Somatic Symptom Disorders

Somatic Symptom & related disorders

• Psychological distress manifesting as physical problems

• No identifiable medical condition causing physical complaint

Somatic Symptom Disorder

Distressing, preoccupying physical symptoms

Functional Neurological Symptom Disorder

Neuro (motor/sensory symptoms)

Factitous Disorder

• Symptoms feigned to gain attention, i.e., assume sick role

• Imposed on self or imposed by another

Illness Anxiety Disorder Criterion A

Preoccupation with having a serious disease

• Different from OCD, PD, phobia

• You think you already have this disease

Illness Anxiety Disorder Criterion B

Somatic symptoms either not present or mild

Illness Anxiety Disorder Criterion C

High level of anxiety about health; individual easily alarmed about health status

Illness Anxiety Disorder Criterion D

Performs excessive health-related behavior or maladaptive avoidance

Illness Anxiety Disorder Criterion E

Must last for at least 6 months

• Focus of concern may shift as areas of concern go away

Age at onset for illness anxiety

Anytime, mode is adolescence

• Hard to diagnose in elderly as it could be depression or dementia

Prevalence of illness anxiety

3-8% of patients in general medical practices

Other qualifications of illness anxiety

• No gender differences

• Typically chronic course

• 4-5 year follow-up: 67% retain diagnosis

Causes of Illness Anxiety

1) Faulty interpretation of physical signs and sensations as evidence of physical illness (anxiety sensitivity)

• Hypervigilant for physical symptoms

• Increase anxiety and makes symptoms seem more intense

• More physical symptoms are produced

2) Develops in context of stressful life event

3) Tend to disproportionate incidence of disease in family of origin

4) “Sick role” associated with benefits

Treatment of Illness Anxiety: Medications

SSRI’s, no evidence of serengenic deficenct, effective for <60% of patients

Treatment of Illness Anxiety: Psychotherapy

• First psychotherapy randomized control trial

• Treatment similar to panic disorder: panic control treatment

• Cognitive: change misattribution of symptoms

• Introceptive exposure: creating symptoms and habituating to those

• 76% of treatment group improved

• 5% of wait-list group improved

• Gains retained at 1 year follow up

• Subsequent studies mirror findings