somatic disorders

Symptom Disorders

Overview

Somatic Symptom Disorders involve physical symptoms suggesting a medical condition without evidence of physical pathology.

Previous terms like Hypochondriasis and Somatization Disorder are now part of DSM-5 criteria for Somatic Symptom Disorder.

Characteristics of Somatic Symptom Disorders (DSM-5)

Three Main Features:

Disproportionate thoughts about the seriousness of symptoms.

High level of anxiety regarding health.

Excessive time/energy spent on symptoms or health concerns.

Historical Terms in DSM-IV

Hypochondriasis:

Preoccupation with fears of serious disease or misinterpretation of bodily symptoms.

Cognitive-behavioral therapy (CBT) and SSRIs effective in treatment.

Prevalence: 2-7%, often chronic, usually occurs in early adulthood.

Somatization Disorder:

Symptoms include multiple physical complaints in various categories.

Typically needs to start before the age of 30, in the absence of a medical explanation.

Notable gender differences: 3-10 times more common in women.

Co-occurs with other mental disorders (depression, anxiety).

Pain Disorder:

Severe pain present in one or more body areas, with psychological factors considered significant.

Not feigned; commonly diagnosed in women.

Illness Anxiety Disorder:

High anxiety about potential illness; minimal to no somatic symptoms present.

25% of individuals with hypochondriasis meet criteria.

Conversion Disorder (DSM-5)

Symptoms affecting sensory or motor functions without physical basis (i.e., blindness, paralysis).

Often occurs after significant stress and can resolve quickly if the stressor is removed.

Notably more common among women and in rural populations.

Pseudo seizures: Seizures without neurological abnormalities.

Treatment Approaches

Somatic Symptom Disorders:

Collaboration with a single physician to manage care.

Combination of medical treatment and CBT to promote healthy coping strategies.

Addressing secondary gain is crucial (avoidance of responsibilities).

Conversion Disorder:

Behavioral and cognitive-behavioral therapies targeted at managing symptoms and improving function.

Malingering and Factitious Disorders

Malingering: Intentional fabrication of symptoms for external incentives (e.g., financial gain).

Factitious Disorder: Motivation by the “sick role”, where the individual seeks the attention that comes with being ill.

Dissociative Disorders

Overview of Dissociative Disorders

Involve disruptions in consciousness, memory, identity, and perception.

Types include Depersonalization/Derealization Disorder, Dissociative Amnesia, and dissociative identity disorder.

Depersonalization/Derealization Disorder

Experiences include feeling detached from oneself (depersonalization) or surroundings (derealization).

Reality testing remains intact; sufferers often report living in a dream.

Onset typically around age 23; chronic in 80% of cases.

Dissociative Amnesia

Characterized by inability to remember autobiographical information, often due to trauma or stress.

Can include Dissociative Fugue, where individuals travel and cannot recall identity.

Treatment often leads to spontaneous recovery of memories.

Dissociative Identity Disorder (DID)

Involves two or more distinct identities or personality states.

Often initiated in childhood; prevalence is 3 to 9 times higher in women.

Controversies surrounding if DID is real or faked, connections to childhood abuse but multifactorial considerations.

Treatment of Dissociative Disorders

Emphasizes integration of identities, often using psychodynamic and insight-oriented approaches.

Limited knowledge on effective treatments overall.

Theories of DID Development

Post-Traumatic Model: 95% of cases report severe abuse, viewing DID as an escape from trauma.

Socio-Cognitive Theory: Suggests suggestibility in therapy leads to the adoption of multiple identities.

Difference from Physical Conditions: Somatic Symptom Disorders present physical symptoms without any identifiable medical pathology, while physical conditions have clear biological or physiological causes.

Hypochondriasis (DSM-IV): Characterized by persistent fears of having a serious illness or misinterpretation of bodily symptoms; it is now included in Somatic Symptom Disorders in DSM-5.

Treatment of Hypochondriasis: Effective treatment often includes Cognitive-Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs).

Somatization Disorder (DSM-IV): This disorder involves multiple physical complaints across various categories without a medical explanation, usually starting before age 30.

Treatment Importance: Addressing secondary gain—where symptoms may be used to avoid responsibilities or gain attention—is crucial in treating Somatization Disorder.

Overlap with Hypochondriasis: Approximately 25% of individuals with hypochondriasis meet the criteria for Illness Anxiety Disorder.

Symptoms of Conversion Disorder: Symptoms may include sensory or motor dysfunction (e.g., blindness, paralysis) without any physical cause, often occurring after significant stress and can resolve upon removal of the stressor.

Pseudo seizures: These are seizure-like episodes without neurological abnormalities. Distinction from seizures is made through the absence of epileptic activity on EEG and often identifiable psychological stressors triggering the episodes.

Primary Gain: Refers to the direct benefit that the patient gains from having the symptoms, such as avoidance of stressful situations or responsibilities.

Secondary Gain: Relates to the external advantages that an individual may achieve due to their symptoms, such as attention, sympathy, or financial benefits.

Munchausen Syndrome: A type of factitious disorder where an individual deliberately produces or feigns symptoms of illness to gain attention and sympathy from others.

Major Dissociative Amnesia: A significant inability to remember personal information, often linked to trauma or stress, affecting one’s identity.

Dissociative Fugue: A subtype of dissociative amnesia involving sudden, unexpected travel away from home, accompanied by inability to recall one’s identity or past.

Dissociative Identity Disorder (DID): A disorder characterized by the presence of two or more distinct identities or personality states, each with its own sense of self and history.

Treatment Goal for Dissociative Identity Disorder: The primary goal is to integrate the separate identities into one primary identity, often using psychodynamic and insight-oriented therapy.

Theories Explaining Dissociative Identity Disorder:

Post-Traumatic Model: Suggests that DID develops as a response to severe trauma, often as a coping mechanism to escape from the abuse.

Socio-Cognitive Theory: Proposes that DID may be encouraged by suggestibility during therapy, which leads to the adoption of multiple identities.