Somatization Flashcards
What is somatization?
Physical complaints or impairments that are either without organic pathology or are grossly in excess of what would be expected from physical findings
-NOT a specific disease, but rather a process within a spectrum of expression
What is characteristic of somatizing patients?
- They are unable to use emotional language to describe their distress
- Express their psychological illness or social distress with somatic symptoms
T/F Somatization is an entirely conscious
FALSE
-Unconscious process
Psychosomatic complaints frequently involve:
- Chronic pain
- Problems with the digestive system, nervous system, and reproductive system
Typical onset for somatization. Does it effect men or women more?
Typical onset = before age 30
-Higher prevalence for women than men
4 mechanisms for somatization
1) Neurobiological
2) Psychodynamic
3) Behavioral
4) Sociocultural
What is the neurobiological mechanism for somatization? What type of advanced imaging would be best for studying this?
Somatization results from defective or deficient neurobiological processing of sensory and emotional information
-fMRI
What is the psychodynamic mechanism for somatization?
Somatizied physiological sensations occur as expression of underlying emotional conflict.
-Somatization enables patients to meet latent needs for nurturing and support
What is the behavioral mechanism of somatization?
Somatization is viewed as behavior that is brought about and reinforced by others in the patient’s environment
-“illness maintained systems” = positive feedback loop/cycle
What is the sociocultural mechanism of somatization?
Social norms concerning emotions
- When a culture does not allow direct communications of emotional content, one means available to express emotions is through physical symptoms
- “big boys don’t cry; man up; grow some balls”
- Somatization serves to notify others of emotional or psychological distress in an acceptable or non-stigmatized manner
Contributing factors for somatization
- Childhood abuse
- Acute stress
- Societal roles
- Learned behavior (Unconscious)
- Secondary gain
- Cultural factors
- Histrionic, narcissistic, and borderline personality traits
T/F Although there are contributing factors for somatization, anyone can somatize
True
T/F PCP encounter perplexing somatic complaints in up to 40% of their patients.
True
Many patients with somatic complains are suffering from ______ and _______, which are common problems seen in the primary setting
Depression and Anxiety
a. k.a. Masked Depression and Anxiety
- may also yield as a eating disorder, addiction, and personality disorders
If a person is described as histrionic, narcissistic, and has borderline personality traits, what do we infer?
They are at risk for somatization
- Histrionic = drama queens
- Narcissistic = all about them (world revolves around them)
- Personality traits = likes to “buck” the system, unstable, uncontrollable (NOT just a non-conformist)
Many patients experiencing depression or anxiety visit their physicians with predominatly physical complaints like:
-Fatigue
-Dizziness
-Headache
-Abdominal Pain
-Extremity Pain
(these are accompanied by requests for “check-ups”)
How do most somatizers present as?
Most are unaware of the psychological disorders (or emotional conflicts) that underlie their symptoms
Even when/if they perceive anxious or depressed feelings, they rarely understand or acknowledge a connection between their feelings and their physical symptoms.
How can physicians detect somatization and be comfortable with the diagnosis?
- Avoid making the patient feel like you’re implying that “it’s all in your head and you need to get over it”
- Patient in deep depression with back pain: the back pain they are experiencing is REAL, and NOT a imaginary manifestation!!!!
What is somatization often misdiagnosed as?
Fibromyalgia
Chronic Fatigue Syndrome
What are some clinical clues to somatization?
- Thick chart syndrome (can’t figure out the cause)
- Increased frequency of visits
- Vague, confusing, or bizarre symptoms
- Resistance to psychological inquiry or explanations
- Specific complaints such as dizziness, fatigue, or insomnia
- Physician’s “heart sink” response
What is a physician’s “heart sink” response?
A patient that the doctor is not looking forward to seeing
-“oh great…., Mrs. Smith is coming in again (sigh)”
What is a DDx for somatization types?
- Acute
- Chronic (somatoform and malingering/factitious disorder)
Results from transient stress that temporarily overwhelms usual coping mechanisms. Usually no history of health care-seeking behavior, and fairly readily accept stress as a cause of their symptoms
Acute Somatization
-Acute = 2 weeks or less
Occurs in the context of a specific psychiatric disorder such as depression, anxiety, personality disorders. Long lasting process. Made up of subcategories.
Chronic Somatization
1) Somatoform Disorders
2) Malingering and Factitious disorder
T/F Chronic Somatization is the most common type of somatization
FALSE.
Acute is the MC type
7 categories of Somatoform disorders (type of Chronic Somatization)
1) Somatization Disorder
2) Undifferentiated Somatoform Disorder
3) Conversion Disorder
4) Pain Disorder
5) Hypochondriasis
6) Body Dysmorphic Disorder
7) Somatoform Disorder Not Otherwise Specified
Key: “symptoms cause physical stress UNCONSCIOUSLY”
Characterized by physical or psychological symptoms that are intentionally produced or feigned in order to assume the sick role. Conscious fabrication of symptoms to gain attention. Allows themselves to have other take care of them instead of them taking care of others
Factitious Disorders
T/F Factitious Disorders and very common and considered a normal variant of psychology
FALSE
-They are very rare and very bizarre
What is the “goal” of factitious patients?
Garner sympathy and gain attention (psychological gains)
-Financially devastating for families of patients (helps DDx malingering)
T/F The presence of factitious symptoms does preclude the coexistence of true physical or psychological symptoms.
FALSE
-it does NOT preclude the coexistence of true physical or psychological symptoms.
Intentionally feigning or grossly exaggerating illness or disability to derive benefit or secondary gain (escape work, gain compensation, or obtain drugs)
Malingering
-NOT financially devastating (helps DDx factitious disorders)
