Chapter 6: Somatic Symptom and Related Disorders and Dissociative Disorders

hypochondriac

former name of illness anxiety disorder

hypochondriac

someone who exaggerates the slightest physical symptom

soma

it means body

somatic symptom disorder

there is an excessive or maladaptive response to physical symptoms or to associated health concerns

somatic symptom disorders

these disorders are sometimes grouped under the shorthand label of “medically unexplained physical symptoms”

somatic symptom disorders

in some cases, the medical cause of the physical symptoms is known but the emotional distress or level of impairment in response to the symptoms is excessive and may make the condition worse

dissociation/ dissociative experiences

people feel as if they are dreaming

dissociation/ dissociative experiences

slight alterations or detachments in consciousness or identity

somatic symptom and dissociative disorders

they are strongly linked historically and evidences indicate they share common features

hystorical neurosis

this is the general heading that somatic symptom and dissociative disorders were formerly categorized

hysteria

a term dating back to Hippocrates and the Egyptians before him which suggests that the cause of these disorders can be traced to a “wandering uterus”

wandering uterus

the cause of hysteria according to Hippocrates

hysterical

refer more generally to physical symptoms without known organic cause or to dramatic or histrionic behavior thought to be characteristic of women

sigmund freud

he suggested the concept of conversion hysteria

conversion hysteria

in this condition, unexplained physical symptoms indicated the conversion of unconscious emotional conflicts into a more acceptable form

neurotic disorders

resulted from underlying unconscious conflicts, anxiety that resulted from these conflicts, and the implementstion of ego defense mechanism

somatic symptom disorder, illness anxiety disorder, psychological factors affecting medical condition, conversion disorder, factitious disorder

five basic somatic symptom and related disorders

somatic symptom and related disorders

individuals are pathologically concerned with the functioning of their bodies

briquet’s syndrome

former name of somatic symptom disorder

pierre briquet

he had patients with seemingly endless lists of somatic complaints for which he could find no medical basis

psychological or behavioral factors

in somatic symptom disorders, the important factor is not whether the physical symptom has a clear medical caude or not, but rather that ____ are compounding the severity and impairment associated with the physical symptoms

hypochondriasis

formerly known as illness anxiety disorder

illness anxiety disorder

in this disorder, physical symptoms are either not experienced at the present time or are very mild, but severe anxiety is focused on the possibility of developing a serious disease

somatic symptom disorder

diagnosis if one or more physical symptoms are relatively severe and are associated with anxiety and distress

illness anxiety disorder

in this disorder, the concern is primarily with the idea of being sick instead of the physical symptom itself and the threat seems so real that reassurance from physicians does not seem to help

anxiety and mood disorders

these are often comorbid with somatic symptom disorders

illness anxiety disorder

characterized by anxiety or fear that one has a serious disease

illness anxiety disorder

the individual is preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease

illness anxiety disorder

in this disorder, reassurances from numerous doctors that all is well and the individual is healthy have, at best, only a short term effect

disease conviction

individuals have a difficult-to-shake belief that they have a disease

somatic symptom disorder

patients with this disorder focus on long-term process of illness and disease

somatic symptom disorder

patients with this disorder continue to seek the opinions of additional doctors in an attempt to rule out disease and are more likely to demand unnecessary medical treatments

somatic symptom disorder

patients with this disorder remain unconvinced and unreassured despite numerous assurances

koro

a culture-specific syndrome fitting comfortably in somatic symptom disorder in which there is the belief, accompanied by severe anxiety and sometimes panic, that genitals are retracting into the abdomen

dhat

a culture-specific disorder prevalent in india which is an anxious concern about losing semen, associated with a vague mix of physical symptoms like dizzines, weakness, and fatigue

koro and dhat

low-grade depressive or anxious symptoms are simply attributed to a physical factor, semen loss

somatizing psychological distress

it is fairly common, and fairly uniform, throughout the world

illness anxiety disorder

diagnostic criteria:

Preoccupation with fears of having or acquiring a serious illness.

illness anxiety disorder

diagnostic criteria:

Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate

illness anxiety disorder

diagnostic criteria:

There is a high level of anxiety about health, and the individual is easily alarmed about personal health status

illness anxiety disorder

diagnostic criteria:

The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctors’ appointments and hospitals).

illness anxiety disorder

diagnostic criteria:

Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time

illness anxiety disorder

diagnostic criteria:

The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, generalized anxiety disorder, or obsessive-compulsive disorder

care-seeking type

Medical care, including physician visits or undergoing tests and procedures, is frequently used.

care-avoidant type

Medical care is rarely used

illness anxiety disorder

you have to specify whether care-seeking type or care-avoidant type

individuals with somatic symptom disorder

they experience physical sensations common to all of us, but they quickly focus their attention on these sensations.

focusing on yourself

this act increases arousal and makes the physical sensations seem more intense than they are

anxiety

If you also tend to misinterpret these as symptoms of illness, ___ will increase further.

increased anxiety

it produces additional physical symptoms, which creates a vicious cycle

somatic symptom disorder

participants with these disorders show enhanced perceptual sensitivity to illness cues.

