[PSYCH] Somatic Symptom Disorders

Videbeck 8th ed. PowerPoint/ Lecture

somatization

transference of mental experiences and states into bodily symptoms

central features of somatic symptoms (3)

• physical complaints suggest major medical illness but have no demonstrable organic basis

• psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms

• symptoms or magnified health concerns are not under the client’s conscious control.

categories of somatic symptom disorders (4)

• somatic symptom disorder

• conversion disorder

• pain disorder

• illness anxiety disorder

somatic symptom disorder

people's symptoms concern and preoccupy them, worry them constantly, and/or drive them to see doctors very frequently

criteria for somatic symptom disorder (3)

• high level of health-related anxiety

• disproportionate concerns about the seriousness of symptoms

• excessive time and energy devoted to these symptoms

illness anxiety disorder

• previously known as Hypochondria or Hypochondriasis

• people are excessively preoccupied (disease conviction) and worried about the possibility of having or getting a serious illness (disease phobia)

manifestations of illness anxiety disorder (3)

• preoccupation with having or acquiring a serious illness, despite minimal or no physical symptoms

• often engage in excessive health-related behaviors (e.g., checking their body for signs of illness)

• exhibit maladaptive avoidance (e.g., avoiding medical appointments out of fear of receiving bad news)

factitious disorder

•  people pretend to have symptoms for no apparent external reason (such as to get time off from work)

• falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with deceptive behavior

• done to assume the sick role

functional neurological symptom disorder, formerly conversion disorder

• physical symptoms that resemble those of a nervous system disorder develop (e.g., blindness, paralysis); suggest a neurologic disorder but are associated with psychological factors

• there may be an attitude of la belle indifférence, a seeming lack of concern or distress, about the functional loss.

clinical course for somatic symptom disorders (2)

• clients with somatic symptom illnesses tend to go from one physician or clinic to another, or they may see multiple providers at once in an effort to obtain relief of symptoms

• tend to be pessimistic about the medical establishment and often believe their disease could be diagnosed if providers were more competent

related disorders (2)

• factitious disorder

• malingering

malingering

• intentional production of false or grossly exaggerated physical or psychological symptom

• done to achieve external rewards

factitious disorder by proxy, Munchausen syndrome by proxy

• when a person inflicts illness or injury on someone else

• to gain the attention of emergency medical personnel or to be a “hero” for saving the victim

other specified somatic syptom and related disorder

presentations that do not meet the full criteria for the above disorders but still result in significant distress or impairment

unspecified somatic symptom and related disorder

symptoms cause distress or impairment but the specific diagnosis within the somatic symptom and related disorders category is unclear

psychosocial theories for somatic symptom disorder

• internalization: people with somatic symptom illness keep stress, anxiety, or frustration inside rather than expressing them outwardly; they express these feelings through physical symptoms (somatization)

  • may also be unintentional/ alexithymia: the inability to identify emotion

biologic theories for somatic symptom disorders (2)

• cannot sort relevant from irrelevant stimuli and respond equally to both types: they may experience a normal body sensation such as peristalsis and attach a pathologic rather than a normal meaning to it

• amplified sensory awareness;: too little inhibition of sensory input amplifies awareness of physical symptoms (e.g., minor discomfort such as muscle tightness becomes amplified because of the client’s concern and attention to the tightness)

treatment of somatic symptom disorder

• empathy and sensitivity to the client’s physical complaints: trusting relationship helps ensure clients stay with and receive care from one provider instead of “doctor shopping.”

• antidepressants, SSRIs: depression and anxiety may accompany or result from somatic symptom illnesses

• pain management for patients with chronic pain; avoid analgesics because of risk for dependence or abuse

• structured cognitive behavioral group