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
