SSD and related disorders: 6.1 a-d

Somatic Symptom disorder

being overly focused on physical symptoms for a long time that have no medical reason,

pain is real, often a psychological undercurrent

Diagnostic criteria for SSD

A. one or more somatic symptoms causing distress or impairment

B. and one of the following:

excessive, thoughts about the severity of symptoms,

great anxiety about their health

put lots of time and energy into their health problems

specifcy if theres predominant pain

persistent course longer than 6 months

specify current severity ( from B)

mild: only 1

moderate: 2

sever: 2 or more 

Prevelance SSD in clinical settings

SSD in clinical setting is 17%

Illness anxiety disorder

formerly known as hypochrondriasis:

high anxiety about developing a disease or illness (doesnt particulary have pain mild if most)

no complaints of somatic symptoms just worry

reassurance from professionals not helpful

Diagnostic criteria for Illness anxiety disorder

1. preoccupied worrying about dev a serious illness or condition

2. no somatic symptoms (if there mild at most) so fear is disproportibate

3. high anxiety about health, easily rattlled by health status

4. excessive checking body to monitor health or avoids hospitals, treatment (maladaptive avoidance)

5. 6 months or longer

6. not better explain by smth else

specify whether care seaking

or care avoidant

Similarity illness anxiety and SSD

they both have similar onset, affect, and heritability like mood and anxiety disorders

SSD is actually often commorbid with anxiety and mood disorders

illness anxiety disorder maniests

there is an underlying anxiety but it comes out as anxiety about dev a serious illness and searching for it in themselves. normal bodily sensations become to them indicate the start of the illness or symptoms

intially goes to family doctor

unnessary tests and treatments

diease conviction

believes they have a diese so wil lkeep seeing doctors despite reassurances. cant shake it

hyochondrias prevelance

(SSD and Illness anxiety while they were classifeid the same)
1-5% in population

7% in primary care settings as high as 17%

Characteristics of those with SSD

middle aged, woman, uneducated, lower socioeconomic status.

from major urban area

relationships of those with SSD

since SSD is their life, they disscuss symptoms as small talk, dont have idenitiy with out it. starts in adolesence. primary relationshi is oftten with doctors

faulty perception of illness with SSD and Illness anxiety

its key that the person is incorrectly diagnosing themselves because it shows that the issue is psychological not physical

Integrative model of SSD and Illness anxiety

trigger (event, info)

Perceived threat

Apprehension (lead to)

focused on body, increased arousal, checking behavior, seeing reassurance

preoccupied with perceived illness

misinterpretation as illness

SSD and Illness anxiety vulnerablities

sensitve to internal cues

see ambigious stimuli as threatening

SSD and Illness anxiety Causes

Similar to anxiety

Biological:
run in families

Psychological:

hyperresponsitivity

why is anxiety focused on illness:

family member had the illness and learned to focus on that as they did

stressfull ilfe event

disproportiate amount of illenss in the family when young (want benefits of attention)

sick role / secondary gain

when your illness allows you to avoid responsibitlies, gain benefits

Treatment of SSD and IA

not much reasech

CBT: target where the stress anxiety lies, checking, thoughts, help seeking beahviours

listen to meaning of symptoms otherwise pateint will go find someone else

exposure therapy effective

SSri responds to treatment

Pscyhologcial factors affecting medical conditon

a SSd related disorder where you have a diagnosed medical disorder which gets negatively affective by one or more psychological or behavioural factors

this affects the course or treatmetn

(being mentally ill can worsen your condition)

Functional Neurological Symptoms Disorder

Physical dyfinction (paralysis, blindness) with not medical cause. dissociative symptoms

Diagnostic criteriafor Functional Neurological Symptoms Disorder

1. one or more voluntary motor, or sensory dysfunction

2. symptoms shown and the conditions avalibale dont match cant diagnose

3. not better explained by another medical disorder

4. the symptom causes clinically significant distress or impairment socially ,job

Specify if 

acute: less than 6 motnsh

persistent: longer than 6

Specify if:
with psych stressor

witohut psyc stressor

rule out all medical cuases

astasia abasia

sonversion symptom leg bpdy paralysis

psychogeneic non-epleptic seizures

globus hystercus

conversion symptom lump in throat

Malingering

faking symptoms of physcial or psyc disorder for personal gain.

indifferent to symptoms

is okay during emergencies

getting out of work, legal difficulties, insurance benefits

Facticious Disorders

between malingering and functional neurological symptoms disorder. 

voluntary like malingering

but does it not for personal gain but to recieve attention take on sick role

adults with this will make their children sick, induce symptoms, lie

check surveilance cameras

Facticious DIsorder diagnostic criteria

fakes one or more physical or psychological signs or symptoms. induces injury or diease as per description

presents themselves to others all ill injured

evident even when theres no obvious reward

not explain better by anything else

specify if single episode or reoccuring (2 or more)

Facticious Disorders Prevelance

almost all women, history of maltreatment, psychological problems

Functional Neurological Symptoms Disorder prevelance

rare in mental health settings

1/3 in epilespy center

in owmen

starting at adolsence close after

5% only have their symptoms go away one study in toronto

Functional Neurological Symptoms Disorder Causes freud theory

1. traumatic event that must be excaped at all cost

2. getting sick to get away from this is unacceptable so its removed from their consciousness

3. conversion symtoms work at helping them escape situation, contuning until its resolved

partial support study shwed trauma is there

but those with the disroder usually show emotional problems liekdepression anxiety

bio vuln under stress real but interpersonal factors more important

Functional Neurological Symptoms Disorder

treated like SSD

attend to the traumatic event

reduce any reinforcemnt of the disorder like secondary gain

therapist should work with both patient and their family