Somatoform Disorders Flashcards
Examples of physical symps that exemplify somatoform disorder
headaches, nausea, paresthesias, menstrual irregularities
General Definition: somatoform disorder
physical symptom not explained by medical condition or substance abuse
UNCONSCIOUS production of symptom, 2 possibilities?
- Depressive or anxiety disorder
2. Somatization Disorder/Somatic Symptom Disorder/Conversion Disorder
CONSCIOUS production of symptom, (2)?
- Facticious disorder (Unconscious motivation)
2. Malingering (Conscious motivation)
Somatoform Disorders as per DSM 4 (DSM 5) listing? (7 as per DSM4, 5 in DSM5)…
- Conversion Disorder
- Body Dysmorphic Disorder
- Factitious Disorder
- Malingering
- Somatic Symptom Disorder (previously Somatization Disorder in DSM4)
- Hypochondriasis (removed in DSM 5)
- Pain Disorder (removed in DSM 5)
General Characteristics of somatoform disorders?
Involve unconscious and social factors that result in both primary and secondary gain.
Primary gain definition?
Internal /psychic motivations
Secondary gain definition?
external motivations like housing, disability, drugs, etc.
Incidence?
Increased in women, starts in early adulthood, worsens with stress,, have anxiety or depression too, impaired socially or on job
Which somatoform disorders look genetic (tend to run in families?)
- Somatization Disorder
- Pain Disorder
- Hypochondriasis
Which somatoform disorders are increased with a fam hx of mood disorders and OCD?
Pain Disorder and Hypochondriasis
Which somatoform disorder is increased with fam hx of alcoholism or antisocial personality disorder?
Somatization Disorder
Neurotransmitter involved in somatoform disorders?
serotonin (hypofunction)
CONVERSION DISORDER: criteria? (7)
- sudden loss of sensation and voluntary motor
- unconscious, no secondary gain, pt aware of symptom loss
- preceded by psychological stress or conflict
- unconcerned about symptoms (la belle indifference)
- usually self limited (lasts less than a month)
- more common in histrionic personality, depression of psychiatrically unsophisticated.(younguns, rural)
- can shorten course with hypnosis, drug assisted interviewing
- sensory: parasthesias, anesthesia, vision, hearing probs
- globus hystericus (pathognomonic), seizures, shifting paralysis
- dermatomes don’t match sensory loss, head moves vertical during seizures, can feel pain, sneeze during seizure, blindness has optokinetic form.
BODY DYSMORPHIC DISORDER: criteria?
- preocupation with imagined or insignificant body defect
- Usually involves face/head (nose too big, breasts/body not symmetrical, etc)
- not caused by eating disorder
- common to use plastic surgery but rarely relieve symptoms
- unconscious, no secondary gain, pt unaware of symptoms, very concerned and worried
FACTITIOUS DISORDER: criteria?
- feign sickness in yourself (or proxy) consciously
- For primary gain-feel safe, cared for. And secondary gain-proud, smart, outsmarted physician
- usually medical people
- get angry and leave when confronted
- interferes with work, school, life
- no sure if true somatic disorder
Symptoms of factitious disorder
grid abdomen (unnecessary surgeries), fever (heat therm, inject feces), hematuria (needlestick), seizures (caffeine, theophylline), skin lesions (chemical irritants easy places), tachycardia (meds), hypoglycemia (insulin inj), DVT (ligature)
FACTITIOUS DISORDER BY PROXY: criteria
1, does it in child for attn on parent
- considered child abuse, must be reported
- parent has hx of child abuse or likes being expert in child’s care
MALINGERING: CRITERIA?
- Not a psych illness. Could be a crime.
- conscious exaggeration of illness for gain (drugs, disability, leave of absence)
- symptoms disappear after secondary gain
- incarcerated and lawsuit involved peeps
SOMATIZATION DISORDER: CRITERIA?
- greater than or equal to 4 pain symptoms
- 2 GI, 1 neuro, 1 sexual
- onset before 30
- Pt is unaware of symptoms, no secondary gain, worried.
- chronic, rarely remit
HYPOCHONDRIASIS: CRITERIA?
- fear of having a really bad medical prob even in face of contradictory info
- can cause dr shopping
- unconscious, unaware of symptoms, worried and concerned, no secondary gain
- must have symptoms for greater than 6 months
- similar mech to GAD, OCD. renamed Illnes anxiety disorder
PAIN DISORDER: CRITERIA?
- PAIN WITHOUT CAUSE
- can be acute (less than 6 months) or chronic (more than 6 months)
- age of onset usually 30s or 40s
- disabling and cause dependence on pain meds
- unconscious, not aware of symptoms, worried or anxious
SSRIs treat?
pain disorder, hychondriasis and body dysmorphic disorder.
treat conversion disorder with what?
sodium amobarbital with drug induced interviewing and hypnosis.
