Somatic Symptom Disorders COMPLETE

Question 1

What are somatic symptom disorder?

Answer 1

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.

Question 2

What are the old names for somatic symptom disorders?

Answer 2

Somatization disorder
Hypochondriasis
Pain disorder
Undifferentiated somatoform disorder

These were all in DSM-4 so no longer apply

Question 3

In relation to diagnosis, what is different about somatic symptom disorders

Answer 3

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

Question 4

What are the DSM categories for somatic symptom disorders

Answer 4

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

Question 5

What is the DSM criteria for somatic symptom disorder?

Answer 5

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.

Question 6

Other things in relation to somatic symptom disorders

Answer 6

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

Question 7

What is the DSM criteria for illness anxiety disorder?

Answer 7

1. Preoccupation with a high level of anxiety around having/acquiring a serious illness
2. Excessive illness behaviour, ie. seeking reassurance from doctors, checking for the illness, maladaptive avoidance of medical care.
3. Somatic symptoms are not present or mild
4. Symptoms present for at least 6 months

Question 8

What is the key difference between Illness anxiety Disorder and Somatic Symptom Disorders

Answer 8

Illness anxiety- mild or no somatic symptoms present

Somatic- one or more somatic symptoms

Question 9

What was Functional Neurological disorder priorly described as, what is it now

Answer 9

Hysteria/ convergence

Now: Functional neurological symptom disorder

Question 10

What is the DSM criteria for functional neurological disorder

Answer 10

1. One or more symptoms of altered motor or sensory function,ie. blindness
2. Incompatibility between the symptom and the recognised neurological/medical condition- the tests show that everything is fine
3. Causes significant distress/impairment

Question 11

What is the case example of Functional neurological Symptom disorder?

Answer 11

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

Question 12

How was Malingering ruled out by EEG in the case study of BT

Answer 12

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.

Question 13

What are things to consider in relation to functional neurological disorder?

Answer 13

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

Question 14

What is factious disorder?

Answer 14

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

Question 15

What’s factitious disorder by proxy

Answer 15

imposing a factitious disorder on another ,e.g someone you’re caring for
Gypsy rose

Question 16

What is the main difference between factitious disorders and malingering

Answer 16

Factitious- Deceptive behaviour even in the absence of rewards

Malingering- done to get the benefits, ie. drugs claim benefits, innocent plea

Question 17

What are the similarities between factitious disorder and somatic symptom disorder

Answer 17

Usually unexplained medical symptoms

Request losts of tests

Lots of time spent on Web MD

Question 18

What are the differences between factitious disorder and somatic symptom disorder

Answer 18

Somatic-unconscious generation of symptoms

Factitious- conscious generation of symptoms

Question 19

What re the extreme behaviours that factitious disorders often illicit?

Answer 19

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

Question 20

Why do people with factitious disorder engage in these extreme behaviours

Answer 20

Its unclear but some speculate that it arises from a need to gain attention

Miss Scott- care, sympathy, wanted someone to care act her

Question 21

Prevalence of SSds

Answer 21

It is difficult to estimate the prevalence because the diagnostic manual changed and they merged categories that have a enormous difference in prevalence

Question 22

What is the estimated prevalence of Somatic Symptom Disorder?

Answer 22

Higher than Somatization Disorder- 1%. And lower than Undifferentiated Somatoform Disorder- 19%

Question 23

What is the estimated prevalence of Illness Anxiety disorder?

Answer 23

1.3- 10%

Question 24

What is the estimated prevalence of conversion disorder/ functional neurological symptom disorder?

Answer 24

2-5/100k
0.00002/0.00005

Question 25

What is the estimated prevalence of factitious disorder

Answer 25

1 percent in hospital settings

Question 26

What is the Aetiology/ Causes of SSD’s

Answer 26

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

Question 27

What are the 2 other models in determining the aetiology of Ssd’s?

Answer 27

Neurobiological model
Cognitive behaviour model

Question 28

Describe the neurobiological model

Answer 28

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

Question 29

Describe the cognitive behavioural model

Answer 29

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

Question 30

Why may some people be more anxious about their health?

Answer 30

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.

Question 31

What about the aetiology of FND

Answer 31

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

Question 32

What are the problems surrounding treatement for SSDs

Answer 32

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

Question 33

What are is the treatement

Answer 33

Cognitive Behavioural Therapy

Question 34

Treatment in relation to thoughts

Answer 34

Change beliefs (e.g. catastrophising minor maladies)

Paying less attention to bodily sensations

Teach coping mechanisms

Question 35

Treatment in relation to feelings

Answer 35

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?)

Question 36

Treatment in relation to behaviour

Answer 36

Stop taking tests

Stop googling

Find strategies to get reinforcement elsewhere

Get family to stop reinforcing behaviour