Somatic Symptom and Psychosexual disorders

Factors that may contribute to somatic symptom and related disorders

Genetic/ biological vulnerability
Early traumatic experience
Learned behaviors
Social/ cultural norms

Somatic symptom disorder

One or more somatic sxs that are actually present and are distressing or result in significant disruption in daily life
Excessive thoughts, feelings, or behaviros related to sxs that are disproportionate and persistent thoughts about seriousness of ones sxs, persistently high level of anxiety about health or sxs, or excessive time/ energy devoted to those concerns

Somatic symptom disorder is often occurs with...

concurrent medical illness

Associated features of somatic symptom disorder

Attribution of normal bodily snesations to physical illness
Worry about illness
Fear that physical activity may damage body
Checking body for abnormalities
Repeated seeking of medical help

MC sxs in somatic symptom disorder in children are...

headache, fatigue, abdominal pain

Somatic sxs disorder is often missed in...

elderly

Illness anxiety disorder

Preoccupation with having or acquiring a serious illness
Somatic sxs not present, or if present they're mild
Preoccupation is clearly excessive or disproportionate
Performs excessive health-related behaviors or maladaptive avoidance
Present for at least 6 months

Specifiers for illness anxiety disorder

Care-seeking
Care-avoidant

Illness anxiety disorder patients typically have elevated rates of medical utilization but do not over-utilize....

mental healh services

Illness anxiety disorder risk and prognostic factors

Precipitated by major life stress or threat to one's health
History of child abuse
History of serious childhood illness

Conversion disorder

-One or more sxs of altered voluntary or sensory function
Clinical findings provide evidence of incompatability between sxs and recognized neuro/ medical conditions (necessary for dx)
Sxs not better explained by another medical/ mental disorder
Sx or deficit causes clinically significant distress (patient not faking)

To make the diagnosis of conversion disorder, what must be present?

Clinical findings that show clear evidence of incompatibility with neurologic disease

la belle indifference

a French term descriptive of the lack of concern for their (imagined) medical problem sometimes shown by people with conversion disorders

Risk and prognostic factors for conversion disorder

Temeramental: maladaptive personality traits
Environmental: History of childhood abuse/ neglect
Genetic/ physiological

Psychological factors affecting other medical conditions

Something going on psychologically (anxiety, depression, etc) and symptoms from that disorder negatively affet an acutal medical condition

Factitious disorder (Imposed on self or another)

Falsification of physical or psychological s/sxs or induciton of injury/ disease, associated with identified deception
Deceptive behavior is evident even in abscence of obvious external rewards (your attention could be that reward- could be malingering)

pseudocyesis

false pregnancy (a woman who believes she is pregnant - this may be a psychological condition or related to underlying pathology, such as a uterine tumor)

Treatment for somatic sx disorders

Treat comorbid psychiatric conditions
Therapy

Delayed ejaculation

Either must be present at least 75% of partnered sexual activity
-Marked delay in ejaculation
-Marked infrequency or absence of ejaculation
Sxs are causing distress/ not better explained by relationship distress/ significant stressor

Delayed ejaculation treatment
What meds can help?

Psychotherapy (Wellbutrin, amantadine, and buspirone can help)

Erectile disorder

At least one of the following must be experienced in 75% of sexual encounters
-Marked difficulty in obtaining an erection during sexual activity
-Marked difficulty in maintaining an erection until the completion of sexual activity
-Marked decrease in erectile rigidity

Risk and prognostic factors for erectile dysfunction

Anxiety disorders
Submissive personality
Age
Tobacco use
Sedentary lifestyle
Medical conditions

Treatment of erectile disorders

Therapy
PDE5 inhibitors

Diagnostic testing for erectile disorders

Nocturnal tumescence testing
Lipid panel
Serum glucose
Thyroid function
TST levels

Female orgasmic disorder

>75% of sexual encounters
-Marked delay in/ infrequency of/ absence of orgasm
-Markedly reduced intensity of orgasmic sensations

Female orgasmic disorder treatment
What meds may help?

