OT 501 Diagnostics (Somatic Symptom and Related Disorders)

what is somatic symptom disorder?

one or more somatic symptoms that are distressing and result in significant disruption of daily life; excessive though, feelings or behaviors (disproportionate or persistent thoughts about seriousness of symptom, high level of anxiety, excessive time and energy devoted to symptoms or health concerns)

how long does somatic symptom disorder last?

more than 6 months

prevalence of somatic symptom disorder

more common in men (5-7%)

imagined pain is

real pain

what are some associated problems of somatic symptom disorder

disability, unemployment, drug addiction, isolation and withdrawal

consequences of pain of somatic symptom disorder

important that people return to work and don't allow that pain to define lifestyle

what is illness anxiety disorder (how long does someone have to have this?)

-preoccupation or fear of having or acquiring disease

-symptoms are either not present or only mild intensity

-high level of anxiety about health and the individual is alarmed by health status

-excessive health related behaviors

-must have for at least 6 months

illness anxiety disorder associated features

-misinterpret bodily symptoms

-concerns about illness may become a central part of self image

-may be much of what they talk about

-doctor shopping

-frustration with physician patient relationship

-may expect special treatment from family

-missed work time

30% of primary care visits could be....

illness anxiety disorder

what is conversion disorder?

symptoms or deficits affecting volunteer or sensory motor functions (paralysis, impaired coordination, difficulty swallowing, loss of touch or pain sensation, double vision, blindness, deafness, seizures or convulsions)

-clinical findings provide evidence of incompatibility

-symptoms not intentionally produced

what psychological factors play a role in conversion disorder?

-pilot may develop double vision

-artist may develop hand paralysis

secondary gain

conversion symptoms don't follow known anatomical pathways... (examples)

paralyzed limb may move during dressing or when attention is engaged

difficulty swallowing equal with solids and liquids

conversion disorder is common in

rural areas, low SES, developing regions, women, during times of stress (war, industrial accidents)

prevalence and course of conversion disorder

RARE

rarely seen before age 10 or after 35

onset is acute

recurrence is common

many things could be misdiagnosed as... (examples)

conversion disorder (MS, substance induced symptoms)

malingering occurs only when

someone is observing

what is malingering?

intentional production of false or grossly exaggerated physical or psychological symptoms; motivated by external incentives

common external incentives of malingering

avoid military

avoid work

getting disability

obtaining drugs

avoid prosecution

what is pain disorder?

Prolonged pain not explained by physical causes (important people return to work and continue their lifestyle)

body dysmorphic disorder

involves excessive preoccupation with an imagined defect in physical appearance, mirror checking, excessive grooming behavior, think everyone notices defect

suspect malingering if....

lack of cooperation during evaluations, antisocial personality, difference between claimed distress and objective finding

what is factitious disorder? (munchausen's syndrome)

intentional production of symptoms (fabricated complaints, self-inflicted conditions)

exaggeration of symptoms

motivation is to assume sick role

what is an example of factitious disorder? (munchausen's syndrome)

injecting substances under skin

associative features of factitious disorder? (munchausen's syndrome)

usually present with dramatic flair

may engage in pathological lying

often have extensive knowledge of medical terminology

may undergo multiple invasive procedures

few visitors

if discovered, deny allegations and leave the hospital

prevalence of factitious disorder? (munchausen's syndrome)

hard to judge (often goes undetected)

munchausen's syndrome by proxy

intentional production of symptoms in another person (typically child)

may like to be seen as heroic parent

prosecuted as child abuse