somatic symptom disorder

participants with this disorder tend to interpret ambiguous stimuli as threatening

somatic symptom disorder

participants with this disorder quickly become aware (and frightened) of any sign of possible illness or disease

better safe than sorry

individuals with somatic symptom disorders, compared with “normals,” take a ______ approach to dealing with even minor physical symptoms by getting them checked out as soon as possible

hyperresponsivity

it might combine with a tendency to view negative life events as unpredictable and uncontrollable and, therefore, to be guarded against at all times

family members

some individuals who develop somatic symptom disorder or illness anxiety disorder have learned from _____ to focus their anxiety on specific physical conditions and illness.

stressful life event, strong memory of illness, social and interpersonal influence

three factors contributing to the etiology of somatic symptom disorders

benefits of being sick

it might contribute to the development of the disorder in some people

sick role

A “sick person” who receives increased attention for being ill and is able to avoid work or other responsibilities

reassurance and education

clinical reports indicate that ___ and ____ can be effective in some cases with health anxiety

reassurance

this is usually given only briefly, by family doctors who have little time to provide the ongoing support and reassurance that might be necessary

mental health professionals

may well be able to offer reassurance in a more effective and sensitive manner, devote sufficient time to all concerns the patient may have, and attend to the “meaning” of the symptoms

explanatory therapy

therapy in which the clinician went over the source and origins of their symptoms in some detail

explanatory therapy

associated with a significant reduction in fears and beliefs about somatic symptoms and a decrease in health-care usage, and these gains were maintained at the follow-up

cognitive-behavioral treatment

focused on identifying and challenging illness-related misinterpretations of physical sensations and on showing patients how to create “symptoms” by focusing attention on certain body areas.

exposure therapy

repeatedly confronting the patient to stimuli that are relevant for health anxieties without using any avoidance and safety behaviors

paroxetine/ paxil

this drug is a selective-serotonin reuptake inhibitor (SSRI)

psychological factors affecting medical condition

the essential feature of this disorder is the presence of a diagnosed medical condition such as asthma, diabetes, or severe pain clearly caused by a known medical condition such as cancer that is adversely affected by one or more psychological or behavioral factors.

conversion

has been used off and on since the Middle Ages (Mace, 1992) but was popularized by Freud

conversion disorder

anxiety resulting from unconscious conflicts somehow was “converted” into physical symptoms to find expression

conversion

allows the individual to discharge some anxiety without actually experiencing it.

functional neurological symptom disorder

a subtitle to conversion disorder

functional neurological symptom disorder

this term is more often used by neurologists who see the majority of patients receiving a conversion disorder diagnosis because the term is more acceptable to patients.

functional

refers to a symptom without an organic cause

conversion disorder

generally have to do with physical malfunctioning without any physical or organic pathology to account for the malfunction

conversion disorder

most of this disorder’s symptoms suggest that some kind of neurological disease is affecting sensory–motor systems, although these symptoms can mimic the full range of physical malfunctioning

conversion disorder

symptoms of this disorder can mimic the full range of physical malfunctioning

conversion disorder

this disorder provide some of the most intriguing, sometimes astounding, examples of psychopathology

astasia-abasia

disorder where a person is unable to stand or walk properly, despite having no physical issues that would prevent them from doing so.

psychogenic non-epileptic seizures

seizures, which may be psychological in origin, because no significant electroencephalogram (EEG) changes can be documented

globus hystericus

the sensation of a lump in the throat that makes it difficult to swallow, eat, or sometimes talk

malingering

intentionally faking or exaggerating symptoms of an illness or injury for personal gain, such as avoiding work, getting financial benefits, or evading legal consequences.

la belle indifference

indifference to the symptoms thought to be present in some people with severe somatic symptom disorder

la belle indifference

it turned out to be not a hallmark of conversion reactions

conversion disorder

diagnostic criteria:

One or more symptoms of altered voluntary motor or sensory function

conversion disorder

diagnostic criteria:

Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.

conversion disorder

diagnostic criteria:

The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

conversion disorder

its symptoms often seem to be precipitated by marked stress taking the form of a physical injury

ruling out medical causes for the symptoms

it is crucial to making a diagnosis of conversion and, given advances in medical screening procedures, this is the principal diagnostic criterion in DSM-5

right inferior parietal cortex

this is an area of the brain that functions to compare internal predictions with actual events. In other words, if an individual wants to move her arm and then she decides to go ahead and move it, this area of the brain determines if the desired action has occurred

right inferior parietal cortex

if this area of the brain is not functioning properly, then the brain might conclude that the movement is involuntary.

malingerers

They are either trying to get out of something, such as work or legal difficulties, or they are attempting to gain something, such as a financial settlement.

malingerers

they are fully aware of what they are doing and are clearly attempting to manipulate others to gain a desired end.

factitious disorders

fall somewhere between malingering and conversion disorders

factitious disorders

its symptoms are under voluntary control, as with malingering, but there is no obvious reason for voluntarily producing the symptoms except, possibly, to assume the sick role and receive increased attention.

factitious disorder imposed on another

When an individual deliberately makes someone else sick

munchausen syndrome by proxy

previous name of factitious disorder imposed on another

typical child abuse

Results from direct physical contact with the child; signs often detected on physical examination

typical child abuse

The perpetrator does not invite the discovery of the manifestation of the abuse

typical child abuse

Children are either the objects of frustration and anger or are receiving undue or inappropriate punishment