Somatic Symptom Illnesses Flashcards
Somatization
- transference of mental experiences and states into bodily experiences
- somatization is universal - everyone has experienced medical symptoms where no cause was found
- for some people, somatization becomes persistent and leads to significant distress
Defense-Psychosocial Theories
- internalization: keeping stress, anxiety inside rather than expressing it
- somatization: expression of internalized feelings and stress as physical symptoms
*unconscious defense mechanisms
Biologic Theories
too little inhibition of sensory input amplifies awareness of physical symptoms and exaggerates response to bodily sensation
Somatic Symptom Illnesses
- somatic symptom disorder
- conversion disorder
- illness anxiety disorder
- persistent somatic symptom disorder w/ predominant pain (Pain disorder)
Somatic Symptom Illnesses: Key Features
- physical complaints suggest medical illness but have no demonstrable organic basis
- psychological factors and conflicts appear to be important in initiating exacerbating and maintaining symptoms
- symptoms or health concerns are NOT under conscious control
- symptoms are real to the patient
- pt believes that it is real- symptoms cause distress even if there is no organic disease
- more common in women
- association w/ anxiety depression
- physical processes must be ruled out first in the assessment process
Somatic Symptom Disorder
- somatization: so many physical complaints
- no organic basis to complaints
- symptoms are inorganic (physical, lab, diagnostic test results show no evidence of pathology)
- diagnosis of exclusion
Somatic Symptom Disorder: DSM Criteria
Specifiers: With predominant pain, persistent
One or more somatic symptoms that result in disruption in daily life:
- Disproportionate, persistent thoughts about the seriousness of one’s symptoms
- High level of anxiety about health or symptoms
- Excessive time and energy devoted to health and these symptoms
Persistent Somatic Symptom Disorder with Predominant Pain
- previously characterized as “pain disorder”
- somatic symptoms predominantly involve pain that results in disruption of ADL’s
- no medical basis for the pain
- persistent = symptoms > 6 months
- tx: pain clinic referral
Somatic Symptom Disorder: Tx
- symptom management, improvement in quality of life
- antidepressants for accompanying depression: SSRIs
- referral to chronic pain clinic
- pt/family education
- empathy
Somatic Symptom Disorder: Client/Family Education
- Focus on health as a whole
- Developing normal routine
- Getting adequate rest and nutrition
- Teach relaxation techniques
Illness Anxiety Disorder
- previously referred to hypochondriasis
- physical symptoms cause excessive worry and are interpreted as severe or life threatening
- concern persists despite negative exam findings
Somatic Symptom vs. Illness Anxiety
- somatic symptom concern about symptoms
- illness anxiety concern about disease
Conversion Disorder
aka functional neurological symptom disorder or conversion reaction
- symptoms involving sensory or motor functions (pseudoneurological)
- motor: paralysis, difficulty swallowing, seizures, speech problems
- sensory: blindness, deafness, hallucinations
- pt’s convert psychiatric symptoms to a neurological problem and then spontaneously convert back to baseline
- onset preceded by psychological stressor, pt may not connect the two
- La belle indifference: calm, lack of concern describing symptoms
Conversion Disorder: Psychogenic Non-Epileptic Seizures
- are not induced by abnormal electrical activity in the brain
- a physical manifestations of psychological distress
- person is unaware of the emotional stress and the mind body link
- sometimes referred to as emotional freeze reaction
- person needs assistance connecting the behavior to the feelings that are there
Factitious Disorder
aka Munchausen Syndrome (old term)
- done w/ intent to deceive
- to achieve attention, to fulfill a sick role (primary gain)
- by proxy- factitious by proxy (leads to someone else suffering)
- association w/ people familiar w/ the medical system
- when done to self: tx=psychotherapy
- symptoms are intentional
