Somatic Symptom and Related Disorders: Lecture Notes

Somatic Symptom and Related Disorders

Readings

  • Rieger (2017) Chapter 8. Somatic Symptom and Dissociative Disorders from Abnormal Psychology: Leading Researcher Perspectives (4th ed.).

Overview

  • This mini-lecture covers:
    • Somatic Symptom Disorder
    • Conversion Disorder
    • Illness Anxiety Disorder
    • Factitious Disorder
    • Factitious Disorder Imposed on Another

Medically Unexplained Symptoms

  • A significant percentage of common symptoms presented to general practitioners remain medically unexplained. (Rieger, 2011).
  • Table 2 shows the percentage of common symptoms presenting to general practitioners that remain medically unexplained:
    • Menstrual problems: 33%
    • Fainting: 33%
    • Headache: 30%
    • Chest pain: 27%
    • Dizziness: 27%
    • Palpitations: 26%
    • Sexual problems: 25%
    • Nausea, vomiting, indigestion: 23%
    • Constipation, diarrhea: 22%
    • Abdominal pain: 21%
    • Dyspnea (difficulty breathing): 19%
    • Fatigue: 19%
    • Joint or limb pain: 17%
    • Back pain: 16%
  • Source: Kroenke, K., Spitzer, R. L., Williams, J. B., Linzer, M., Hahn, S. R., de Gruy, F. V., & Brody, D. (1994). Physical symptoms in primary care: Predictors of psychiatric disorders and functional impairment. Archives of Family Medicine, 3, 774-779.

Somatic Symptom Disorder

  • Definition: The experience of one or more debilitating somatic symptoms.
  • Symptoms are accompanied by abnormal thoughts, feelings, and behaviors.
  • Abnormal reactions include:
    • Disproportionate and persistent thoughts about the seriousness of symptoms.
    • Persistently high anxiety about one’s health or symptoms.
    • Spending excessive time and energy over health concerns (e.g., excessive healthcare utilization).

Conversion Disorder

  • Definition: Disturbance in motor or sensory functioning.
  • Not consistent with any recognized medical condition.
  • Causes significant distress and/or impairment.
  • Epidemics of conversion disorder, ‘mass hysteria’, occur periodically.
  • One person becomes sick, and the experience of symptoms, beliefs about the cause of symptoms, and anxiety about the symptoms generalizes to others.

Illness Anxiety Disorder

  • Definition: Preoccupation with having or getting a serious illness.
  • Somatic symptoms are not prominent.
  • High levels of health anxiety and excessive health-related behaviors.
  • The individual may worry about a particular disease/illness or a number of different types.
  • If a medical condition is present, the level of preoccupation is excessive.

Treatment of Somatic Symptom and Related Disorders

  • Table 8.4 outlines treatments for chronic somatic symptom and related disorders:
    • Perception of physical symptoms:
      • Pain relief medications.
      • Relaxation.
      • Distraction.
      • Attention training.
    • Attribution, disease-conviction:
      • Reattribution.
      • Challenging thoughts.
    • Concern, illness-worry, preoccupation:
      • Education, explanation.
      • Behavioral experiments.
      • Reassurance.
    • Illness behavior:
      • Education, explanation.
      • Pharmacological treatment of depression and anxiety.
      • Cognitive-behavioral treatments for depression and anxiety.
      • Distraction.
    • Social and occupational functioning:
      • Coordination between all health professionals.
      • Secondary consultations by psychologists.
      • Graded activity.
      • Exposure.
      • Early return to work.
      • Couple or family therapy.
      • Assistance with rapid resolution of compensation claims.

Cognitive Behavioral Model

  • The Cognitive Behavioral Model includes the following components:
    • Somatosensory amplification
    • Perception of symptoms
    • Attribution regarding symptoms
    • Concern/anxiety about illness
    • Illness behavior
  • Copyright ©2011 McGraw-Hill Australia Pty Limited (Rieger, 2011)

Factitious Disorder and Factitious Disorder Imposed on Another

  • Factitious disorder, imposed on the self:
    • Fabrication of psychological or medical symptoms.
    • May involve the induction of injury or disease in oneself, or others, and presenting oneself or others as ill.
    • This behavior does not appear to have any obvious external reward.
    • Has been known as ‘Munchausen’s syndrome’.
  • Factitious disorder, imposed on another:
    • An individual induces illness in another.
    • Has been known as ‘Munchausen’s by proxy’.

Summary

  • This mini-lecture covered:
    • Somatic Symptom Disorder
    • Conversion Disorder
    • Illness Anxiety Disorder
    • Factitious Disorder
    • Factitious Disorder Imposed on Another