Somatic symptoms and impulse control disorders Flashcards
definition: somatization
experiencing and communicating of emotional distress as physical illness
what are the reasons for somatization?
- emotional disturbances have physical effects upon the body (and vice versa)
- a physical symptom may be perceived as a necessary ticket of admission to receiving care from the clinician
- physical distress carries less shame and connotation of weakness than emotional distress
- dysfunctions in neuroendocrine system have been linked to functional disorders, including chronic fatigue syndrome and some kinds of chronic pain
- psychiatric illness
what are the attributes of patients with unexplained symptoms?
- vague / atypical symptoms
- multiple organ systems
- impairment in functioning may seem disproportionately high compared to observable pathology
- higher awareness of bodily sensations (and higher reactivity)
- denial that symptoms might relate to psychological factors
- sensitivity to side effects, unresponsive to therapeutic effects
what is required to care for patients with somatization?
more patience and caring
what are the criteria for somatic symptom disorder?
- one or more somatic symptoms that are distressing or result in significant disruption of daily life
- excessive thoughts, feeling, behaviors related to the symptoms:
- disporportionate and persistent thoughts about symptoms’ seriousness
- persistently high level of anxiety about health or symptoms
- excessive time and energy devoted to symptoms
need a distressing symptom you are worrying about
what is the difference between somatic symptom disorder and illness anxiety disorder?
- SSD: need a distressing symptom you are worrying about
- IAD: no symptoms
what are the criteria for illness anxiety disorder?
- preoccupation with health to the exclusion of everything else
- somatic symptoms are either not present or are mild
- high level of anxiety about health
- individual performs excessive health related behaviors or else exhibits maladaptive avoidance
- illness preoccupation must be present at least 6 months
how long must illness preoccupation be present to diagnose illness anxiety disorder?
6 months
are patients with illness anxiety disorder responsive to reassurance?
no
what are the criteria for conversion disorder?
- one or more symptoms of altered voluntary motor or sensory function
- clinical findings show incompatibility between the symptom and recognized neurological or medical conditions
- symptom causes clinically significant distress or impairment
can conversion disorder coexist with medically explained neuro disorders (e.g. seizures)?
yes
what should you tell a patient with conversion?
state that s/he has benign neuro dysfunction that is made worse by stress
features of factitious disorder
- intentional production of symptoms
- presents self to others as ill or injured
- goal is to assume sick role rather than obtain external rewards
MAKING SYMPTOMS ON PURPOSE
features of malingering
- not a psychiatric disorder
- lying (reporting symptoms that are not occurring)
- goal is to obtain some other desired benefit or outcome, not the sick role itself (disability, worker’s comp, release from jail / military)
what should you do for patients with unexplained symptoms?
- develop a trusting, empathic relationship
- stick with ONE primary care provider
- schedule regular visits so patient’s have access to you without needing to invent a symptom
- be honest when unsure about etiology
- diagnostic and treatment efforts should be guided by signs rather than symptoms
