Somatic Symptoms

what settings are somatic symptom and related disorders most commonly found in

more commonly found in primary care and other medical settings- not psychiatric

these diagnoses are now made on the basis of the presence of symptoms and signs rather than the absence of a medical explanation

somatic symptom and related disorders

what are some contributing factors to somatic symptom disorders

-genetic and biological vulnerability (increased sensitivity to pain)

-early traumatic experiences (violence, abuse, deprivation)

-medical iatrogenesis (excessive referrals and diagnostic testing)

-learning (lack of reinforcement of nonsomatic expressions of distress)

-sociocultural norms (minimize ssuffering)

t/f: somatic symptom disorder pain can be specific or non specific (fatigue)

true

although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than ___________ )

6 months

( Criterion B) excessive thoughts, feelings, or behaviors related to the somatic symptoms of 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

somatic symptom disorder

what severity is this:

-only one of the symptoms specified in criterion b is fulfilled

mild

what severity is this:

-two or more of the symptoms specified in criterion B are fulfilled

moderate

what severity is this:

-two or more of the symptoms specified in criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom)

severe

Somatic symptom disorders need to be specified if:

there is predominant pain, and if there is persistence with severe symptoms, marked impairement, and long duration (more than 6 months)

most individuals who previously would have been diagnosed with hypochondriasis in DSM-IV are now classified as having what

somatic symptom disorder

in 1/3 of somatic symptom disorder cases, what other disorder now applies

anxiety disorder

what is the DSM-IV criteria for illness anxiety disorder

A. Preoccupation with having or acquiring a serious illness

B. Somatic symptoms are not present or, if present, are only mild in intensity. IF another medical condition is present of there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate

C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status

D. The individual performs excessive health-related behaviors

E. Illness preoccupation has been present for at least 6 months

F. The illness-related preoccupation is not better explained by another mental disorder

What specifier is this:

medical care, including physician visits or undergoing tests and procedures, is frequently used

care-seeking type

what specifier is this:

medical care is rarely used

care-avoidant type

what is the DSM-IV criteria for functional neurological symptom disorder

A. one or more symptoms of altered voluntary motor or sensory function

B. clinical findings provide evidence of incompatibility between symptom and recognized neurological or medical conditions

C. the symptom or defecit is not better explained by another medical or mental disorder

D. The symptom of deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation

There may be one or more neurological symptoms of various types. The diagnosis rests on clinical findings that show clear evidence of incompatibility with recognized neurological disease. it is not a diagnosis of exclusion

functional neurological symptom disorder

how frequent is an acute episode of functional neurological symptom disorder

present for less than 6 months

what are some specific symptom specifiers of functional neurological symptom disorder

-weakness or paralysis

-abnormal movement

-with swallowing symptoms

-speech symptoms

-seizures

with functional neurological symptom disorder, what is onset associated with

onset may be associated with stress or traume, either psychological or physical in nature but is absent in 50% of individuals

is functional neurological symptom disorder more common in men or women

2-3 times more common in women

the diagnosis emphasizes the objective identification of falsification of signs and symptoms of illness and not the individual motivations of the falsifier

factitious disorder

what is the DSM-IV criteria for factitious disorder

A. falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception

B. The individual presents himself or herself to others as ill, impaired, or injured

C. The deceptive behavior is evident even in the absence of obvious external rewards

D. the behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder

when an individual falsifies illness in another (e.g. children, adults, pets)

factitious disorder imposed on another

the diagnosis requires demonstrating that the individual is taking surreptitious actions to misrepresent, simulate, or cause signs or symptoms of illness or injury even in the absense of obvious external rewards

factitious disorder

when is onset for factitious disorder

onset is often after hospitalization for a medical condition or mental disorder

what are some treatments for somatic symptom disorders

CBT, psychodynamic therapy, family therapy, biofeedback, PT, OT, Medication

what are some OT specific treatments for somatic symptom disorders

leisure activities, anxiety management, creating a schedule, education, symptom management, SUPPORT