Week 10 Lecture 10b) Somatic Symptom Disorders (Formerly Somatoform Disorders) - Peter Enticott - (DN) 39:00 Flashcards
What were the DSM-5 Somatic Symptom Disorders formerly known as in the DSM-IV-TR?
DSM-IV-TR Somatoform Disorders
DSM-5 Somatic Symptom Disorders
What has changed from DSM-V-TR to DSM-5?
Moved from 7 to 3 conditions
- Somatic Symptom Disorder
- Illness Anxiety Disorder
- Conversion Disorder (Functional Neurological Symptom Disorder)
Subsumed DSM-IV-TR categories
- Somatisation Disorder (hysteria)
- Undifferentiated Somatoform Disorder
- Conversion Disorder
- Pain Disorder
- Hypochondriasis
- Body Dysmorphic Disorder
- Somatoform Disorder NOS
39:30
Describe some features of Body Dysmorphic Disorder.
Where has this been relocated in the DSM-5
Relocated to OCD and related conditions
- preoccupied with an exagerated or imagined deficit in bodily appearance
e.g., nose, arms,
left side of face (interesting as assoc. with right parietal cortex, where we assemble our bodily representation) - disabling, hours in mirror, avoiding others
- comorbid disorders
Why do plastic surgeries rarely solve the problem in patients with Body Dysmorphic Disorder?
because the problem is in the brain. No matter the reality, the brain will continue to see ……….and will never be satisfied with outcomes e.g., Michael Jackson was thought to have BDD
How does Somatic Symptom Disorder (SSD) differ from DSM-IV’s Somatoform Disorder?
Why did DSM-5 make this change?
DSM-IV Somatoform Disorder - involved bodily symptoms similar to SSD, but focus was on underlying ‘psychological cause’
DSM-5 Somatic Symptom Disorder - excessive concern (preoccupation) about ‘physical symptoms’ or health
because it is literally impossible to distinguish between a symptom that has a medical cause & one that has no identifiable medical cause. Just because we can’t find the medical cause, does not mean it doesn’t exist.
42:20
Pain Disorder (DSM-IV)
- disabling pain, but can’t figure out cause
- onset, continuation & severity thought to be underpinned by psychological factors
- typically following a stressful or traumatic event
- description more vague in terms of location, sensation & triggers
44:05
Somatisation disorder (DSM-IV)
..
Hypochondriasis (DSM-IV)
…
Which three DSM-IV conditions have been subsumed under
‘Somatic Symptom Disorder’ in DSM-5
Somatisation
Pain Disorder
Hypochondriasis (if accompanied by somatic symptoms)
DSM-5 criteria for ‘Somatic Symptom Disorder’
- 1 or more somatic symptoms causing DISTRESS or DISRUPTION on persons life
- Individual devotes excessive time, energy, experiences anxiety, & concern to somatic symptom/s
- Persistent (at least 6mnths)
Specifiers
- With predominant pain (previously pain disorder)
- Severity: mild, moderate, severe
Its about the person’s experience with their somatic complaints, rather than what might have caused them
this moves away from having psychological trauma/states as the basis for these symptoms as it is really difficult to quantify
DSM-5 criteria for ‘Illness Anxiety Disorder’
- preoccupation with fears of having illness even though no more than mild somatic symptoms
- high anxiety about health
- excessive health-related behaviours
- at least 6 months
- rare to see this without moderate or severe somatic complaints
SPECIFIER
care seeking or care avoidant
48:15
Conversion Disorder (DSM-IV)
prevalence unclear - 3%, higher for inpatients?
- sudden onset of symptoms e.g.,
sensory: tunnel vision, tingling, loss of feeling, vision, hearing
motor: paralysis, seizures - develops in adolescence/early adulthood
- comorbid depression, anxiety
- diagnosis is difficult: is the cause not there because it is absent or because we can’t find it
DSM-5: Conversion Disorder (Functional Neurological Symptom Disorder)
- Neurological symptoms WITHOUT medical cause
IMPT: they need to be - Inconsistent with medical tests or a recognised neurological disorder (needs to be fairly atypical)
- Causes FUNCTIONAL impairment across various domains
50:30
What questions exist with regard to Conversion Disorder?
Is it medical…….is it psychological….
Is it not there because its not there or because we can’t find it
What is the difference between
Malingering and Factitious Disorder?
Malingering: faking psychological or somatic symptoms for gain
Factitious disorder: faking symptoms, but without evidence of gain
51:15
