Somatic symptoms #2

What are somatic symptom disorders?

Disorders involving physical symptoms that cause significant distress or impairment, influenced by psychological factors.

What is the key feature of somatic symptom disorders?

The excessive thoughts, feelings, and behaviors surrounding the physical symptoms, regardless of whether the symptoms are medically explained.

How did the DSM-5 change the classification of somatic symptom disorders?

It moved away from requiring medically unexplained symptoms and focuses on the psychological response to symptoms.

What characterizes Somatic Symptom Disorder?

One or more distressing somatic symptoms, excessive thoughts or behaviors regarding the symptoms, and symptoms persisting for at least 6 months.

What are common excessive behaviors in Somatic Symptom Disorder?

Disproportionate thoughts about symptom seriousness, high anxiety about health, and excessive time devoted to health concerns.

What distinguishes Illness Anxiety Disorder (IAD) from Somatic Symptom Disorder?

IAD involves preoccupation with having a serious illness with minimal or absent somatic symptoms, while Somatic Symptom Disorder focuses on distressing physical symptoms that are present.

What are the core features of Illness Anxiety Disorder?

Preoccupation with having a serious illness, minimal somatic symptoms, high anxiety about health, and excessive health-related behaviors or avoidance.

What characterizes Conversion Disorder?

One or more symptoms of altered voluntary motor or sensory function, with clinical findings showing incompatibility with recognized neurological conditions.

What are common presentations of Conversion Disorder?

Weakness or paralysis, abnormal movements, swallowing difficulties, speech problems, non-epileptic seizures, and sensory loss.

What important clinical point is associated with Conversion Disorder?

Symptoms are not intentionally produced; they may involve genuine neurological changes influenced by psychological stressors.

What is the modern understanding of Conversion Disorder?

It involves genuine neurological changes in how the brain processes motor and sensory signals, often associated with psychological stress.

What is a key teaching point regarding individuals with somatic symptom disorders?

Their physical symptoms are real, and they genuinely suffer; they are not 'faking it.'

How long must symptoms persist for a diagnosis of Somatic Symptom Disorder?

At least 6 months.

What is a common misconception about the symptoms in somatic symptom disorders?

That the symptoms are imagined or not real; they are real to the person experiencing them.

What is the term used to describe the psychological process in Conversion Disorder?

Conversion refers to the psychodynamic theory that psychological distress is converted into physical symptoms.

What role does psychological stress play in somatic symptom disorders?

Psychological stress can exacerbate or trigger the physical symptoms experienced by individuals.

What is the duration requirement for Illness Anxiety Disorder?

At least 6 months.

What are the two types of behaviors seen in Illness Anxiety Disorder?

Excessive health-related behaviors (like checking) or maladaptive avoidance (like avoiding doctors).

What is the significance of distinguishing between Somatic Symptom Disorder and Illness Anxiety Disorder?

It helps in tailoring treatment approaches based on whether the focus is on distressing symptoms or fear of illness.

What is a common outcome of excessive reassurance-seeking in Illness Anxiety Disorder?

Temporary relief followed by a fixation on new diseases or symptoms.

What type of symptoms are associated with Somatic Symptom Disorder?

Any somatic symptoms such as pain, fatigue, gastrointestinal problems, headaches, and dizziness.

What type of symptoms are associated with Conversion Disorder?

Specifically neurological symptoms like paralysis, seizures, blindness, loss of speech, and sensory loss.

How many symptoms are typically present in Somatic Symptom Disorder?

Often multiple symptoms that can vary over time.

How many symptoms are typically present in Conversion Disorder?

Usually one or a few specific neurological deficits.

What is the onset pattern for Somatic Symptom Disorder?

Gradual onset; symptoms may wax and wane.

What is the onset pattern for Conversion Disorder?

Often sudden or acute onset, which may follow a stressor.

What is the primary diagnostic feature of Somatic Symptom Disorder?

Excessive thoughts, feelings, and behaviors about the symptoms, including anxiety and preoccupation.

What is the primary diagnostic feature of Conversion Disorder?

Incompatibility between symptoms and known neurological or medical conditions, with positive signs on examination.

Can medical findings be present in Somatic Symptom Disorder?

Yes, medical findings may or may not be present and can coexist with actual medical conditions.

Can medical findings be present in Conversion Disorder?

No, symptoms cannot be explained by neurological disease or medical condition.

What bothers patients most in Somatic Symptom Disorder?

The symptoms themselves and anxiety about what they mean.

