Somatic Symptom Disorders COMPLETE Flashcards
What are somatic symptom disorder?
Excessive concerns about physical symptoms/health
They focus heavily on physical symptoms like pain, weakness/shortness of breath etc.
That focus results in major distress/impairment
They have excessive thoughts feelings and behaviours about this- they make frequent doctor visits and request lots of tests.
What are the old names for somatic symptom disorders?
Somatization disorder
Hypochondriasis
Pain disorder
Undifferentiated somatoform disorder
These were all in DSM-4 so no longer apply
In relation to diagnosis, what is different about somatic symptom disorders
The diagnostic criteria has been simplified to allow for easier diagnosis by non-psychiatric health professionals.
Their somatic nature of the symptoms means that they are frequently presented to GPS specialists and emergency rooms
What are the DSM categories for somatic symptom disorders
Somatic Symptom disorder
Illness anxiety disorder
Functional Neurological disorder
Factitious disorder
Psychological Factors Affecting Other Medical Conditions
Other Specified Somatic Symptom and Related Disorder
Unspecified Somatic Symptom and Related Disorder
What is the DSM criteria for somatic symptom disorder?
One/ more somatic symptom that is distressing or results in significant disruption of daily life.
Excessive thoughts/feelihngs or behaviours related to the somatic symptoms or health concerns, ie. dedicating excessive time and energy
Symptoms must be present for at least 6 months.
Other things in relation to somatic symptom disorders
Doesn’t matter if symptom can be medically explained for not (unlike in DSM-IV)
Often difficult to find biological cause to medical symptoms (e.g. fibromyalgia, chronic fatigue)
Medicine continues to advance
Doctors can be sued for malpractice and sometimes run unnecessary tests!
Doctors struggle to balance these scenario
What is the DSM criteria for illness anxiety disorder?
- Preoccupation with a high level of anxiety around having/acquiring a serious illness
- Excessive illness behaviour, ie. seeking reassurance from doctors, checking for the illness, maladaptive avoidance of medical care.
- Somatic symptoms are not present or mild
- Symptoms present for at least 6 months
What is the key difference between Illness anxiety Disorder and Somatic Symptom Disorders
Illness anxiety- mild or no somatic symptoms present
Somatic- one or more somatic symptoms
What was Functional Neurological disorder priorly described as, what is it now
Hysteria/ convergence
Now: Functional neurological symptom disorder
What is the DSM criteria for functional neurological disorder
- One or more symptoms of altered motor or sensory function,ie. blindness
- Incompatibility between the symptom and the recognised neurological/medical condition- the tests show that everything is fine
- Causes significant distress/impairment
What is the case example of Functional neurological Symptom disorder?
BT
Suffered brain damage in an accident as a young woman, gradually lost her vision. Diagnosed with cortical blindness.
13 years later; in therapy for dissociative identity disorder
10 different alters
One of the alters, a teenage boy, suddenly regained partial vision a few months into therapy.
Range of sight expanded across different levels of processing and vision began to return to other alters.
EEG ruled out malingering
Consensus was that B.T. was experiencing conversion symptoms; the loss of vision was caused by psychological distress.
“In situations that are particularly emotionally intense, the patient occasionally feels the wish to become blind, and thus not ‘need to see.” (Strasburger)
Psychodynamic research indicates that patients with conversion blindness are unconsciously suppressing their ability to see
How was Malingering ruled out by EEG in the case study of BT
When embodying alters that still couldn’t see, electrical activity in B.T.’s occipital lobe was consistent with a lack of sensory input
Vice versa when embodying a sighted alter.
What are things to consider in relation to functional neurological disorder?
Things to consider- not faking, experiencing an inability despite there not being an actual neurological condition
The connections that exist between the brain and body are incredible.
Doctors have such a difficult job to care for patients with these symptoms - tension between not wanting to diagnose a real medical condition over minor symptoms
What is factious disorder?
Falsification of physical or psychological signs or symptoms, or induction of injury or disease.
