Somatoform Disorders-Sweeny Flashcards
What are the common features of Somatoform disorder?
- physical symptoms suggesting medical etiology
- symptoms are not fully explained by a general medical condition, or by direct effects of substance, or by another mental disorder (i.e. Panic D/O)
- symptoms must cause clinically significant distress or impairment in social, occupational, or other areas of functioning.
- commonly seen in medical settings
What are the different types of somatoform disorders?
- Somatization disorder
- Undifferentiated Somatoform Disorder
- Conversion disorder
- Pain disorder
- Hypochondriasis
- Body Dysmorphic Disorder
- Somatoform D/O, NOS
What is the criteria for Somatization Disorder?
4:2:1:1
Clinical Description:
A. Extended history of physical complaints before age 30
B. ***Must have 4 pain sx’s, 2 gastrointestinal symptoms, 1 sexual symptom, 1 pseudo neurological symptom
Substantial impairment (social or occupational)
C. Sx’s Cannot be explained by GMC
D. Symptoms NOT INTENTIONALLY produced or feigned (as in Factitious Disorder)
-mostly affects unmarried, low socioeconomic status females
Which comorbidities commonly occur with Somatization Disorder?
Major Depressive D/O, Panic D/O, and Substance-Related D/O
Frequently assoc with PD’s: Histrionic, Borderline, and Antisocial.
What is the treatment for Somatization Disorder?
psychotherapy to increase the pts awareness that sx’s might be psychological
-assign a “gatekeeper” physician and establish regular visits –> DO NOT REFER OUT
What is the criteria for Undifferentiated Somatoform Disorder?
A. One or more physical complaints (e.g. fatigue, loss of appetite, gastrointestinal or urinary complaints (NO 4:2:1:1)
B. Symptoms cannot be fully explained by known general medical condition OR in the presence of a GMC the symptoms are in excess of what would be expected from H&P/labs
C. Distress (occupational/social)
D. Duration: at least 6 months
E. Not better accounted for by another mental disorder
F. Symptom not intentionally produced or feigned
What is the criteria for Conversion Disorder?
STRESSOR
Clinical description:
-One or more sx’s or deficits affecting voluntary motor or sensory function (i.e. mutism, blindness, paralysis, amnesia, lump in throat, urinary retention, )
*Follow a stressor (often remit quickly)
-Lack physical or organic pathology
-Persons show “la belle indifference” vs. distress over sx’s
-Retain most normal functions, but lack awareness
-rare
-35 yo
-more common in rural areas and low socioeconomic status
-females>males
What comorbidities are common with conversion disorder?
personality disorders: dependent, histrionic, passive-aggressive, antisocial
What is thought to be the cause of Conversion Disorder?
Detachment from the past trauma and negative reinforcement
What is the treatment for Conversion Disorder?
- Similar to somatization disorder
- Core strategy is attending to the trauma
- Remove sources of secondary gain
- Reduce supportive consequences of talk about physical symptoms
What is the DSM IV criteria for Pain Disorder?
-Pain in one or more sites in the body associated with significant distress or impairment.
Course of sx’s:
- initially may have been a clear physical reason
- psychological factors play a major role in maintaining it
-3 sub-types: from pain judged to primarily result from psychological factors to pain judged to be due to a general medical condition (axis III not axis I)
What is the best treatment approach for Pain Disorder?
If medical treatments for existing physical conditions are in place and pain remains
OR
If the pain seems clearly related to psychological factors, psychological interventions are appropriate.
***Multi-disciplinary approach
What is Hypochondriasis?
- Physical complaints without a clear cause for a minimum of 6 months duration
- Severe anxiety about the possibility of having a serious disease – belief is not delusional
- Patients have a difficult time identifying and acknowledging the symptoms as mental
- Medical reassurance does not seem to help
What is the course of Hypochondriasis?
What are common comorbidities?
- any age of onset, most common in early adulthood.
- runs a CHRONIC course
- males=females
- comorbid: anxiety and depressive disorders
- must consider an underlying medical condition as a differential*
What is the best treatment for hypochondriasis?
- Challenge illness-related misinterpretations (CBT)and SSRI’s
- Provide more substantial and sensitive reassurance
- Stress management and coping strategies (symptoms can worsen with stress)
What is Body Dysmorphic Disorder? Who is affected?
- Preoccupation with IMAGINED defect in appearance
- Most common regions: face or head
- Often display ideas of reference for imagined defect (i.e. hair thinning, wrinkles, scars, vascular markings, paleness, facial asymmetry)
*Suicidal ideation and behavior are common
- males=females
- onset: early 20s
- chronic course
What comorbidities are common with Body Dysmorphic Disorder?
OCD and Depression
suicide risk
What is the treatment for Body Dysmorphic Disorder?
- Treatment parallels that for obsessive compulsive disorder (Cognitive Behavioral Therapy)
- Medications (i.e., SSRIs) that work for OCD provide some relief
- Exposure and response prevention is also helpful
- Plastic surgery-often found to be of no benefit
What are some examples of Somatoform, NOS?
- Pseudocyesis – false belief of being pregnant.
- A disorder involving nonpsychotic hypochondriacal sx’s of less than 6 months duration.
- A disorder involving unexplained physical complaints (e.g. fatigue or body weakness) < 6 mo
What are Factitious Disorders?
- Intentional production or feigning of physical or psychological problems
- Behavior motivation is to assume the sick role
- Often occur in health care work place (M>F)
- Absence of external incentives (i.e. economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering)
- normal–> above average IQ
What is Factitious Disorder by Proxy?
-intentional production or feigning of physical or psychological signs or sx’s in another person who is under the individual’s care
(Munchausen syndrome by proxy – mandated Child Abuse Report)
How does Malingering differ from Factitious Disorder?
In malingering, there is motivation (external incentives) for the faking of illnesses (there is no motivation in Factitious disorder)
*NOT considered an Axis I diagnosis
What is Malingering?
- Intentional production of false or grossly exaggerated physical or psychological symptoms
- motivation=external incentives (ex: avoid work, avoid military duty or criminal prosecution, obtain drugs)
- more common in men
- avoid confrontation–> become aggressive
What is dissociation?
When specific, anxiety-provoking thoughts, emotions, or physical sensations are separated from the rest of the psyche
Occurs in both psychiatrically disordered patients as well as in non-disordered individuals.
