Somatic Symptoms and Related Disorders Flashcards
Types of DSM-V (2013) Somatoform Disorders 4
- Somatic symptom disorder
- Conversion disorder
- Illness anxiety disorder
- Other specified somatic symptom and related disorder.
DSM IV (1994)
- Somatization disorder
- Hypochondriasis
- Conversion Disorder
- Pain Disorder
- Body Dysmorphic Disorder
- Undifferentiated Somatoform Disorder
- Somatoform Disorder NOS
Somatic Symptom Disorder is defined as?
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
- Persistently high level of anxiety about health or symptoms.
- Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
- Specify if: With predominant pain (previously pain disorder)
- Specify if: Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
- Specify current severity: mild, moderate, or severe.
SOMATIC SYMTPOM DISORDER Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 3
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
- Persistently high level of anxiety about health or symptoms.
- Excessive time and energy devoted to these symptoms or health concerns.
SOMATIC SYMTPOM DISORDER Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). What things do you have to specify?
- Specify if: With predominant pain (previously pain disorder)
- Specify if: Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
- Specify current severity: mild, moderate, or severe.
Somatoform symptoms 4
- Symptoms suggest a physical disorder
- Symptoms cannot adequately be explained physiologically
- Symptoms are often (but not always) described in dramatic ways 4. Other disorders, such as anxiety disorders, mood disorders, and personality disorders, often co-exist
Characteristics of the somatoform patient? 4
- Not improving
- Pain everywhere
- Your most difficult pt
- Come in every day
Characteristics of Somatization Disorder? 4
Treatment? 3
Causes? 3
Physical symtpoms of somatoform disorder
- Age of onset?
- HOw will lit present in Kids?
- Course?
- Culture: cultural influences appear to affect what?
- Symptoms vary across cultures. examples?
- Lower levels of somatization d/o with what?
- older…natural aging
- tummy aches (do we teach them?)
- Chronic, rarely cured
- Culture: cultural influences appear to affect the gender ratios and body locations of somatoform d/o (Greek and Puerto Rican cultures report higher rates among men than is the case for the US)
- Symptoms vary across cultures (e.g. burning hands and feet, “worms in the head”, “ants under the skin” much more common in Africa and South Asia)
- Lower levels of somatization d/o with higher education levels
Pathopysiology of somatoform disorder?
Need to be sick!
Becoming physically sick is less stressfull than being unsuccessfull
“There is no medicine or
surgery to remove the
need to be sick”
Somatization Disorder: Causes? 3
Causes
- Family history of illness
- Relation with antisocial personality disorder
- Weak behavioral inhibition system
Somatic Symptom Disorder: Treatment? 4
- No treatment proves superior effectiveness
- However, we need to reduce visits to numerous medical specialists
- Assign one main Primary Care Provider
- Reduce supportive consequences of talk about symptoms
Things to focus on and manage with patients that have somatoform?
4
- Allow patient role
- Concentrate on functions
- Frequent, short visits
- Single provider
- Conversion Disorder is what?
- Onset, reappearance, termination of disease?
- Mostly found in who? 2
- Physical symptoms suggesting neurological problems
- Sensory impairment: Any modality
- Paresthesias, blindness, paralysis - Sudden onset, sudden termination, sudden reappearance
- Mostly women; men in combat
Often misdiagnosed
La belle indifference: 1/3 of cases
Facts about Conversion Disorder
- Age of onset?
- Course?
- Culture: Found in who commonly? 3
- Age of Onset: Late childhood- early adulthood rarely before 10 or after 35
- Course: Onset acute or sudden, symptoms remit after about 2 weeks, but recur approximately 25% of the time
- Culture:
- More common in rural areas,
- lower SES, and
- lower educational levels
Conversion Disorder…criteria
6
A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a Neurological or other General Medical Condition
B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors
C. The symptom or deficit is not intentionally feigned (as in Factitious Disorder or Malingering)
D. The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience
E. The symptom or deficit causes clinically significant distress or impairment in functioning
F. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of Somatization Disorder, and is not better accounted for by another mental disorder