Somatoform and Dissociative Disorders

Question 1

Somatic Symptom and Related
Disorders

Answer 1

• Illness Anxiety Disorder
• Somatic Symptom Disorder
• Conversion disorder (Functional Neurological
  Symptom Disorder)
• Psychological factors affecting other medical
  conditions
• Factitious disorder
• Other specified and Unspecified somatic symptom
  disorders (and related disorder)

Question 2

Illness Anxiety Disorder
(Hypochondriasis)

Answer 2

● Preoccupation with the contracting, or
having, a serious disease
● No or minimal somatic Sx.
● ***Preoccupation persists despite appropriate medical
evaluation and reassurance (or avoids doctors or hospitals)
● Causes significant distress
● Duration is at least 6 months

Question 3

Illness Anxiety Disorder (Hypochondriasis) etiology

Answer 3

● Unknown- Serotonin and hyperactivity in frontal lobe areas, possible biological markers have been found…
● Beliefs/Conditioning - believe an uncomfortable
sensation is something bad
● Familial pattern for somatization
● Childhood sexual abuse or recent sexual or physical violence
● Some patients amplify symptoms

Question 4

Course and Prognosis of Illness Anxiety Disorder

Answer 4

● Episodes last from months to years
● Episodes are often separated by equally long
dormant periods

Question 5

Illness Anxiety Disorder treatment

Answer 5

Patients usually resistant to psychiatric treatment (Therapy or Medications)
● Psychotherapy can be helpful
● Pharmacotherapy is useful if there is an underlying drug-responsive comorbidity (ie depression, anxiety, etc)

Question 6

DSM V Criteria of Somatic Symptom Disorder

Answer 6

● 1 or more somatic symptoms that are distressing or result
in significant disruption of daily life
● Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following
● Though the specific somatic symptom
may change, the disorder is persistent
(usually more that 6 months)

Question 7

at least 50% of patients with
somatization disorder have ____

Answer 7

a coexisting mental disorder

Question 8

*If the onset of multiple somatic symptoms is in the older patient, it should be presumed to be ____

Answer 8

a nonpsychiatric medical condition, like delirium

Question 9

Although there may be episodes of increased symptom severity, there generally are no quiescent periods with

Answer 9

Somatic Symptom Disorder

Question 10

Somatic Symptom Disorder Tx

Answer 10

● Regularly scheduled visits with primary physician (monthly is recommended)
● Brief Visits with partial physical examination for new complaints
● Try to avoid additional laboratory and diagnostic procedures
● Strategy: increase patient’s awareness of the possibility that psychological factors are involved in the symptoms until patient is willing to see mental health clinician
● Pharmacotherapy indicated with coexisting mental disorder

Question 11

Somatic Symptom Disorder - With Predominant Pain (Previously “Pain Disorder”) is characterized by the following

Answer 11

● Pain in one or more anatomical sites is the predominant focus of the clinical presentation and of sufficient severity to warrant clinical attention
● Psychological factors judged to have an important role in onset, severity, exacerbation, or maintenance of the pain
● Not intentionally produced or feigned, and no secondary gain is intended (ie drug seeking)
● The pain is not better accounted for by mood, anxiety, or psychotic disorder, and does not meet criteria for dyspareunia (if the event presentation is pelvic pain)

Question 12

Treatment of Somatic Symptom Disorder
- With Predominant Pain

Answer 12

● Pharmacotherapy
○ Analgesic medications are NOT generally helpful for most patients with pain disorder (can lead to abuse and dependence)
○ Antidepressant medications ARE useful (SSRIs, SNRIs, TCAs)
● Psychotherapy: Psychodynamic therapy can be helpful
● Other potential therapies: `Biofeedback, hypnosis, Trans Electrical Nerve
Stimulation (TENS), pain control programs

Question 13

Functional Neurological Disorder
“Conversion Disorder” criteria

Answer 13

○ One or more symptoms of altered voluntary motor or sensory function
○ Clinical findings provide evidence of incompatibility
between the symptom and recognized
neurological or medical conditions

Question 14

Functional Neurological Disorder
“Conversion Disorder” is characterized by:

Answer 14

○ Sensory or motor complaints suggestive of
neurological illness or other medical condition
○ Initiation or exacerbation of the symptom or deficit is preceded by conflicts or other
stressors
○ Symptom is not intentionally produced or
feigned

Question 15

Paralysis, blindness, and mutism are common
_____ disorder symptoms

Answer 15

conversion

Question 16

Functional Neurological Disorder
“Conversion Disorder” Treatment

Answer 16

● Resolution can be facilitated by education and psychotherapy techniques (#1 Treatment: explain the disease!)

Question 17

When you think conversion disorder, think ____

Answer 17

neurologic presentation

Question 18

Body Dysmorphic Disorder

Answer 18

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
● At some point, patients perform repetitive behaviors (mirror checking, grooming, picking, reassurance seeking) or mental acts (comparing his/her appearance
to others) in response to appearance concerns
● Causes clinically significant distress or impairment
● Not better explained by concerns with body fat/weight & don’t meet eating DO criteria

Question 19

SSRIs such as Fluoxetine (Prozac) are effective in reducing symptoms in at least 50% of patients with

Answer 19

Body Dysmorphic Disorder

Question 20

Procedures (surgical, dermatological, dental, etc.) are almost invariably ____ in Body dysmorphic disorder

Answer 20

unsuccessful

Question 21

T/F Patients with somatic symptom disorders are REALLY experiencing symptoms

Answer 21

T

Question 22

Is Somatization Disorder more common in men or women?

Answer 22

Much more likely to be in
women