Somatic Symptom and Related Disorders

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Bryce Stevens
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1 Somatic Symptom and Related Disorders

2 Somatic Symptom and Related Disorders Excessive concerns about physical symptoms or health Soma means body In DSM-IV-TR physical symptoms have no known physical cause Nearly impossible to know actual cause DSM-5 removes requirement that symptoms not be medically caused Three major somatic symptom disorders: Somatic symptom disorder Illness anxiety disorder Conversion Disorder

3 Diagnoses of Somatic Symptom and Related Disorders

4 DSM-5 Criteria for Somatic Symptom Disorder - Distressing or disruptive somatic symptom(s). - Excessive thoughts, feelings, behaviours about the symptoms or related health worries as per (at least one) of: Persistent, excessive thoughts about symptoms seriousness. Much anxiety about symptoms or health (persistent). Excessive time and energy spent on these symptoms or health concerns. -More than 6 months of being symptomatic.

5 DSM-5 Criteria for Somatic Symptom Disorder Specifiers: With predominant pain. Persistent (continuous, disabling, severe symptoms). Severity: mild, moderate, severe.

6 DSM-5 Criteria for Illness Anxiety Disorder - Preoccupied with having or getting serious illness. - If there is a physical condition, or risk for it, the preoccupation is clearly excessive. - Very concerned about their health. - Excessive health related behaviours or maladaptive avoidance. - No/mild somatic symptoms. - Duration 6 months. - Care seeking type / Care avoiding type

7 Conversion Disorder Sensory or motor function impaired but no known neurological cause Vision impairment or tunnel vision Partial or complete paralysis of arms or legs Seizures or coordination problems Aphonia Whispered speech Anosmia Loss of smell

8 Conversion Disorder Hippocrates Believed disorder only occurred in women Attributed it to a wandering uterus Originally known as Hysteria Greek word for uterus Freud Coined term conversion Anxiety and conflict converted into physical symptoms Famous case of Anna O.

9 DSM-5 Criteria for Conversion Disorder There are changes in sensory and voluntary motor functions that are incompatible with recognized neurological or medical conditions. Not better explained by another mental disorder or medical disorder. Significant distress or impairment in functioning.

10 DSM-5 Criteria for Conversion Disorder With weakness or paralysis. With abnormal movements. With swallowing symptoms. With speech symptoms. With attacks or seizures. With anaesthesia or sensory loss. With special symptom categories. With mixed symptoms. Voluntary motor Sensory Both

12 secondary gain la belle indifference psychosomatic

13 Conversion Disorder Onset typically adolescence or early adulthood Often follows life stress Prevalence less than 1% More common in women than men Often comorbid with: Other Somatic symptom disorders Major depressive disorder Substance use disorders

14 Etiology of Somatic Symptom and Related Disorders: Neurological Factors No support for genetic influence Concordance rates in MZ twin pairs do not differ from DZ twin pairs Why are some people more aware and distressed by bodily sensation? Anterior insula and anterior cingulate hyperactive Somatic symptoms influenced by emotions and stress

15 Etiology of Somatic Symptom and Related Disorders: Neurological Factors

16 Etiology of Somatic Symptom and Related Disorders: Cognitive Behavioral Factors Two important cognitive variables: Attention to bodily sensations Automatic focus on physical health cues Attributions (interpretation) of those sensations Overreact with overly negative interpretations Two important consequences: Sick role limits healthy life alternatives Help-seeking behaviors reinforced by attention or sympathy

17 Mechanisms Involved in Somatic Symptom and Related Disorders

18 Etiology of Somatic Symptom and Related Disorders: Social and Cultural Factors Decrease in incidence of conversion disorders since last half of 19 th century Higher incidence may have been due to more repressed sexual attitudes or low tolerance for anxiety symptoms More prevalent In rural areas In individuals of lower SES In non-western cultures

19 Treatment of Somatic Symptom and Related Disorders Few controlled treatment outcome studies Cognitive Behavioral Treatment Identify and change triggering emotions Change cognitions about symptoms Replace sick role behaviors with more appropriate social interactions Antidepressants Tofranil Effective even at low dosages that do not alleviate depressive symptoms

20 Factitious Disorder Factitious Disorder Imposed on Self & Factitious Disorder Imposed on Another DSM-5 Criteria for Factitious Disorder Fabrication of physical or psychological symptoms or disease Deceptive behavior is present in the absence of obvious external rewards Behavior is not explained by another mental disorder

22 Case 1 30-year old Jane Do suddenly lost her ability to see. She went for medical work-up from general practitioners to specialists. In the mean time she started wearing large dark glasses and acquired a neat, foldable white cane. After an extensive workup no medical explanation for the sudden loss of vision could be found. Diagnosis:?

23 Case 2 35-year old John Do s father died of a heart attack 1 year ago. Ever since John fears getting a heart attack despite feeling well otherwise. He can t help worrying about it nearly constantly. He checks his pulse rate frequently. He is easily alarmed if the pulse rate goes over a 80 or falls below 65, because 72 is a normal pulse rate. He goes from one medical practitioner, including specialists, to the other to find reassurance that he is well. He is temporarily reassured when his CVS checks out normal, but the reassurance does not last long before the worrying starts again. Diagnosis:?

24 Case 3 35-year old John Do s father died of a heart attack 1 year ago. Since then he gets episodes of tightness around the chest accompanied by a feeling of having difficulty to breath. Now he can t help worrying about it nearly constantly. He checks his pulse rate frequently. He is easily alarmed if the pulse rate goes over a 80 or falls below 65, because 72 is a normal pulse rate. He goes from one medical practitioner, including specialists, to the other to find reassurance that he is well. He is temporarily reassured when his CVS checks out normal, but the reassurance does not last long before the worrying starts again. Diagnosis:?

25 Case 4 15-year old Jane Do s suffers from insulin dependent diabetes mellitus. She has been thoroughly informed on how to use insulin and what her diet should be. Furthermore, she is an intelligent girl who understand all of this. Nonetheless, at times she secretly stops her insulin for no clear external gain like missing a test, and takes in too much carbohydrate containing foods and drinks. This results in hyperglycaemic, ketoacidotic comas that necessitate emergency treatment. Because this behaviour is secretive, her doctors wonder what they are doing wrong regarding her treatment. The patient herself seem very forgiving, tells them that she knows they are doing their best, and seems to enjoys the attention of doctors and nurses. Diagnosis:?

Chapter 5 - Somatic Symptom, Dissociative, and Factitious Disorders

Chapter 5 - Somatic Symptom, Dissociative, and Factitious Disorders SOMATIC SYMPTOM AND RELATED DISORDERS -Physical symptoms (eg. pain) or concerns about an illness cannot be explained by a medical or