Comprehensive Guide to Somatic Symptom and Mood Disorders in Psychology

Somatic symptom disorders

Body disorders (soma meaning body) that primarily present as physical symptoms. Individuals genuinely experience physiological symptoms; they are not pretending.

Etiology and general presentation of somatic symptom disorders

Symptoms have psychological causes, often associated with stress. Individuals seek treatment from medical doctors, often in emergency rooms, and resent being sent to psychologists because they believe symptoms are physical. Doctors run tests, find no cause, and recommend psychological help.

Factitious Disorder (formerly Munchausen's Disorder)

A disorder where people self-impose symptoms, often by inducing them (e.g., swallowing substances or injecting). They enjoy the 'sick role.'

Factitious Disorder Imposed on Another (Munchausen's by Proxy)

Inducing symptoms in another person under their care (e.g., a mother inducing symptoms in her child to **********************). The child experiences symptoms, but the adult gets the diagnosis. Considered criminal and child abuse.

Malingering

Faking symptoms for monetary or external gain (e.g., pretending back injury for compensation). Somatic symptom disorders involve genuine physiological symptoms, not pretending.

Factitious disorder vs. malingering

Factitious disorder seeks the sick role, not financial gain. No external incentive like in malingering.

Conversion Disorder (Functional Neurological Symptom Disorder)

Sensory or motor symptoms suggesting a neurological disorder, with no physiological cause. Symptoms appear suddenly after great stress; underlying cause is psychological.

Specific symptoms of Conversion Disorder

Numbness, paralysis, blindness, seizures. Includes psychogenic movement (twitches), sensory symptoms (loss of voice), psychogenic seizures (pseudo seizures without brain activity), and physiologically impossible presentations (e.g., glove anesthesia).

Commonalities of Conversion Disorder and Somatic Symptom Disorder

Both occur in response to severe stress and are viewed as forms of escape from stress (e.g., blindness avoids dealing with stressor).

"La belle indifference" in Conversion Disorder

Individuals are not as distressed by severe symptoms (e.g., paralysis) as expected. Concerned more about how it relates to others or what others think, rather than the physiological meaning.

Somatic Symptom Disorder (SSD)

Physical symptoms (e.g., pain, aches) with no physiological cause, and the person is bothered by them. One of the disorders in the somatic symptom category.

Illness Anxiety Disorder (IAD), formerly hypochondriasis

Persistent anxiety over having an undetected physical illness. No or minimal somatic symptoms. Worried about being sick, overreact to perceived symptoms. Lasts at least 6 months.

Cognitive patterns in Illness Anxiety Disorder

1. Catastrophization (minor experiences suggest major issues). 2. Overgeneralization (small symptom means everything wrong). 3. All-or-Nothing Thinking (pain jumps to cancer). 4. Selective Attention (focus on illness-related symptoms, dismiss alternatives).

Behavioral presentations and specifiers in Illness Anxiety Disorder

Excessive health-related checking. Specifiers: Care-seeking type (many doctors, insist on tests). Care-avoidant type (avoid doctors due to fear of confirmation).

Treatment insight for Illness Anxiety Disorder

Involves obsessive thinking and compulsive checking; may use Exposure and Response Prevention (ERP), e.g., avoid looking up symptoms online. Avoid sites like WebMD.

Moods in mood disorders

Pervasive, longer, life-altering experiences. Emotions are momentary/temporary. Mood is like the season; emotion is daily weather.

Affective symptoms of depressive disorders

Feeling sad, down, empty, hopeless, worthless, irritable, anxious; inability to experience joy.

Cognitive symptoms of depressive disorders

Pessimism, self-criticality, rumination, trouble with memory/focus/comprehension/decision-making, thoughts of suicide/death.

Behavioral symptoms of depressive disorders

Social withdrawal, lack of motivation, overwhelming daily activities, lower productivity, lack of hygiene, slowed speech/responses.

Physiological symptoms of depressive disorders

Appetite/weight changes, sleep disturbance (insomnia/hypersomnia), fatigue, unexplained aches/pains, lack of sexual drive, physical slowness.

Major Depressive Disorder (MDD)

Common disorder, episodic. Requires 5+ symptoms for 2+ weeks, more days than not. At least one required: sad/depressed mood or loss of interest. No manic episodes.

MDD specifiers: Peripartum Onset

Symptoms during pregnancy or within 4 weeks of childbirth (replaces 'postpartum depression' due to hormonal changes).

MDD specifiers: Psychotic Features

So depressed they have delusions or hallucinations.

MDD specifiers: Seasonal Pattern (SAD)

Onset in fall/winter, remission in spring/summer. More prevalent in higher latitudes due to light differences.

Persistent Depressive Disorder (Dysthymia)

Chronic depression, lesser severity. Depressed mood for 2+ years, no symptom-free period >2 months. 2+ additional symptoms (low energy, low self-esteem, poor concentration, hopelessness).

