Somatic symptom and related disorders

What are Somatic symptom and related disorders?

Group of disorders characterized by excessive thoughts feeling, and behaviours related to somatic symptoms. These individuals experience real physical symptoms, but cannot be fully explained by a medical condition.

Somatic symptom disorder main symptoms

Involves presence of physical symptoms and a preoccupation with these symptoms. Since there is no biological reason for these symptoms, doctors tell these patients they can’t help, which makes them feel crazy.

Extra symptoms of somatic symptom disorder

Continuously feeling weak and ill, pain (which can be anywhere and severe), gastrointestinal distress, psychogenic seizures.

Somatic symptom disorder main DSM symptoms

One of more somatic symptoms that cause distress or result in significant disruption in daily life. Excessive thoughts, feelings, and behaviors related to the somatic symptoms. Occurs for more than 6 months.

Difference between SSD, SAD, and OCD

Does this person have compulsion? Dees this person have anxiety about most things in their life?

Illness anxiety disorder

Used to be called hypochondriasis. Physical symptoms are absent or mild. The main preoccupation is the “idea” of being sick. Involve repetitive behaviors similar to OCD rituals.

What has a high rate of comorbidity with illness anxiety disorder?

Anxiety disorder and depressive disorder

Repetitive behaviors of Illness anxiety disorder

Reassurance seeking, self-monitoring (eg. blood pressure), and avoidance of feared situations (sometimes avoid doctor out of fear their worries are true). Reassurance seeking can cause friction between doctors and the patient, as the doctor does not validate their fear. Relationships also get fractured due to reassurance seeking.

Illness anxiety disorder

Preoccupation with having or acquiring serious illness. Somatic symptoms are not present, or are mild. High levels of anxiety about health. Excessive health-related behaviors. 6 months or more, but the target of the concern can change (eg, which disease they are scared of).

What is the difference between SSD and IAD?

SSD is preoccupation on the bodily symptoms. IAD is preoccupation with getting sick or more sick.

IAD stat/factors

Low prevalence 1-5% in the population. Late age of onset; develops in adolescence. more common in unmarried women. Lower SES.

Etiology of SSD and IAD psychological factors

Children and adults who report more aches and pains have more negative emotions. Poor self-awareness of the presence of these emotions and are less able to regulate their emotions. Lack of understanding of emotional stress and its relation to physical functioning.

Etiology of SSD and IAD behaviorism and environmental factors

Behavioral principles: modelling and reinforcement (maybe grew up with someone who had a chronic illness and learnt that illness = reassurance).

Environmental stressors: stress, childhood abuse, family seperation, family conflict.

Etiology of SSD and IAD cognitive factors

Distorted cognitions: somatic amplifications - inaccurate beliefs about prevalence and contagiousness of illnesses, meaning of bodily sensations/symptoms, course and treatment of illnesses.

Treatment of SSD and IAD

Hard to treat, because people don’t like hearing their pain is all in their head. CBT - Reduce stress, minimize help-seeking behaviors, relating to others. We can never remove the pain, but we can reduce their distress.

Conversion disorder (functional neurological symptom disorder)

Motor symptoms or deficits, globus, sensory abnormalities, la belle indifference. Overall incompatibility between symptom and recognized neurological or medical conditions.

motor symptoms or deficits

Impaired coordination or balance, paralysis or weakness, tremor, gait abnormality, abnormal limb posturing.

Globus

Aphonia (inability to speak), sensations of choking, difficulty swallowing, shortness of breath, feelings of suffocation

Sensory abnormalities

Loss of touch or pain sensations double vision or blindness, deafness, hallucinations

La belle indifference

Substantial emotional indifference to the presence of these dramatic symptoms (not necessary symptom).

Are symptoms of conversion disorder real?

ppl with conversion disorder are not faking (not unconscious process either). We currently think the symptoms are purely caused by psychology but are not sure.

Does conversion disorder follow typical neurological patterns. Give an example:

No it doesn’t! Glove anesthesia - when ppl with conversion disorder can’t feel their hand. This is impossible because of the way that our sensory nerves are organized.

