Somatic Symptom Illness Notes

Somatic Symptom Illness

Psychosomatic: The connection between the mind (psyche) and the body (soma) in states of health and illness.
Hysteria: Refers to multiple physical complaints with no organic basis; the complaints are usually described dramatically. This term has been removed from the DSM-5 manual as a diagnosis.
Internalization: People with somatic symptom illnesses keep stress, anxiety, or frustration inside rather than expressing them outwardly.
Somatization: The transference of mental experiences and states into bodily symptoms.

Transference of mental experiences and states into bodily symptoms.
Characterized by:
- Presence of physical symptoms that suggest a medical condition with no organic basis to fully account for them.
3 Central Features
- Physical complaints suggest medical illness but have no demonstrable organic basis.
- Psychological factors & conflicts seem to play a role in initiating, exacerbating, & maintaining symptoms.
- Symptoms or magnified health concerns are NOT under the client’s conscious control.

Include
- Somatic Symptom Disorder
- Conversion Disorder
- Pain Disorder
- Hypochondriasis (Illness Anxiety Disorder)
Characteristics
- More common in women.
- Reports of pain are most common complaint.
- Pain symptoms make it difficult to determine physical versus psychological causation.
- “Thick file” clients.

One or more symptoms that cause persistent distress or significantly disrupt daily life.
Symptoms persist for at least 6 months.
Excessive thoughts, behaviors, feelings related to the somatic symptoms as manifested by at least one of the following:
- Disproportionate, persistent thoughts regarding seriousness of symptoms.
- Persistent, high level of anxiety about health or symptoms.
- Excessive time & energy devoted to these symptoms or health concerns (APA, 2013).

Involves unexplained, usually sudden deficits in sensory or motor function.
Significant functional impairment which warrants medical evaluation.
Symptoms or deficit is not better explained by another medical or mental disorder.
Client may have an attitude of “la belle indifference” regarding functional impairment (Videbeck, 2020).
Motor symptoms: weakness/paralysis, tremor, gait abnormalities.
Sensory symptoms: altered, reduced, or absent skin sensation, vision, or hearing.
Other: seizure-like activity, changes in speech, diplopia, episodes of unresponsiveness resembling syncope or coma (APA, 2013).

Formerly known as Hypochondriasis.
Excessive preoccupation and disproportionate fear that one has, or will get, a serious disease.
Clients may misinterpret body functions or sensations (Videbeck, 2020).
High anxiety.
Somatic symptoms usually not present, or if present are mild.
Illness preoccupation present over 6 months (the specific illness that is feared may change over that time).
Illness preoccupation not better explained by another mental disorder (APA, 2013).

Somatic Symptom Disorder:
- Onset: adolescents (may not be diagnosed until 25 years of age).
- Chronic or recurring.
Conversion Disorder:
- Onset: 10-35 yrs. of age.
- Chronic or recurring.
Illness Anxiety Disorder
- Onset: usually early-late adulthood (rare in children).
- Chronic or recurring.

FABRICATED & INDUCED ILLNESS:

People feign or intentionally produce symptoms for some purpose or gain.
People willfully control the symptoms.
Malingering:
- The intentional production of false or grossly exaggerated physical or psychological symptoms – motivated by external incentives.
Factitious disorder, imposed on self aka Munchausen’s Syndrome:
- A person intentionally produces or feigns physical or psychological symptoms solely to gain attention.
Factitious disorder, imposed on others aka Munchausen’s Syndrome by proxy:
- A person inflicts injury or illness on someone else to gain the attention of emergency personnel or to be a “hero” for saving the victim.

Psychosocial:

Internalization leads to Somatization.
Primary gains: Direct INTERNAL benefits that being sick provides.
Secondary gains: The EXTERNAL or personal benefits received from others because one is sick (attention and comfort measures).
More common in women.
Childhood Sexual Abuse.
Boys are taught to be stoic.

Biologic:

SSRI Antidepressants (See Table 21.2)

Chronic pain clinic (if pain is a somatic symptom) for:

The client will identify the relationship between stress and physical symptoms
The client will verbalize emotions
The client will follow a daily routine
The client will demonstrate alternative healthy coping mechanisms to deal with stress, anxiety, anger etc.

Teaching Health Promotion

Coping Strategies

Emotion-focused coping strategies: Help clients relax and reduce feelings of stress
Problem-focused coping strategies: Help to resolve or change a client’s behavior or situation or manage life stressors

Encourage expression of emotions

Teach the relationship between stress & physical symptoms
Journaling (links emotions being experienced with physical symptoms and severity)
Limiting time client can focus on physical symptoms may be necessary
Teach family about primary & secondary gains
Help clients focus on emotional feelings

Establish daily health routine, including adequate rest, nutrition, and exercise
Teach about relationship of stress and physical symptoms and mind-body relationship
Educate about proper exercise, nutrition, and rest
Educate client in relaxation techniques
Educate client by role-playing social situations and interactions
Encourage family to provide attention and encouragement when client has fewer complaints
Encourage family to decrease special attention when client is in “sick” role.