Premenstrual Dysphoric Disorder (PMDD)

Severe symptoms (e.g., depression) a week before menstruation, subside after. Requires 5 symptoms, including mood swings/irritability/depressed mood/anxiety/tension, plus physical/behavioral (fatigue, sleep/appetite changes, bloating).

Difference between mania and hypomania

Mania: Full-blown, exaggerated activity/emotions (racing thoughts, pressured speech, inflated self-esteem, reckless behavior, possible psychosis). Lasts 1+ week. Hypomania: Milder, less impairment. Lasts 4+ consecutive days.

Bipolar I Disorder

Requires full manic episode. Diagnosed even without depressive episode.

Bipolar II Disorder

At least one major depressive episode (2+ weeks) and one hypomanic episode (4+ days).

Rapid Cycling specifier in bipolar disorders

4+ mood episode changes in a year (not day-to-day). About 25% of Bipolar I have this.

Cyclothymic Disorder

Chronic, 2+ years. Cycles between hypomania and dysthymic-level depression. More frequent/faster changes than Bipolar I/II.

Biological factors in depressive disorders

Genetics (runs in families). Low serotonin/norepinephrine. High cortisol/chronic stress depletes serotonin. Insomnia/increased REM. Irregularities in amygdala/hippocampus/prefrontal cortex. Concussions increase risk.

Biological factors in bipolar disorders

Stronger genetics (40% concordance in identical twins). High norepinephrine, low serotonin. Stress exacerbates.

Psychological factors in depression (behavioral theories)

Insufficient social reinforcement; social withdrawal reduces positive interactions, deepening depression.

Psychological factors in depression (cognitive theories - Beck's Triad)

Dysfunctional beliefs/negative schemas from early experiences. Negative views of self, future, world.

Learned Helplessness in depression

Develops from uncontrollable negative events.

Attributional Style in depression

Explaining negative events as global, stable, internal (e.g., failure due to being 'stupid'), leading to helplessness/hopelessness.

Hopelessness View in depression

Belief that desired outcomes won't happen, actions have no effect.

Social factors in depression

Isolation/rejection increase stress. Cyberball game shows exclusion activates depression-related brain areas.

Gender differences in depression prevalence

More common in women (1 in 4 lifetime risk vs. 1 in 8 men). Possible reasons: social acceptability of expressing sadness, hormones (menstrual/pregnancy), stress from labor imbalance.

Biological treatments: Antidepressant Medications

SNRIs (serotonin/norepinephrine), SSRIs (serotonin). Block reuptake, increase availability. Suppress symptoms, not cure.

Biological treatments: Mood Stabilizers for Bipolar

Bring lows up, highs down. Lithium (60-80% effective, monitor for side effects like liver damage). Anticonvulsants. Antidepressants must combine with stabilizer to avoid mania.

Electroconvulsive Therapy (ECT)

For severe depression. Electric current causes seizure to reactivate neurons. Under supervision; side effect: memory loss.

Transcranial Magnetic Stimulation (TMS)

Magnetic pulses reactivate neurons for severe depression. Side effect: temporary headaches.

Light Therapy

For SAD/sleep issues. Special lights reset circadian rhythms.

Lifestyle treatments for mood disorders

Moderate/intense exercise releases endorphins. Omega-3 supplements.

Cognitive Behavioral Therapy (CBT) for mood disorders

Identify distorted thoughts (Beck's triad), replace with realistic statements. Effective with medication.

Behavioral Activation for depression

Increase pleasurable activities despite lack of motivation; underestimate enjoyment.

Interpersonal Psychotherapy (IPT) for depression

Depression in interpersonal context. Focus on relationships, social skills, conflict resolution, communication.

Mindfulness for mood disorders

Recognize negative thoughts without attaching; observe and let go.

Social Rhythm Therapy for Bipolar

Create routines to reduce stress, regulate mood, prevent relapse. Therapy helps manage, not reduce symptoms.

Definition of suicide

Intentionally ending your life. Not a disorder, but thoughts of death/suicide are symptoms (e.g., in MDD).

How common is suicide?

Top 10 cause of death in US. Actual number 20-30% higher due to stigma/underreporting.

Disorders associated with suicide

MDD, substance use, schizophrenia, borderline personality, PTSD.

Risk factors: Hopelessness and Helplessness

Common emotion: hopelessness (nothing can improve). Related to increased suicidality.

Risk factors: Stressful Events

Intolerable psychological pain. Frustrated needs (e.g., feeling failure when goals blocked).

Risk factors: Alcohol and Drugs

Frequently involved in attempts.

Risk factors: Modeling (Suicide Contagion)

Media reports increase rates. Talking can increase for vulnerable people.

Who is most at risk: Gender

Men 4-5x more likely to die; women 3x more likely to attempt.

Who is most at risk: Age

Highest: 25-44 and 45-64. 15% under 25.

Who is most at risk: Race/Culture

Highest: Native Americans. Lowest: Asian Americans.

Who is most at risk: Marital Status

Married least likely; divorced highest.

Who is most at risk: Professions/Groups

Psychiatrists, physicians, lawyers, law enforcement, dentists, psychologists. Higher in LGBTQ adolescents, rape survivors. Most common death in prison.