The deceptive behaviour is evident even in the absence of obvious external rewards
What’s factitious disorder by proxy
imposing a factitious disorder on another ,e.g someone you’re caring for
Gypsy rose
What is the main difference between factitious disorders and malingering
Factitious- Deceptive behaviour even in the absence of rewards
Malingering- done to get the benefits, ie. drugs claim benefits, innocent plea
What are the similarities between factitious disorder and somatic symptom disorder
Usually unexplained medical symptoms
Request losts of tests
Lots of time spent on Web MD
What are the differences between factitious disorder and somatic symptom disorder
Somatic-unconscious generation of symptoms
Factitious- conscious generation of symptoms
What re the extreme behaviours that factitious disorders often illicit?
Lengthy hospital stays
Painful tests done
Take drugs that damage themselves
Fake tests, steal urine or blood
Undergo surgeries and blood transfusions
Example: Faked blood and underwent leukaemia treatment, they swapped blood samples
Why do people with factitious disorder engage in these extreme behaviours
Its unclear but some speculate that it arises from a need to gain attention
Miss Scott- care, sympathy, wanted someone to care act her
Prevalence of SSds
It is difficult to estimate the prevalence because the diagnostic manual changed and they merged categories that have a enormous difference in prevalence
What is the estimated prevalence of Somatic Symptom Disorder?
Higher than Somatization Disorder- 1%. And lower than Undifferentiated Somatoform Disorder- 19%
What is the estimated prevalence of Illness Anxiety disorder?
1.3- 10%
What is the estimated prevalence of conversion disorder/ functional neurological symptom disorder?
2-5/100k
0.00002/0.00005
What is the estimated prevalence of factitious disorder
1 percent in hospital settings
What is the Aetiology/ Causes of SSD’s
Genetics- no- twin concordance is very low and can be explained by shared environmental factors
Environment:
Childhood adversity
Physical Trauma
Insecure Attachment
Psychological
Excessive anxiety over health
Increased need to experience attention
What are the 2 other models in determining the aetiology of Ssd’s?
Neurobiological model
Cognitive behaviour model
Describe the neurobiological model
Attention: Are some ppl more sensitive to body sensations and then more prone to think that they are more serious than they actually are
Patients with somatoform disorder displayed greater activation in insult and ACC
Also report higher pain ratings of standardised unpleasant stimuli
Electrosentivive- Believe that they are sensitise to electromagnetic fields - debunked
Even experienced the fake stimulus
Describe the cognitive behavioural model
Anxiety, stress and depression amplify attention to pain, amplify the experience of pain, catastrophise the consequences of pain and can cause somatic symptoms directly (e.g. anxiety induced chest pain, muscle tension).
Our brains interact with the world through perception, not ‘cold processing’ of stimuli (sensation) etc
Why may some people be more anxious about their health?
Acute stress exposure can kick start the cycle
Excessive concern over physical health and minor symptoms may have been learnt in childhood
People may receive sympathy, support, and subsequently reinforcement of behaviour from health professionals etc.
What about the aetiology of FND
This disorder is v.rare so not a lot of research
Freud believed that medically unexplained physical symptoms can be caused by unconscious conflict
Symptoms are thematically related to unconscious desires
What are the problems surrounding treatement for SSDs
Tough for MPs to diagnose- dont want to be dismissive or miss something important
Tough to get people to take a referral to mental health services- when they want general medicine
What are is the treatement
Cognitive Behavioural Therapy
Treatment in relation to thoughts
Change beliefs (e.g. catastrophising minor maladies)
Paying less attention to bodily sensations
Teach coping mechanisms
Treatment in relation to feelings
Reduce stress and anxiety that may trigger concerns
Treat depression, etc
Teach people to recognise links between body and brain (when do I get anxious?)
Treatment in relation to behaviour
Stop taking tests
Stop googling
Find strategies to get reinforcement elsewhere
Get family to stop reinforcing behaviour
