 1 or more defects/flaws in physical appearance not observable/appear slight to others
ii. At some point during course: patient has performed repetitive behaviors (mirror checking, excessive grooming) or mental acts (comparing appearance to others) in response to appearance concerns
iii. Preoccupation causes significant distress/impairment in social, occupations, or other important areas of functioning
iv. Appearance preoccupation not better explained be concerns with body fat/weight in someone whose symptoms meet criteria for eating disorder
v. Specify if with muscle dysmorphia
vi. Specify degree of insight:
1. With good/fair insight
2. With poor insight
3. With absent insight/delusional beliefs
vii. Equal in both genders, more common in US, high prevalence in 1st degree relatives of OCD patients, mean age is 16-17 years
be able to. . .
indicate a diagnosis of the mental health disorders listed above in objective 1 when given a clinical scenario and pertinent details
describe the typical presentation of a patient with somatic symptom disorder
- Patients undergo expensive, time-consuming, ineffective treatments
- Often unusually sensitive to medication side effects
- Feel workup/treatment inadequate
- Patients don’t perceive themselves as psychiatrically disturb/resist referral
- Associated with anxiety/depressive disorders
- Increased risk for suicide
State the screening tool and findings that might indicate the possibility of somatic symptom disorder
- Patient Health Questionnaire (PHQ): possibility of disorder considered when patient is “bothered a lot” by 3+ of the symptoms without medical explanation
- Labs: no specific findings
- Neuroimaging studies not reported
- May have diagnosis of: fibromyalgia, chronic fatigue syndrome, chronic pain syndrome, dysautonomia (disorder of ANS with diminished/excessive functioning)
State the treatment approaches a clinician might use when managing a patient with somatic symptom disorder
- Avoid statements like: “this is all in your head” “there is nothing wrong with you”
- ONLY diagnostic/therapeutic procedures if objective signs/symptoms present
- Only 1 provider prescribe all meds/coordinate medical care
- Confrontational approach will lead to patient looking for new provider
List some of the complications and the prognosis for a patient with somatic symptom disorder
- Complications: iatrogenic
i. Addiction to prescribed analgesics/anxiolytics
ii. Surgical complications if exploratory surgery performed - Management of disease aimed at reducing symptoms/containing costs
- No cure/evidence of reduced life span
List information that might be found in the history of a patient with illness anxiety disorder
- No evidence of genetic input but it’s a familiar disorder
- History of childhood illness/serious childhood illness may predispose development
- May follow major life stress or serious but ultimately benign threat to individual’s health
Describe the typical presentation (signs and symptoms) of a patient with illness anxiety disorder
- Fear/concern about disease rather than symptoms
- Normal aches/pains seen as evidence of serious disease
- Relates history in very detailed manner with little affect
- Emotionally constricted/limited in social, occupations and sexual functioning
- Keep their own personal medical records
- Own some type of medical reference like Merck Manual or Physical Desk Reference
- Patients feel short-lived relief when reassured they have no serious disease but within hours/days will doubt assessment and return for another visit
State which patients with anxiety illness disorder might have the best prognosis
Patients with transient hypochondriasis in response to acute illness/life stress have good prognosis and possibly complete remission
Munchausen syndrome
refers to the type of factitious disorder w/ mostly physical sx
Describe the typical presentation and background of a patient with Munchausen syndrome
- Dramatic/inconsistent medical history
- Unclear symptoms not controllable—become more severe or change once treatment started
- Predictable relapses after improvement in condition
- Extensive knowledge of hospitals. medical terminology and textbook descriptions of illnesses
- Presence of many surgical scars
- Appearance of new/additional symptoms after negative test results
- Presence of symptoms only when patient is being observed
- Willingness/eagerness to have medical tests, operations, procedures
- History of seeking treatment at many facilities (even in other cities)
- Reluctant to let provider meet with family, friends, prior providers
- Problem with identity/self-esteem
List four methods of illness falsification used by patients with factitious disorder
- exaggeration of sx/feelings
- fabrication: lying, adding blood to urine, falsifying medical records, inflicting wounds on self/others
- simulation: faking blackout/ seicure
- induction: ingesting substance, injecting fecal matter to produce abscess/induce sepsis
State possible etiologies of factitious disorder
- Cause not known but researchers believe biological and psychological factors play role in development
- Some theories:
i. History of abuse/neglect as child
ii. History of frequent illnesses in them/family members requiring hospitalization
State factors possibly predisposing a patient to develop factitious disorder
- Often have histories of:
i. Abuse
ii. Trauma
iii. Family dysfunction
iv. Social isolation
v. Early chronic medical illness
vi. Professional experience in healthcare - Many are caregivers searching for nurturance (role-reversal)
- Typically react with hostility/threaten litigation when confronted
Indicate the differential diagnoses when evaluating a patient with factitious disorder
- Somatic symptom disorder: not trying to provide false information/be deceptive
- Conversion disorder/hysteria: 1+ symptoms of altered voluntary motor/sensory function incompatible with recognized neuro/medical conditions (ex: normal EEG w/seizure)
State the treatment of factitious disorder
- Goal: change person’s behavior/reduce misuse of medical resources, if imposed on another, ensure safety/protection of any real/potential victims
- Primary treatment: psychotherapy
i. Cognitive-behavioral therapy: changing thinking/behavior of patient
ii. Family therapy: teach family not to reward/reinforce behavior of patient - No meds used to treat→BUT treat any related disorder (ex: depression/anxiety)
List possible signs and symptoms observed in patients with body dysmorphic disorder
- Preoccupation with hair/facial features (ex: shape of nose)
- Males more likely preoccupied with genitalia
- Females tend to have comorbid eating disorders
- Many have ideas/delusions of reference
- Associated with high levels of anxiety, social anxiety, social avoidance, depression, neuroticism and perfectionism
- Majority have tried cosmetic treatment to improve perceived deficit
- Responds poorly to treatment/sometimes disorder made worse by treatment→prompts increased number of lawsuits
- Fears humiliation due to imagined defect→may cause patient to be more homebound
- Seeks medical treatment frequently
treatment for body dysmorphic disorder
- Psychotherapy not useful
- Long term prognosis unknown
- Increased risk of suicide
Identify other mental disorders often comorbid with body dysmorphic disorder
- High rate of psychiatric comorbidity: depression, anxiety, OCD
- SSRIs first line for comorbidities
Define and describe muscle dysmorphia
- Preoccupation that one’s body is too small/insufficiently lean or muscular
- Have normal-appearing body/are even very muscular
- May be preoccupied with other areas (ex: skin/hair)
- Majority diet, exercise, lift weight excessively (may cause bodily damage)
- High potential to use steroids
differential diagnoses for a patient being evaluated for body dysmorphic disorder
- Normal appearance: physical defects clearly noticeable are not classified as BDD
- Eating disorder: concerns about being fat considered symptom of eating disorder rather than BDD→may be comorbid
- OCD: BDD focuses only on appearance, OCD may have several focuses
- Illness anxiety disorder (hypochondriasis): not related to appearance
- Anxiety disorder: common comorbidity, can diagnose both if present
- Psychosis: common comorbidity, usually delusions of reference