What bothers patients most in Conversion Disorder?

The functional impairment, such as inability to walk, see, or move an arm.

What psychological response is common in Somatic Symptom Disorder?

High anxiety, catastrophic thinking, and excessive health behaviors.

What psychological response may be observed in Conversion Disorder?

May show 'la belle indifférence', an inappropriate lack of concern, though not always.

Are associated stressors identifiable in Somatic Symptom Disorder?

They may or may not be identifiable.

Are associated stressors identifiable in Conversion Disorder?

Often (but not always) temporally related to a psychological stressor or conflict.

What is the duration criterion for Somatic Symptom Disorder?

At least 6 months.

What is the duration criterion for Conversion Disorder?

No specific duration; symptoms can be transient.

What is the typical course of Somatic Symptom Disorder?

Chronic and persistent.

What is the typical course of Conversion Disorder?

May be episodic or a single episode; can resolve suddenly.

Give an example of a symptom from Somatic Symptom Disorder.

"My back pain is unbearable and I'm terrified it means cancer. I've seen 8 doctors and spend hours researching it online."

Give an example of a symptom from Conversion Disorder.

"I woke up this morning and my arm won't move. I can't feel anything in it."

What type of checking behaviors are common in Somatic Symptom Disorder?

Frequent body checking, doctor visits, reassurance-seeking, and online research.

What type of checking behaviors are common in Conversion Disorder?

Less likely to engage in excessive checking; more focused on the loss of function itself.

What is the treatment focus for Somatic Symptom Disorder?

Reduce anxiety and catastrophic thinking; address health-related behaviors.

What is the treatment focus for Conversion Disorder?

Physical therapy to retrain function; address underlying psychological stressors.

Can Somatic Symptom Disorder and Conversion Disorder co-occur?

Yes, a patient can have both disorders.

What is a memory aid for Somatic Symptom Disorder?

WORRY about symptoms; focus on thoughts, feelings, and behaviors about the symptoms.

What is a memory aid for Conversion Disorder?

NEUROLOGICAL symptom without neurological cause; focus on incompatibility between symptom presentation and known medical conditions.

What is derealization?

A dissociative experience where the individual feels disconnected from their surroundings, perceiving them as unreal or dreamlike.

What are common patient descriptions of derealization?

Patients may say, 'I feel like I'm living in a dream' or 'Everything looks fake, like a movie set.'

What distinguishes depersonalization/derealization disorder from psychosis?

In depersonalization/derealization, reality testing is intact; the person knows their feelings aren't real, unlike in psychosis where they believe altered perceptions are real.

What psychological factors can affect medical conditions?

Psychological or behavioral factors can influence the course of a medical condition, interfere with treatment, or pose additional health risks.

How can anxiety affect diabetes management?

Anxiety about needles may lead to refusal to check blood glucose levels and forgetting insulin doses, worsening diabetic control.

What is Factitious Disorder?

A condition where an individual falsifies physical or psychological symptoms to assume the 'sick role' without external rewards.

What is the difference between Factitious Disorder Imposed on Self and Imposed on Another?

Imposed on Self involves falsifying one's own illness, while Imposed on Another involves falsifying illness in another person, often a child.

What are the clinical challenges in treating Factitious Disorder?

Treatment is difficult due to the tendency of individuals to flee when confronted and the high risk involved when imposed on another.

What is the impact of depression on post-heart attack recovery?

Depression can lead to non-adherence with cardiac rehabilitation, stopping medications, and returning to unhealthy coping mechanisms.

What is the significance of intact reality testing in depersonalization/derealization disorder?

It indicates that the individual recognizes their altered perceptions are not reflective of reality.

What triggers episodic derealization in some individuals?

High-stress situations can trigger episodes of derealization, during which perceptions of reality become distorted.

What are common fears of patients with depersonalization/derealization disorder?

Patients often fear they are 'going crazy' or developing serious mental illnesses like schizophrenia.

What is the role of psychological factors in asthma management?

Anxiety can trigger asthma attacks and maladaptive beliefs may lead to avoidance of necessary treatments like inhalers.

What is the primary motivation behind Factitious Disorder?

The motivation is to assume the 'sick role' for attention and care, not for external gains like financial benefits.

What is the relationship between panic attacks and derealization?

While derealization can occur during panic attacks, it can also persist beyond the panic episode.

What are the symptoms of Malingering?

Malingering involves intentional falsification of symptoms for external incentives, but it is not classified as a mental disorder.

