Chapter 33 - Somatic Symptoms and Dissociative Disorders

Somatic Symptom Disorder (SSD)

involves one or more physical symptoms with excessive amount of time, energy, emotion, behavior related to significant distress

Physical symptoms may or may not be explained by a medical condition

Signs of people with SSD: Dx

Sicker than sick

Intense focus on their bodies

Report all aspects of their life are poor

Constantly have appointments with doctors

- provider shop when they do not receive enough attention

Common complaints of SSD

Excessive thoughts of 1 or more physical symptoms

Pain is followed by fatigue

Common symptoms

- dysmenorrhea, lump in throat, vomiting, SOB, buring in sex organs, painful limbs, amnesia, GI issues

Who?

Effects women and men but mostly non-white women

Less educated

Lower socioeconomic status

High emotional distress

Why?

High levels of physiologic response

Physical expression of emotional problems

Found in cultures with greater stigma against mental health

Link between childhood sexual abuse/trauma and somatization

Social/Emotional communication: "only get communication when sick"

When?

Can start seeing signs in childhood with frequent complaints of stomachache, headache, cramps, nausea

Not begin diagnosis until adolescence

Symptoms begin after age 30

Can be lifelong

How does it affect life?

Ineffective coping

Social - main social network is health care providers

Employment - trouble keeping a job

Family - may be married to antisocial, family focuses on pt not themselves

Evidence Based Care

1. allow enough time to talk about physical symptoms and then address mental illness

2. assess SSD with health attitude survey

3. address physical functioning - usually have major fatigue and daily task are overwhelming

Medications

Multiple doctors - multiple meds - muktiple side effects

Self medicate with alcohol and weed

they like benzo

Meds prescribed:

- antidepressants for underlying depression and anxiety

- duloxetine - SSRI and SNRI indicated for neuropathy, MDD, anxiety

Therapeutic Relationship

Takes time and patience

try non-pharmacologic strategies for pain

help establish healthy routine of exercise and healthy diet

change focus to staying healthy

encourage CBT and stress management

Illness Anxiety Disorder (Hypochondria)

Fear of developing serious illness based on misinterpretation of body sensations

Fear of illnesses continues despite medical reassurance

Interferes with psychosocial functioning

Spends a lot of money trying to figure out what is wrong

Conversion Disorder

Severe emotional distress is expressed through CNS physical symptoms - all neuro testare normal

- impaired balance, paralysis, aphonia, difficulty swallowing, sensation of lump in throat, blindness, deafness

All very real to patient

Facticious Disorder

Munchausen's Syndrome

Intentially cause illness/injury/fabricate medical records to receive attention from health care workers

Include seizures, wound-healing, ingest poisons, abscesses

Pedological Fantastica - red flag of disorder - their own story of personal triumphet (true and false)

Can be imposed onto another (mother to child normally)

Different for borderline personality disorder (BPD)

Doctor finds out and gets angry - pt angry - new doctor

Facticious Disorder Priority

Safety from self-injurious behavior