Somatic Symptom Disorders

Question 1

Hypochondriasis

Answer 1

Presence of distressing somatic symptoms due to abnormal thoughts feelings and behaviors causing the symptoms and in response to symptoms

Often are painfully depressed and anxious

can have chronic medical conditions with somatic symptoms, but also be a hypochondriac

Can present in up to 40% of patients

• unexplained and perplexing somatic complaints
• are difficult patients and difficult encounters

Treatment: CBT is 1st line

Question 2

Somatic symptom disorder

Answer 2

“One or more somatic symptoms that are distressing or result in significant disruption of daily life FOR GREATER THAN 6 MONTHS”
- patient has what they believe is predominant pain that is debilitating (not something minor)

Excessive thoughts, feeling or behaviors related to the somatic symptoms and associated health concerns. Needs at least one of the following:

• disproportionate and persistent thoughts about the seriousness of ones symptoms
• persistently high level of anxiety about health or symptoms
• excessive time and energy devoted to these symptoms or health concerns

there is nothing medically wrong with the patient, it is all psychological and a physical manifestation of stress

** must specify “with predominant pain” if the specific somatic symptom is pain**

Treatment: CBT to find root cause of the somatic symptoms (it is usually some unique stressor).

Question 3

Illness anxiety disorder

Hypochondriac

Answer 3

Preoccupation with having or acquiring a serious illness
- often associated with a real medical diagnosis they have or a family member has

THERE ARE MINIMAL-NO SOMATIC SYMPTOMS

Individual performs excessive health-related behaviors or exhibits maladaptive avoidance to healthcare. Must specific subtype:

• care seeking = always shows up and is open to undergoing invasive tests/procedures
• care avoidant = refuses medical care

there is no better explanation for the symptoms including medical and psychiatric conditions.

Tx: behavioral therapy (CBT)

Question 4

Conversion disorder

Functional neurological symptom disorder

Answer 4

One or more symptoms of altered voluntary motor or sensory function that is generally caused following a dramatic event/ acute stressor
- symptoms causes clincially significant distress or impairment in social occupation or other important areas of function

Clinical findings provide evidence of incompatibility between symptoms and known medical conditions (doesnt add up)

Symptom or deficit is not better explained by another medical or psychiatric disorder

Question 5

Factitious disorder

Muncher

Answer 5

Falsification of physical or psychological signs or symptoms or induction of injury or disease
- there is identified deception but it is unconscious and not for external gain*

Always presents himself/herself to others as ill, impaired or injured

• the symptoms are intentional*
• the motivation is conscious*
• the reason is for attention or sympathy*
• patient is usually relieved when told nothing is wrong
• there is usually absence of obvious external rewards (no obvious gain like malingering)*
• do this to participate in the medical system due to psychiatric disturbances

can be proxy, where they do this to someone else, usually a child or elderly. Is child abuse or elderly abuse

Question 6

Malingering

Answer 6

Similar to factitious disorder except there IS INTENTIONAL MOTIVATION

• patient intentionally causes symptoms
• the motivation is conscious

Patients intentionally hurt or give themselves illnesses to have an external gain of some sort
- symptoms go away once the external gain is achieved*

Patients get irritated if told nothing is wrong with them/ nothing serious is going on and are very non compliant with treatments
- compared to factitious disorder where the patient is relieved to be told nothing is wrong

Question 7

Treatment guidelines for somatic symptom and related disorders

Answer 7

“ CARE MD”

1) CBT

2) Assess
- rule out true medical causes and treat comorbid psychiatric disorders

3) Regular visits
- short frequent visits with focused exams
- discus recent stressors

4) Empathy
- listen to the patient and acknowledge their repeated discomfort

5) Med-psych interface
- help patient self discover the mid-body connection
- DONT say “your symptoms are all psychological”

6) Do no harm
- avoid unnecessary diagnostic procedures and specialists consultants