Therapy
Wellbutrin and PDE5 inhibitors may help

Female sexual interest/ arousal disorder

Lack of or significantly reduced sexual interest/ arousal
-Absent/reduced interst in sexual activity, sexual thoughts, reduced initiation of sexual activity, reduced genital/ non-genital sensations during sex
-Causes significant distress

Female sexual interest/ arousal disorder treatment

Therapy
Addyi
Vyleesi

Genito-Pelvic Pain/ Penetration disorder

Persistent/ recurrent difficulty with one/ more of following:
-Vaginal penetration during intercourse/ penetration (tampon even)
-Marked vulvovaginal/ pelvic pain during intercourse/ penetration
-Marked fear/ anxiety from problems
-Marked tensing/ tightening of pelvic floor muscles during attempted penetration

Risk and prognostic factors for Genito-Pelvic Pain/ Penetration disorder

Sexual and/or physical abuse
Pain sometimes begins as vaginal infection but persists after infection resolves

Genito-Pelvic Pain/ Penetration disorder treatment

Therapy
Physiotherapy (pelvic floor therapy)
Anesthetics/ Botox (no indication)

Male hypoactive sexual desire disorder

Persistently/ recurrently deficient sexual/ erotic thoughts or fantasies AND deficient desires for sexual activity
-causes significant distress

Male hypoactive sexual desire disorder treatment

Therapy

Premature (early) ejaculation

Persistent/ recurrent pattern of ejaculation occuring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes
-Causes distress/ impairment

Premature ejaculation treatment

Therapy
Behavior techniques
Analgesics, antidepressants, PDE5 inhibitors

Paraphilia

Any intense and persistent sexual interest other than sexual interest in genital stimulation or foreplay with phenotypically normal, physiologically mature, consenting partners

Voyeuristic disorder criteria

Recurrent and intense sexual arousal from observing an unsuspecting person who is naked/ term or engaging in sexual activity
-Can manifest by fantasy, urge, or behavior
-Individual has acted on these sexual urges with a non-consenting person or sexual urges cause clinically significant distress
Individual must be 18+

Other specificed sexual dysfunction

Sxs present and causing distress but do not fully meet diagnostic criteria
MUST specify why presentation does not meed diagnostic criteria

Voyeuristic disorder in full remission years required

At least 5 years

Most common of potentially law-breaking sexual behaviors

Voyeuristic disorders

Risk and prognostic factors for voyeuristic disorder

Childhood sexual abuse
Substance misuse
Hypersexuality
More common in males

Exhibitionistic disorder

Recurrent/ intense sexual arousal from exposure of one's genitals to an unsuspecting person
Manifested by fantasies, urges, behaviors
Individual has acted on these sexual urges with a non-consenting person or sexual urges cause clinically significant distress

Risk and prognostic factors for exhibitionistic disorder

Antisocial personality disorder
Alcohol use disorder
Pedophilia
Hx of childhood sexual and emotional abuse
Hypersexuality

Frotteuristic disorder

Recurrent and intense sexual arousal from touching or rubbing against non-consenting person
Manifested by fantasies, urges, behaviors
Individual has either acted on these urges on non-consenting person or urges cause sig. distress

Sexual masochism disorder

Recurrent/ intense sexual arousal from act of being humiliated, beaten, bound, or otherwise made to suffer
Manifested by fantasies, urges, or behaviors that cause clinically sig. distress

Sexual sadism disorder

Recurrent/ and intense sexual arousal from physical or psychological suffering of another person
Manifested by fantasies, urges, behaviors that cause sig. distress

Unique specifier with sexual masochism disorder

asphyxlophilia

Pedophilic disorder
How old must individual be/ distance from children's age?

Recurrent/ intense sexually arousing fantasies, urges, or behaviors involving sexual activity with prepubescent child/ children (generally 13 and younger)
Individual has either acted on these urges or urges cause sig. distress
Individual is at least 16 years of age and at least 5 years older than the child/ children

Fettishistic disorder

Recurrent/ intense sexual arousal from either the use of nonliving objects or a highly specific focus on non-genital body parts
Fantasies, urges, or behaviros that cause sig. distress

Transvestic disorder

Recurrent/ intesnse sexual arousal from cross-dressing
Fantasies, urges, or behavior that cause sig. distress impairment

Gender dysphoria

Distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender

Gender dysphoria in children diagnostic criteria

Plus...
-In boys, strong rejection of typically masculine toys/ activities
-Strong dislike of one's sexual anatomy
-Strong desire for the primary and/or secondary sex characteristics that amtch one's experienced gender
-Sx cause sig. distress

Gender dysphoria in adolescents and adults diagnostic criteria

Treatment for paraphilic disorders and gender dysphoria

Therapy/ support groups