HD 3700 Prelim 2- Somatic Symptoms Disorders

Somatic Disorders

• characterized by prominent bodily (somatic) symptoms and/or anxiety around illness

Somatic symptom disorders

• one or more somatic symptoms that are distressing or result in significant disruption of daily life 

  • somatic symptoms may or may not have a clear cause 

  • can include, pain, swelling, coughing, fatigue, palpitations, dizziness, GI symptoms 

somatic symptoms disorders

• excessive thoughts, feelings, or behaviors related to the somatic symptoms are associated health concerns as manifested by at least one of the following 

  • disproportionate and persistent thoughts about the seriousness of one’s symptoms 

  • persistently high level of anxiety about health or symptoms 

  • excessive time and energy devoted to these symptoms or health concerns

• although 1 symptom may be not be cont present, the state of being symptomatic is persistent

  • specially if pain is predominant and if symptoms are mild, moderate, or severe

SSD prevalence

• relatively common: 5-7% of population

• more common in women

• more common in people who have tendency to experience bodily sensations intensely and to pay attention to bodily cues

Illness Anxiety Disorder

• preoccupation with having or acquiring serious physical illness

• somatic symptoms are not present; or if present are only mild

  • if another medical condition is present, or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate

• high level of anxiety about health

• performs excessive health-related behaviors

• present for at least 6 months

• illness- related preoccupation not better explained by another mental disorder

disease conviction

• strong persistent belief in having a serious physical illness, despite lack of medical evidence and info/ reassurance from health care professionals 

• often present in illness anxiety disorder  

Predictors of SSD and illness anxiety disorder

• related to cognition and perception of physical signs

• enhanced sensitivity to cues of illness

• current stress

• belief that severe illnesses are common

• disproportionate early life experiences of disease in family members

• covid increased these disorders

how this can maybe occur (flow chart)

treatment for ILD and SSD

• CBT frist

  • yield strong effects with relatively brief course 

• modifying thoughts around symptoms or illness 

• adding behaviors to boost quality of life and relationships 

• help people interpret physical symptoms without assuming they are dangerous

functional neurological symptom disorder (conversion disorder)

• >1 symptoms of altered voluntary motor or sensory function

• clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions

glove anesthesia

• neurology, functional: refers to a symptom without an organic cause

• people lose all feeling and become numb in one hand

• physical damage to ulnar nerve causes numbness (pinky - ½ ring)

• physical damage to radial never causes numbness ½ ring -thumb

specify if with

• with weakness/ paralysis

• with abnormal movement

• with swallowing symptoms

• with attacks / seizures

• with anesthesia / sensory loss

• with special sensory symptoms

• with mixed symptoms

primary gain

• anxiety around an unconscious conflict is reduced by “converting” psychological symptoms to physical ones

secondary gain

• symptoms may be prolonged or exacerbated if they result in some kind of benefit, sympathy, attention

prevalence

• episodes of unresponsiveness / seizures are the most common functional symptom globally

• more common in women

• 16-20% of new neurology patients

What are some primary environmental risk factors?

• achievement- related pressure 

• trauma and stress 

  • high rates of functional blindness among Cambodian refugees who witnessed war trauma

• infections and inflammation

prognosis

• long term prognosis of FND is similar to that for multiple sclerosis and Parkinson’s

• significant decrements in quality of life due to symptoms

• course can be waxing and waning

FND over time

• prevalence has shifted over history

• common in turn of the century europe, particularly in women

• increased during WW1&2

Mass Psychogenic Illness

• outbreaks of functional neurological disorder within a group of people who share daily activities

• spread of symptoms is often very rapid

• ex) dancing manias

spread of mass psychogenic illness is exacerbated by…

• rumors and misinformation about causes

• community pressure to solve problem

• lack of attention to psychological explanations

• anxiety related to presumed causes (vaccines, chemical exposure)

• negative perception of government and health authorities

• psychological stressors

• media and social media coverage

• physical proximity or close-knit group

Factitious Disorder 

• falsification or physical / psychological signs or symptoms or induction of injury or disease, associated with identified deception

• criteria:

  • individual presents themselves to others as ill, impaired or injured

  • deceptive behavior is evident even in absence of obvious external rewards

  • behavior is not better explained by another mental disorder like delusional or psychotic

• can occur for oneselfs or be imposed on another by proxy

• early life maltreatment, particularly physical and emotional maltreatment

• 60% experience severe childhood illness 

• higher prevalence among health care professionals 

• patients describe uncontrollable urge to maintain behaviors 

Falsification of symptoms can be extreme

• creating lesions, swelling

• ingesting substances to create abnormalities in blood

• contamination of medical samples with blood or stool

Munchhausen’s Syndrome

• nickname of factitious disorder

Malingering

• intentionally presenting false symptoms for personal gain

• usually but not always financially motivated

• not considered psychological disorder

• factitious disorder differs from malingering because the symptoms are not linked to personal gain

treatment for factitious disorder

• disorder by proxy is often by legal issue

• no standard treatment

• frequently DONT consent to treatment

• prognosis considered poor

• some improvement with CBT and supportive treatments

• some improvement documented when comorbid conditions are treated