Somatic Symptom Disorder

Somatic symptom disorder

Physical symptoms with no organic cause

Conversion Disorder - DSM IV

Loss of voluntary motor or sensory function without organic pathology

(Functional Neurological Symptom Disorder – DSM 5)

 Illness Anxiety Disorder (Hypochondriasis)

Preoccupation with having a serious illness

Factitious Disorder (Munchausen Syndrome)

 “Faking it” to assume the sick role

Somatic symptom disorder checklist

One or more bodily symptoms causing persistent distress for at least 6 months

Plus 1 of:

1. Excessive thoughts, feelings, and/or behaviors related to these bodily symptoms

2. Persistently high level of anxiety about health or symptoms

3. Excessive time and/or energy devoted to health or symptoms

4. Examples of symptoms: headaches, chest pain, nausea, diarrhea, erectile or menstrual difficulties, double vision or paralysis.

Somatic symptom disorder features

• 5-7%prevalence

• More common in: females, older age, lower socioeconomic status, less education, less insightful, and those who have experiences a recent stressful life event

• Typically have multiple physical complaints

• Can and often does occur along with real physical
  problems

• Appraise their symptoms as unduly threatening despite reassurance

• Excessive medical consultation and intervention (usually ineffective)

• Resistant to psychological referral

Causes of somatic symptom disorder features

Significant genetic contribution

• Stress

• Lack of insight

• Secondary reward

• Concurrent physical illness

Psychodynamic theorist ideas on somatic symptom disorder

• People have 2 different mechanisms in play with this disorder. The first is the primary gain, this is where people keep their internal conflicts out of awareness. A man who doesn't want to express anger will have arm pain. Secondary gain is when people receive kindness or are excused from certain activates.

Treatment for somatic symptom disorder

• Hard to treat

• Cognitive behavioural therapy, which reduces stress and minimizes help seeking behaviours

• Anti-anxiety and antidepressant medications

Conversion disorder checklist

• Severe physical dysfunction without corresponding physical pathology (e.g., loss of sight)

• Caused by psychological factors

• Not under voluntary control

 

Features of conversion disorder

• Weakness or paralysis; abnormal movements/tremor; altered skin sensation, vision or hearing; seizures; speech absence or difficulties

• Transient conversion symptoms common, persistent conversion disorder very rare

• Onset anytime, but common in children

• 2-3 times more common in females, men under extreme stress, lower socioeconomic status, and cultures where expression of emotional distress inhibited

Causes of conversion disorder

• Stressful life events

• Secondary gain

• Repression

• Lack of insight

Treatment for conversion disorder

• Reduce stress

• Remove original noxious situation and/or secondary reward

• Hypnosis

Illness anxiety disorder checklist

1. Preoccupation with having or acquiring a serious illness

1. Unlike somatic symptom disorder physical symptoms not present or very mild

2. Individual is easily alarmed about health status

3. Performs excessive health-related behaviours and/or body checking behaviours or maladaptive avoidance (missing doctors appointments)

4. Fear persists despite medical reassurance that there is no illness

5. Not better explained by another mental disorder

Features of illness of anxiety disorder

• Common

• Equal sex ratio

• Usually chronic

• Doctor shopping

Treatment for illness anxiety disorder

• Difficult to treat

• Behavioural approach with exposure to illness cues and prevention of response
  plus reassurance produce rapid improvement in health and social functioning

• Challenge beliefs about illness

• Antidepressants for depression and anxiety

Factitious disorder checklist

• Malingering (faking)

Factitious disorder imposed on self Assessment

1. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with deception

2. Presents as impaired or injured

3. Deceptive behavior is evident outside of obvious rewards

4. Not better explained by another mental disorder

Features of factitious disorder ( imposed on self)

• More common in males

• Early onset

• May engage in pathological lying

• Often have extensive knowledge of medical terminology and hospital routines

• May eagerly undergo multiple invasive procedures and operations

• Few visitors in hospital

• Repeated hospitalizations in different
  hospitals and cities

• Usually incompatible with maintaining steady job, family ties, and interpersonal relationships

Features of factitious disorder ( imposed on others)

• Victim usually being preschool child and perpetrator mother;

• Insufficiently concerned about problem;

• Perpetrator may have history of being
  abused;

• Comorbid Somatic Symptom and/or Personality Disorders may be present;

• Often coexists with Factitious Disorder in perpetrator, although quiescent when victim's symptoms prominent

Causes of factitious disorder

• Possible predisposing factors of other mental disorders

• Presence of severe Personality Disorder

• More common among those who had general medical conditions during childhood or adolescence that led to extensive medical treatment and hospitalization

• More common among those employed in a medically related position

• Important relationship with a physician in the past

• Secondary Reward

Treatment disorder

• Difficult to treat

• Medications usually ineffective

• Psychotherapy usually ineffective (high drop out rates)

• Remove secondary reward (difficult because of doctor shopping)