Somatic Symptom and Related Disorders

Somatic Symptom Disorder

individuals must be experiencing chronic somatic symptoms that are distressing to them. They must also be experiencing dysfunctional thoughts, feelings, and/or behaviors

Psychoanalytic View of Somatic Symptom Disorder

It was long thought that symptoms developed as a defense mechanism against unresolved or unacceptable unconscious conflicts. Rather than being expressed directly, psychic energy was instead channeled into more acceptable physical problems

malingering

consciously faking symptoms to achieve a specific goal such as winning a personal injury lawsuit

CBT

treatment for somatic symptom disorder

Illness anxiety disorder

A. Preoccupation with having or acquiring a serious illness.

B. 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), t

Conversion disorder

It is characterized by the presence of neurological symptoms in the absence of a neurological diagnosis

la belle indifférence

Early observations dating back to Freud suggested that most people with conversion disorder showed very little of the anxiety and fear that would be expected in a person with a paralyzed arm or loss of sight.

sensory, motor, seizures, mixed presentation

four categories of symptoms in conversion disorder

glove anesthesia

the per son cannot feel anything on the hand in the area where gloves are worn

single limb

conversion paralysis is usually confined to a __________ such as an arm or a leg

aphonia

the person is able to talk only in a whisper although he or she can usually cough in a normal manner.

globus

the sensation of a lump in the throat

conversion hysteria

Conversion disorder - Freud used the term _______ for these disorders (which were fairly common in his practice) because he believed that the symptoms were an expression of repressed sexual energy— that is, the unconscious conflict that a person felt about his or her repressed sexual desires.

Primary Gain

The reduction of anxiety or internal conflict through the development of physical symptoms, allowing avoidance of confronting unconscious issues.

Secondary Gain

Additional benefits from being ill, such as attention, sympathy, or relief from responsibilities, which may reinforce the disorder.

behavioral approach

Treatment for Conversion Disorder

factitious disorder

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

B. The individual presents himself or herself to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

malingering

intentionally producing or grossly exaggerating his or her physical symptoms and is motivated by external incentives such as avoiding work or military service or evading criminal prosecution

factitious disorder imposed on another

sometimes referred to as Munchausen’s syndrome by proxy, the person seeking medical help has intentionally produced a medical or psy chiatric illness (or the appearance of an illness) in another person. This person is usually someone (such as a child) who is under his or her care

Somatic Symptom Disorder (Criterion A)

Involves one or more somatic symptoms that are distressing or result in significant disruption of daily life.

Somatic Symptom Disorder (Criterion B)

Involves excessive thoughts, feelings, or behaviors related to somatic symptoms or health concerns, shown by at least one of:

1. Disproportionate thoughts about seriousness

2. Persistently high health anxiety

3. Excessive time and energy devoted to symptoms

Somatic Symptom Disorder (Criterion C)

Although any one somatic symptom may not be continuous, the symptomatic state is persistent—typically more than 6 months.

Somatic Symptom Disorder with Predominant Pain

A specifier used when the somatic symptoms primarily involve pain (formerly known as pain disorder).

Persistent Somatic Symptom Disorder

A specifier for cases with a persistent course—severe symptoms, marked impairment, and duration of more than 6 months.

women

which gender are more prone to somatic symptom disorder?

shenjing shuairuo

often translated as "weakness of nerves," is a cultural syndrome primarily reported in China, characterized by a combination of physical and mental fatigue, irritability, sleep disturbances, and other symptoms that cannot be traced to a specific organic cause

Illness Anxiety Disorder – Criterion B

Somatic symptoms are absent or mild. If a medical condition is present, the worry is clearly excessive or disproportionate.

6 months

how long should the symptoms last for illness anxiety disorder?

Care-Seeking Type

Frequently uses medical care such as physician visits and medical tests.

Care-Avoidant Type

Rarely uses medical care due to fear or anxiety.

In illness anxiety disorder, the anxiety is about the meaning of symptoms, not the symptoms themselves.

Key Distinction of Illness Anxiety Disorder from Somatic Symptom Disorder

Functional Neurological Symptom Disorder (Conversion Disorder) - Criterion A

One or more symptoms of altered voluntary motor or sensory function.

psychoanalytic

The term “conversion” originated in ________ theory, which proposes that unconscious psychic conflict is “converted” into physical symptoms.

women

Functional neurological symptom disorder is two to three times more common in _______ for most symptom presentation