Somatic symptoms & dissociative Disorders

What is somatic symptom disorder

• preoccupation w perceived health issue and exaggeration in which there is no medical explanation

• demand unnecessary tests and do not comply w recommendations

• experience significant distress and impairment in functioning

• common complaints

  • GI issues, palpitations

  • dysphagia

  • SOB

  • dizziness

• onset before age 30

• comorbid psych illnesses: anxiety & depression that manifest through physical s/s

• often refuse psych tx

• secondary gains: attn from others bc they’re sick

• not fakin s/s

interventions for somatic symptom disorder

• promote self care

• health teaching and promotion

• case management

• SSRIs most effective

• psychotherapy and fu visits

ex of primary gain

recover from illness and become healthy

hypochondriasis

another term for illness anxiety disorder

Key features illness anxiety disorder

• extreme concern and preoccupation w having devastating disease

• extreme worry and fear

• course of illness chronic and relapsing

• few somatic complaints = life threatening illness

conversion disorder

aka functional neurological disorder

key features of functional neurological disorder

• presence of deficits in voluntary motor or sensory function

• “la belle indifference” versus distress: not concerned w loss of functioning, just adapt no questions asked

• co morbid conditions: depression, anxiety, PD

• s/s do not correspond to medical basis, no explanation, not faking

s/s of functional neurologic disorder

• paralysis

• blindness

• movement and gait disorder

• numbness

• paresthesia

• loss of vision or hearing

• episodes resembling epilepsy

• decreased pain threshold, difficulty expressing emotions

etiology of somatic & functional d/o

• hx of early trauma

• having a lower pain threshold

• easily distracted and impulsive

Assessment of person with somatic symptom disorder

• symptoms & unmet needs

• voluntary control of symptoms

• secondary gains

• cognitive style

• ability to communicate feelings and emotional needs

• dependence on medication

What is factitious disorder

• deliberately fabricating symptoms of illness or self injury w/out obvious gains

• symptoms are made up

• want to assume the “sick role”

2 types of factitious disorder

• munchausen syndrome

  • imposed on own self

• munchausen by proxy: imposed on another (kids or those with decreased intellect)

Malingering

• consciously feigning an illness for obvious benefit

• this is criminal, not mental

• goal is typically to gain disability, insurance fraud, and avoiding prison

what are dissociative disorders

• disturbances in normally well integrated consious, memory, identity, and perception

• unconscious defense mechanism

• protects the individual against overwhelming anxiety

• Reality testing is intact

• altered mind-body connection

• hx of early child abuse

types of dissociative disorders

• depersonalization/derealization

• dissociative amnesia w/ fugue

• dissociative identity disorder

what is depersonalization/derealization disorder

• feeling unreal , detached, out of body, numb, in a dreamlike state

• experiencing a distorted sense of time or visual perception

• reality testing remains intact

what is dissociative amnesia

• inability to recall important personal info

• beyond normal forgetfulness

• often traumatic or stressful nature

  • generalized: larger time gap

  • localized: specific time gap/event

what is dissociative amnesia w/ fugue

• sudden unexpected travel away from customary locale

• inability to recall one’s identity and some or all of the past

dissociative identify disorder

• aka multiple personality disorder

• presnce of two or more distinct personality states

• primary personality (host) usually not aware of alters

• alternate personality (alters) or sub-personalities take control of behavior

• alters often aware of each other

• each alter thinks and behaves as a separate individual

• personality change happens under extreme stress

causes of dissociative disorder

• child & sexual abuse

assessment of dissociateive disorder

• rule out medical cause

• identity and memoty

• hx of head trauma and seizure disorders

• moods

• impact on patient and family

• suicide risk

dissociative disorder interventions

• basic level

  • mileu therapy- calm, quiet and structured, decrease anxiety

  • health teaching and health promotion- coping skills, stress management

  • pharmacological interventions- non specific, anti anxiety & SSRIs

• advanced practice

  • CBT

  • psychodynamic psychotherapy