Role of guns in suicide

Men use guns (60% of male suicides). Women use poisoning. Guns more successful.

How to identify danger in therapy for suicide

66%+ communicate intent. Check: 1. Ideation (thoughts). 2. Plan (specific increases danger). 3. Means (access, e.g., guns). 4. Intent (now?).

What to do if a friend is suicidal: Reduce the Means

Remove/lock up means (pills/guns) to delay act, let despair pass.

What to do if a friend is suicidal: Contract for Safety

Agreement on steps if suicidal (call hotline/911).

What to do if a friend is suicidal: Broaden Options/Reduce Pain

Reduce psychological pain, show other options. Suicide involves tunnel vision.

What to do if a friend is suicidal: Seek Intervention

If unwilling to safety measures and danger, involuntary hospital admission.

Non-Suicidal Self-Injury (NSSI)

Prevalence of NSSI

High, e.g., 17% lifetime in college students.

Associated features of NSSI

Secretive, not for attention (hide injuries). History of abuse/trauma, high negative affect (loneliness/anxiety/dysphoria), low impulse control, co-occurs with eating disorders.

Difference between NSSI and suicide

Lacks conscious suicidal intent. NSSI is a coping strategy for relief from overwhelming emotions. Physical pain preferable to psychological; provides control when numb/out of control.

Substance Use Disorder (SUD)

Maladaptive recurrent use over 12+ months. Combines old abuse/dependence. Requires 2+ symptoms.

Symptoms of SUD

1. Larger amounts than intended. 2. Unsuccessful cut-down. 3. Time spent obtaining/using/recovering. 4. Craving. 5. Failing obligations. 6. Continued use despite social problems. 7. Giving up activities. 8. Hazardous use. 9. Continued despite physical/psych problems. 10. Tolerance. 11. Withdrawal.

SUD severity levels

Mild: 2-3 symptoms. Moderate: 4-5. Severe: 6+.

Intoxication

Physical/psychological changes from psychoactive drug (e.g., sluggishness from alcohol).

Withdrawal

Negative effects when not getting needed drug. Usually opposite of substance effects.

Tolerance

Need more drug for effects; body/brain adjust for homeostasis.

Effects/Intoxication for Alcohol (Depressant)

Low: confidence, relaxation, reduced inhibitions. High: fatigue, lethargy, confusion, sleep issues, impaired judgment/coordination.

Withdrawal for Alcohol

Stage 1: shakiness, sweating, anxiety, headache, nausea. Stage 2: seizures. Stage 3 (DTs): hallucinations, delusions, severe sweating, heart issues, possible death.

NTs for Alcohol

GABA (binds receptors, shuts down neurons). Chronic: lower GABA production.

Effects for Benzodiazepines/Barbiturates (Depressants)

Slow down CNS.

NTs for Benzodiazepines/Barbiturates

Chronic: lower GABA production.

NTs for Opioids

Chronic: lower endorphin. Dopamine in reward pathway.

Effects/Intoxication for Caffeine (Stimulant)

Restlessness, nervousness, insomnia, rapid heart, shaking/twitching.

Withdrawal for Caffeine

Fatigue, headaches, irritability, feeling slow.

Effects/Intoxication for Amphetamines (Stimulant)

Behavioral changes, rapid heartbeat, dilated pupils, blood pressure changes, nausea, vomiting, weight loss, weakness, slowed breathing, chest pain, confusion, seizures, coma. Can induce psychosis.

Withdrawal for Amphetamines

Dysphoric mood, fatigue, bad dreams/insomnia, increased appetite/weight, slow/agitated.

NTs for Amphetamines

Release dopamine/norepinephrine, block reuptake. Chronic: lower endorphin.

Effects/Intoxication for Cocaine (Stimulant)

Rush, euphoria, powerful feeling. Similar to amphetamines. Can cause 'cocaine bugs' hallucination.

Withdrawal for Cocaine

Dysphoric mood, fatigue, bad dreams/insomnia, increased appetite/weight, slow/agitated.

NTs for Cocaine

Blocks reuptake, increases activity. High dopamine. Chronic: lower endorphin.

Effects/Intoxication for Cannabis

Impaired coordination, euphoria/anxiety, slowed time, red eyes, dry mouth, rapid heartbeat. Increases psychosis risk.

Withdrawal for Cannabis

Irritability, anger, nervousness, sleep trouble, depressed mood, sweating, shaking, stomach aches, fever, chills.

NTs for Cannabis

Reduced anandamide. Affects dopamine.

Effects for Hallucinogens

Change perceptions (e.g., time).

Binge Drinking

5+ drinks in one occasion. 40%+ in 18-25 year olds (2015). Dangerous as CNS depressant; can shut down brain functions, lead to death.

Gender differences in alcohol use/response

Men 2x likely for SUD. Women intoxicate easier (less metabolizing enzyme). Safe: women 1/day (7/week), men 2/day (14/week).

Age differences in substance use

18-25 highest for illicit drugs, binge, AUD.