Somatisation and eating disorders Flashcards
What is health anxiety
Excessive health-related concerns (e.g. ruminations on having an illness, suggestibility if one reads or hears about a disease, unrealistic fear of infection)
Somatic perceptions (eg preoccupation with bodily sensations or functioning)
Behaviours (eg repeated reassurance seeking, avoidance of medications or medical personnel)
What is somatisation disorder
process by which “psychological distress is expressed through physical symptoms and subsequent medical help-seeking”
There must be a history of at least 2 years complaints of multiple and variable physical symptoms that cannot be explained by any detectable physical disorder
Preoccupation with symptoms causes persistent distress
persistent refusal to accept medical reassurance
There must be a number of symptoms from at least 2 of the following systems:
GI Symptoms: Abdominal pain, nausea, feeling bloated, bad taste in mouth, complaints of vomiting, complaints of frequent loose bowel motions
Cardiovascular: breathlessness without exertion, chest pains
GU symptoms: dysuria, unpleasant sensation around the genitals, complaints of unusual or copious vaginal discharge
Skin and pain complaints: blotchiness, discoloration, pain in limbs, unpleasant numbness or tingling sensation
What is hypochondriasis
persistent belief, of at least 6 months, of the presence of a maximum of two serious physical diseases (of which at least one must be specifically named by the patient)
persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder)
Preoccupation with the belief and the symptoms causes persistent distress or interference with personal functioning in daily living, and leads the patient to seek medical treatment or investigation
Persistent refusal to accept medical reassurance that there is no physical cause for the symptoms or physical abnormality
What is factitious disorder?
Munchausen’s
Patient feigns or exaggerates symptoms for no obvious reason
Patient may even inflict self-harm in order to produce symptoms or signs
Internal motivation with aim of adopting the sick role
Munchausen syndrome by proxy - the patient imposes symptoms to other individuals (e.g. a child)
What is malingering
Conscious manufacturing or exaggerating of symptoms for a secondary gain e.g. benefits, housing, other than assuming the sick role
Epidemiology of somatisation
The female-to-male ratio has been estimated to be 10:1 for somatization disorder, from 2:1 to 5:1 for conversion disorder and from 2:1 for pain disorder.
Other epidemiology is hard to estimate
Normal illness behaviors
Adopt sick role
Expected to seek help
Expected to co-operate with treatment
Expected to wanting to get better
Abnormal illness behaviors
Taking too many tablets and using too many aids
Illness behavior continuing beyond appropriate timescale
Not wanting to get better
Denial of the problem
Not wanting to get medical advice
Going too doctors too often
3 types of health anxiety
Cognitive type (awareness and fear of disease) Somatising type (high symptom awareness and bodily occupation) Behavioral type (high disease conviction and avoidance)
Aetiology of health anxiety
Predisposing factors FH of OCD Family members with health anxiety Somatisation disorder among relatives Early life trauma (sexual trauma, violence)
Precipitating factors
Significant illness of a loved one
Personal experience of previous illness - misinterpret body signs
Perpetuating factors
Increase sensitivity in certain brain area (prefrontal cortex, anterior cingulate)
Somatosensory amplification (paying too much detail on minor body sensations)
Differentials for medically unexplained symptoms, and somatisation
Depression and anxiety disorders may present with somatic complaints
Personality disorders may complicate evaluation
Initial presentation of some organic syndromes:
MS, SLE, porphyrias
Dissociative disorders (the presence unconsciously produced symptoms that affect voluntary sensory or motor functions, suggesting a medical or neurological disorder)
psychosis or schizophrenia can also present with hypochondriacal delusion (very rarely)
What is dissociative disorder
Classically a traumatic event leads to a disruption of the usually integrated functions of consciousness, memory, identity or perception.
Patient may deny the impact of the traumatic event.
Presentation is variable:
amnesia
fugue (sudden, unexpected journey that may last a few months, together with memory loss, confusion about personal identity)
stupor
trance or possession disorders
motor disorders (like the case of Anna O. - paralysis of limbs)
anaesthesia/sensory loss
convulsions (“pseudo-seizures” or “psychogenic non-epileptic seizure”)
What is the role of investigations in medically unexplained symptoms
Limited.
Minimise unneccessary tests and treatments, because over-investigation/medication will reinforce anxiety.
But definitely perform the reasonable investigations
Bio-psychosocial approach to managing medically unexplained symptoms
Evidence for long-term efficacy is weak
SNRIs. SSRIs may be useful
In hypochondriacal delusion - antipsychotic
Avoid routine benzodiazepines
CBT (modify dysfunctional thoughts in response to symptoms and decrease problematic behaviors such as reassurance seeking and avoidance)
Psychoeducation
Encourage normal function (do not activities normal function)
Involve social network to improve emotional support
Prognosis of somatisation and hypochondriasis
Most respond well to medication, psychotherapy or both.
Anxiety and depression usually effectively treated with medication
May affect functioning if + chronic distress:
Mental health problems
Severe symptoms
