Somatoform Disorders

Question 1

What is pain disorder?

Answer 1

• This term was in DSM-IV-TR as a somatoform disorder but is no longer used in the DSM-5 (pain disorder now constrained within somatic symptom disorder
• psychological factors play a significant role in the onset and maintenance of pain

Question 2

What is body dysmorphic disorder?

Answer 2

• In the DSM-5 under OCD condition

- preoccupation with imagined or exaggerated defects in physical appearance

Question 3

What is hypochondriasis?

Answer 3

• This term was in DSM-IV-TR as a somatoform disorder term no longer in DSM-5. It is now called somatic symptom disorder, hypochondriasis was pejorative
• Preoccupation with fears of having a serious illness

Question 4

What is conversion disorder?

Answer 4

• Now also called functional neurological symptom disorder
• Sensory or motor symptoms without any physiological cause , suggesting a neurological disorder (although the
  body organs and nervous system are found to be fine).

Question 5

What is somatization?

Answer 5

• This term was in DSM-IV-TR as a somatoform disorder but is no longer used in the DSM-5
• Recurrent, multiple physical complaints that have no biological basis

Question 6

What is the diagnostic criteria of somatic symptom disorder?

Answer 6

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life
B. excessive thoughts, feelings, behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. disproportionate and persistent thoughts about the seriousness of one’s symptoms
2. persistently high level of anxiety about health/symptoms
3. 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 present (typically more than 6 months)

Question 7

What are the specifiers for somatic symptom disorder?

Answer 7

Specify if:
- with predominant pain (previously pain disorder): this specifier is for individuals whose somatic symptoms predominantly involve pain
Specify if:
- Persistent: a persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months)
Specify current severity:
-Mild: only one of the symptoms specified in Criterion B is fulfilled
- Moderate: two or more of the symptoms specified in criterion B are fulfilled
- Sever: two or more of the symptoms specified in criterion B are fulfilled, plus there are multiple somatic complaints (or one very sever somatic symptom)

Question 8

What is the diagnostic criteria of Illness anxiety disorder?

Answer 8

A. preoccupation with having or acquiring a serious illness
B. somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history), the preoccupation is clearly excessive or disproportionate
C. there is a high level of anxiety about health, and the individual is easily alarmed about personal health status
D. the individual performs excessive health related behaviours (e.g., repeatedly checks his/her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments)
E. illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time
F. The illness related preoccupation is not better explained by another mental disorder

Question 9

What are the specifiers for Illness anxiety Disorder?

Answer 9

Specify whether:

• care-seeking type: medical care, including physician visits or undergoing tests and procedures, is frequently used
• Care avoidant type: Medical care is rarely used

Question 10

What are the four contributing factors in the cognitive model of health anxiety?

Answer 10

1. Critical precipitating incident
2. Previous experience of illness and related medical factors
3. Presence of inflexible or negative cognitive assumptions
4. Severity of anxiety

Question 11

What are examples of conversion disorder?

Answer 11

• Paralysis of arms or legs
• Seizures and coordination disturbances
• Sensation of prickling, tingling, or creeping on the skin
• Insensitivity to pain

Question 12

What is Anaesthesias?

Answer 12

• Loss or impairment of sensations
• Sudden loss or partial loss of vision (blindness or tunnel vision)
• Aphonia (loss of the voice and all but whispered speech)
• Anosmia (loss or impairment of the sense of smell)

Question 13

When does conversion disorder tend to appear?

Answer 13

• Tends to appear suddenly in stressful situations

Question 14

What is the diagnostic criteria for conversion disorder?

Answer 14

A. One or more symptoms of altered voluntary motor or sensory function
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
C. The symptom or deficit is not better explained by another medical or mental disorder
D. Causes significant clinical distress

Question 15

What are the specified symptom types for conversion disorder?

Answer 15

• with weakness or paralysis
• with abnormal movement
• with swallowing symptoms
• with speech symptoms
• with attacks or seizures
• with anesthesia or seizures
• with special sensory symptom
• with mixed symptoms

Question 16

What are the specifiers for conversion disorder?

Answer 16

Specify if:
- acute episode: symptoms present for less than 6 months
- persistent: symptoms occurring for 6 months or more
Specify if:
- with psychological stressor
- without psychological stressor

Question 17

What is the etiology of conversion disorder from a psychoanalytic perspective?

Answer 17

• Specific symptoms related to traumatic events
• Freud: Unresolved Electra Complex
• • Anna O- Freud’s patient. Electra complex, Was unconsciously competing with her mother for her fathers attention. One day, she saw a snake in a hallucination who tried to attack her father but she could not help her father because her arm was stuck /asleep behind her head she could not move it and then her fingers became snakes and skulls. Then after the hallucination ended she was outside and saw a stick and made her remember the snake and as a result she couldn’t move her arm. Memories are repressed and then get displaced into psychosomatic symptoms.

Question 18

What is the etiology of conversion disorder from a behavioural and cognitive perspective?

Answer 18

• Similar to malingering in that the person adopts the symptom for some additional benefit (secondary gain)
• Role of cognitive factors examined in research on children and adolescents who were evaluated with a test battery of neurocognitive functioning
• Research showed that conversion symptoms were linked with deficits in attention, executive functioning, and working memory
• • the issue with this research is that we don’t know if these deficits occurred before, during or after bc the research base is thin.

Question 19

What is the etiology of conversion disorder from a social/cultural perspective?

Answer 19

• Decrease incidence of conversion disorder in the last century
• Increase among people with lower socio-economic status and from rural areas

Question 20

What is the difference between somatic symptom disorder and illness anxiety disorder?

Answer 20

• Somatic symptom disorder: person presents with a physical symptom (the symptom is physically present or noticeable.) They are overly preoccupied with it and spend a lot of time thinking about it.
• • Can be diagnosed with and without pain (pain disorder used to be a separate diagnosis in DSM 4 but now it is subsumed within SSD)
• • Makes them think they have something really serious, time consuming
• Illness anxiety disorder on the other hand (new to DSM 5, did not exist before), a person who has this does not have any symptoms (don’t present with symptoms). Instead, they believe they might catch or develop something serious. Overlaps with the idea of specific phobia (i.e., being scared to develop something.)
• • NO SYMPTOMS (if they do have them, they are very minimal). If they are preoccupied with pain or illness symptoms that is SSD.

Question 21

What is malingering?

Answer 21

When people fake the symptoms of conversion disorder for some sort of social, or economic benefit/gain