What is a common experience reported by individuals with derealization?

They may feel like they are watching a movie of their life rather than actively living it.

What is the effect of denial on medical conditions?

Denial can delay treatment and worsen the course of a medical condition, such as diabetes.

How can psychological factors influence the pathophysiology of a medical condition?

Psychological factors can exacerbate underlying conditions, leading to worse health outcomes.

What is the significance of recognizing psychological factors in medical conditions?

It allows for a comprehensive treatment approach that addresses both medical and psychological needs.

What is a common outcome for patients with Factitious Disorder when confronted?

They often flee from treatment settings or seek care from different providers to avoid detection.

What is the impact of psychological factors on treatment adherence?

Psychological issues such as anxiety or depression can lead to poor adherence to treatment regimens.

What is a potential consequence of untreated psychological factors in medical patients?

Untreated psychological factors can lead to increased risk of complications and poorer overall health outcomes.

What is malingering?

The intentional production of false or exaggerated physical or psychological symptoms motivated by external incentives.

Is malingering considered a mental disorder?

No, malingering is not classified as a mental disorder.

What are the core features of malingering?

Intentional fabrication or gross exaggeration of symptoms with clear external motivations.

What are some external motivations for malingering?

Financial compensation, avoiding work or military duty, obtaining prescription drugs, avoiding criminal prosecution, and obtaining housing or benefits.

Describe an example of malingering for financial motivation.

Michael, a construction worker, claims severe back pain after an injury but is later seen loading heavy furniture and playing basketball.

What inconsistencies were noted in Michael's case?

He showed inconsistent effort during evaluations and pain behaviors increased when observed.

Describe an example of malingering to avoid legal consequences.

Brian, facing felony charges, claims to hear voices and experiences memory loss, but his symptoms are inconsistent with any actual disorder.

What did psychiatric evaluations reveal about Brian?

Invalid symptom validity test scores and dramatic over-endorsement of psychiatric symptoms.

Describe an example of malingering to obtain drugs.

Ashley presents to the ER requesting Dilaudid for a migraine, but her behavior and medical history suggest she is seeking narcotics.

What should clinicians do when malingering is suspected?

Maintain a professional demeanor, document observations, use symptom validity tests, and obtain collateral information.

What is an important ethical consideration regarding malingering?

Clinicians should avoid premature accusations and consider underlying issues that may drive the behavior.

What is the primary motivation behind malingering?

External rewards such as money, drugs, or avoiding duty/prosecution.

How does the response differ when confronted between malingering and factitious disorder?

Malingerers often stop or become angry; those with factitious disorder may flee to a new provider.

What is a key distinction in the pattern of behavior between malingering and factitious disorder?

Malingering is usually situation-specific, while factitious disorder shows a chronic, pervasive pattern across life.

How do individuals with malingering typically respond when their goal is achieved?

Their symptoms usually resolve.

How do individuals with factitious disorder typically respond when their goal is achieved?

Their symptoms may continue or worsen.

What is a common behavior of someone with factitious disorder regarding medical procedures?

They may seek or accept invasive procedures.

What is a common behavior of someone who is malingering regarding medical procedures?

They usually avoid invasive procedures.

What is the primary feature of Somatic Symptom Disorder?

Excessive response to physical symptoms.

What is the main characteristic of Illness Anxiety Disorder?

Fear of having a disease despite minimal or absent physical symptoms.

What type of dysfunction is associated with Conversion Disorder?

Motor or sensory dysfunction that is not intentional.

What is a key feature of Depersonalization/Derealization Disorder?

Altered sense of self or reality with variable somatic complaints.

What is the treatment approach for Somatic Symptom Disorder?

Cognitive-Behavioral Therapy (CBT) to challenge catastrophic thinking and reduce reassurance-seeking behaviors.

What are some specific interventions for Depersonalization/Derealization Disorder?

CBT focusing on anxiety reduction, grounding exercises, and addressing triggers.

What role do SSRIs or SNRIs play in treating Depersonalization/Derealization Disorder?

They may help, especially when comorbid anxiety or depression is present.

What is the primary treatment for Conversion Disorder?

Physical therapy to retrain motor and sensory function, along with addressing underlying stressors.

What is the challenge in treating Factitious Disorder?

Patients often refuse treatment and may require immediate child protection intervention if imposed on another.

How should malingering be approached in a clinical context?

Document findings objectively and avoid premature labeling to protect the therapeutic relationship.