Conversion disorder stats

Conversion disorders are rare in mental health settings. Prevalence in neurological setting is 30% (there is a chance that the medical reason is not being identified). Primarily happens in women, developing in adolescence.

Causes of Conversion disorder

Repression of stress/anxiety (unconscious) → When anxiety becomes conscious the person converts it to physical symptoms → positive reinforcement (not faking may just be unconsciously learred). Interpersonal factors: stress, abuse, parental divorce. Less educated, low SES.

Treatment of conversion disorder

Identify source of stress; reduce stress. Minimize help seeking behaviors (improves relationships). CBT

CBT thought records

Clinician gets patient to identify Situation → physical sensations → thought → emotion → evidence for or against → alternative thought → How do I feel now? → feedback loop to situation. Considering these helps identify triggers and bodily awareness as well as encouraging critical thinking and adaptive cognitions.

CBT for somatic symptom disorders

It’s not just the symptoms that cause distress; it’s how the symptoms are interpreted and responded to (which is what CBT targets). Trigger (bodily sensation) → thought → emotion → behaviour - CBT targets emotion and behavior.

Jordan notices their heart rate beating rapidly during a work presentation. They think, “this must mean I’m having a heart attack.” They become panicked, leave the room, and book a medical appointment that afternoon. Tests are normal, but Jordan remains convinced something is wrong. In this scenario describe the thought record.

Situation = presentation. Sensation = heart rate up. Thought = I’m having a heart attack. Emotion = anxiety/fear. Behavior = Panic and books appointment. Evidence for thought = Heart rate up. Evidence against thought = Tests show nothing. Alternative thought = I’m just nervous. Outcome = I know I’m not dying and am just nervous

Factitious disorder (Munchausen syndrome)

Physical or psychological symptoms are intentionally faked - the patient is looking to gain attention and support - internal incentives. Not Malingering (produces symptoms to escape military service, or criminal prosecution) -external incentives.

Factitious disorder main DSM criteria

Falsification of physiological or psychological symptoms or induction of injury or disease associated w identified deception. Presents self as ill, impaired or injured. Deceptive behavior is evident - even in absence of external rewards.

Factitious disorder (imposed on self)

Deceptive practices to produce signs of illness or mental illness in oneself. Goes to emergency rooms during evenings and weekends so they will be seen by junior staff. Invents false demographic information, including aliases and false info about the past.

Lab result examples in factitious disorder patients (presenting complaint vs lab evidence)

Hematuria (blood in urine) = Red candy in urine samples. Nonhealing wound = mouthwash found in wound. Diarrhea = Excessive ingestion of castor oil or laxatives. Pain from kidney stones = Glass fragments in urine. Vomiting = ipecac abuse.

Factitious disorder (imposed on another)

Deceptive practices to produce signs of illness in someone else. Most often a mother produces symptoms in her child (infants to teenagers). This is considered child abuse even thought it’s a DSM diagnosis. Sometimes seen in nursing homes where nurses inflict symptoms on adults.

Factitious disorder (Imposed on another) how does it differ from typical child abuse?

There is usually no awareness of abuse in the child. The perpetrator invites the health care system to check on their child. Mothers gain attention from doctors, who praise them for being a good mother. Faking of illness/medical condition is not obvious upon physical examination.

Functional impairment of factitious disorder

Issues with employment, physical disability, overuse of health services, economic costs.

Impact of factitious disorder on medical system

Doctor-shopping - to find the doctor that will give them the most attention. Factitious disorder = numerous hospitalizations and can develop medical conditions as a result of their self-administered injuries. Factitious disorder imposed on another imposed on another = 6-22% of childrendie

Overall description of Somatic symptom disorder

One or more somatic symptoms (symptoms are moderate to severe). Disproportionate concerns about seriousness. Anxiety. Excessive time and energy devoted to health. Diagnosed medical illness may or may not be present.

Overall description of Illness anxiety disorder

Preoccupation/anxiety/worry about having or acquiring a serious illness. No medical condition. If symptoms present they are mild.

Conversion disorder

Symptoms affecting motor or sensory functions. Incompatible with neuro or medical conditions (eg, glove anesthesia)

Factitious disorder

Faking or inducing symptoms to gain sympathy/medical care/attention