Study Guide - Somatic Symptoms Disorders

What does somatic mean?

of or pertaining to the body

Why is it difficult for doctors to diagnose somatic symptom and related disorders?

Symptoms are internal and difficult to measure

Individuals could be faking, imagining, over exaggerating, or really experiencing the symptoms they report

Regardless, the symptoms ARE associated with significant distress and/or impairment

The symptoms could also be caused by a real, medical illness or disorder

What are the three types of somatic symptoms?

1. Symptoms can be localized/diffused and specific/nonspecific, but they are treated as authentic

2. Often diagnosed when another medical condition is present

3. Significant worry about the illness is often present and because of this, patients will oftentimes “shop” at different doctors’ offices to confirm the seriousness of their symptoms

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

For somatic symptom disorder, the patient presents with multiple somatic symptoms at one time that are significant enough to impact their daily functioning

For illness anxiety disorder, the patient does not typically present with any somatic symptoms but if they do, the symptoms are just mild in intensity

a.     What was illness anxiety previously called and what is it characterized by?

Previously called hypochondriasis

Involves the excessive preoccupation with having or acquiring a serious medical illness but the patient does not typically present with any somatic symptoms

◦ If there is a medical diagnosis, the anxiety about the severity of their disorder is excessive or disproportionate for the actual diagnosis

Anxiety is not relieved with reassurance

Patients will often research rare illnesses that could possibly be linked to their symptoms

In rare case, some cases of invalidism have been reported

a.     People with illness anxiety disorder are at a risk of developing what other kind of disorders?

personality disorders and somatic symptom disorder

1.     What was functional neurological symptom disorder called?

Conversion Disorder

1.     What does functional neurological symptom disorder look like?

Diagnosis requires that the symptoms not be explained by a neurological disease and there must be evidence of incompatibility of the medical disorder and the symptoms

Symptoms include:

•Weakness

•Paralysis

•Abnormal gait or other movements

•Altered, reduced, or absent skin sensations

•Vision or hearing impairment

ADDD How does factitious disorder differ from somatic symptom disorder, illness anxiety disorder, and conversion disorder?

FD symptoms are faked and deception is the purpose

a.     What factors contribute to developing facticious disorder?

Possibly due to depression, a lack of parental support during childhood, or an excessive need for social support

b.     What are the two forms of factitious disorder?

factitious disorder or factitious disorder by proxy

c.     What do people with FD do to legitimize their health concerns in the eyes of health professionals?

Behaviors include altering tests, falsifying medical records, ingesting a subject that would show up as abnormal on lab results, injuring oneself or inducing illness

1.     What is the prevalence of these disorders among men and women?

women are more often diagnosed with somatic symptom disorder

1.     What is the prevalence of these disorders among Asians?

Symptoms are more common in eastern cultures

1.     What is the prevalence of these disorders among Americans?

5-7% of the US

western cultures are less preocupied with somatic symptoms than western cultures

2.     Somatic disorders are most commonly comorbid with which disorders?

Anxiety and depression are most commonly codiagnosed

◦ Those with illness anxiety disorder have a higher chance of developing somatic symptom disorder and personality disorders

◦ 2/3 of those with illness anxiety disorder are likely to have at least one other psychological disorder

◦ Personality disorders are more common in individuals with conversion disorder than the general public

◦ Often comorbid (60%) with physical disorders categorized under central sensitivity syndromes (CSSs) (e.g., fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome)

What is the Psychodynamic etiology for somatic disorders?

Suggests that somatic symptoms present as a response against unconscious emotional issues

• What initiates and maintains somatic symptoms?

• Primary gain → produce internal motivators and provides protection from the anxiety or emotional symptoms

• Secondary gain → can range from attention and sympathy, to missed work, to obtained financial assistance, etc.

What is the cognitive etiology for somatic disorders?

Somatic related disorders are a result of negative beliefs or exaggerated fears of physiological sensations (i.e., patients catastrophize)

What is the behavioral etiology for somatic disorders?

Propose that somatic related disorders develop and are primarily maintained by reinforcers (usually attention or receiving disability)

• This is different from the psychodynamic school of thought which lists attention and receiving disability as secondary gains

What is the sociocultural etiology for somatic disorders?

Family members or close friends of those with somatic symptom disorder, or at least overattentiveness to somatic symptoms, are more likely to develop the disorder themselves

• Western cultures focus less on somatic complaints than Eastern cultures

1.     What are the various types of psychophysiological disorders?

Headaches

◦ Migraines → throbbing and localized pain accompanied by nausea, vomiting, light sensitivity, vertigo, etc.

◦ Tension → dull, constant and localized ache

◦ Gastrointestinal

◦ Ulcers → painful sores in the stomach lining caused by digestive acids burning a hole in the stomach lining due to bacteria and exacerbated by stress

◦ Irritable Bowel Syndrome (IBS) → involves abdominal pain and extreme bowel habits (diarrhea and/or constipation) often linked with anxiety and/or depression

◦ Insomnia

◦ Difficult falling or staying asleep due to anxiety, depression, and/or overactive arousal systems; and with decreased sleep, there can be even more psychological distress

◦ Occurs in more than one third of the US population

◦ Cardiovascular related disorders

◦ Coronary Heart Disease → features a five-fold increase of depression; anxiety and anger are early predictors of cardiac events

◦ Hypertension → elevated blood pressure often affected by constant stress, anxiety, and depression

a.     What does psychophysiological mean?

When physical illnesses seem to be caused or worsened by an interaction of biological, psychological, or sociocultural factors

1.     What are the treatment options for somatic disorders? Which is most effective?

Two types

◦ Multidisciplinary → symptoms are managed by many providers, oftentimes including a physician, psychiatrist, and psychologist

◦ Interdisciplinary → harder to find, multiple disciplines interact and identify a treatment goal Psychotherapy

◦ Psychodynamic → aka interpersonal psychotherapy; focuses on the relationship between self experience and the unconscious, and how these factors contribute to body dysfunction

◦ CBT → aims to have patients accept their medical condition by addressing avoidance behaviors and mediating expectations of treatment

◦ Behavioral → involves bringing attention to physiological symptoms

Psychopharmacology

Best if all healthcare providers work together harmoniously

What are the treatment options for psychological disorders?

Relaxation training → teaches individuals how to relax muscles on command

Biofeedback → where an individual is connected to a machine that allows for continuous monitoring of involuntary physiological reactions (e.g., heart rate, galvanic skin response, respiration, muscle tension, body temperature, etc.)

Hypnosis → an extreme sense of relaxation

Group therapy → usually involve CBT and other cognitive/behavioral strategies in a group setting to encourage acceptance of disease while also addressing maladaptive coping strategies