Ch. 8 -- Somatic & Related Disorders

Somatic & Related Disorders

Shared Features

= “Presence of somatic symptoms and/or illness anxiety associated with significant distress or impairment” (p. 174)

Somatic symptoms can take many forms:

  • Faked
  • Imagined
  • Exaggerated
  • Real & influenced by external factors

Symptoms “may be a part of a real medical illness or disorder, and therefore…should be treated medicinally” (p. 174)

  • Difficult to assess

Somatic Symptom Disorder

Criteria:

  1. One or more somatic symptoms that are distressing and disruptive to life
  2. Excessive thoughts, feelings, behaviors related to somatic symptoms as manifested by:

   

  1. Disproportionate and persistent thoughts about the seriousness of the illness.
  2. Persistently high level of anxiety about health/symptoms.
  3. Excessive time/energy devoted to these symptoms/concerns.

Patients:

  • Present with significant worry about their illness
  • Fear medical status is more serious than it typically is
  • “Shop” different health care providers

Prevalence: 4-6%

  • More among women than men

Comorbidity: PTSD, OCD

Illness Anxiety Disorder

= “High anxiety in the absence of somatic symptoms” (DSM, p. 351)

Criteria:

  1. Preoccupation with a serious illness
  2. Absent or mild somatic symptoms
  3. Highly anxious about health
  4. Excessive health-related behaviors or maladaptive avoidance
  5. Have symptoms for at least 6 months

Specified either as:

  • Care-seeking type
  • Care-avoidant type

In contrast to Somatic Symptom Disorder, Illness Anxiety Disorder:

  • Doesn’t typically present with somatic symptoms
  • Symptoms do not drive the anxiety
  • More concerned about acquiring a serious illness

Unclear prevalence

  • Equal rates among men & women

Comorbid with:

  • OCD
  • Personality Disorders

Functional Neurological Symptom Disorder

Earlier: “Conversion Disorder”

= “Unconscious psychic conflict ‘converted’ into physical symptoms” (p. 175)

= “Individual presents with one or more symptoms of altered voluntary motor or sensory function” (p. 175)

  • Evidence of incompatibility of the medical disorder and the symptoms

Symptom types include:

  • Weakness/Paralysis
  • Abnormal Movement
  • Swallowing Symptoms
  • Speech Symptoms
  • Attacks/Seizures
  • Anesthesia/Sensory Loss

Comorbidity: Personality Disorders

Factitious Disorder

Earlier: Munchausen Syndrome

Deliberate falsification of symptoms on oneself

Criteria:

  1. Falsification of symptoms; induction of injury/disease
  2. Presenting as ill, etc.
  3. Deceptive behavior continues w/ no external reward

   

  1. external reward ex. faking hearing voices in order to not serve a harsh sentence by reason of insanity
    1. Not better explained by another disorder

Possible causes:

  • Depression
  • Lack of parental support during childhood
  • Excessive need for social support

Prevalence: unknown

Etiology

Possible explanations:

  1. Psychodynamic
  2. Cognitive
  3. Behavioral
  4. Sociocultural

Treatment

  1. Biopsychosocial model (most effective)

   

  1. Multidisciplinary - treated by multiple different types of providers

       1. Interdisciplinary - coordinated and collaborated treatment

  1. Psychotherapy

   

  1. Psychodynamic
  2. CBT
  3. Behavioral
    1. Rarely used: Medication

Psychological Factors Affecting Other Medical Conditions

Criteria:
  1. Medical symptom/condition present
  2. Psychological/Behavioral factors adversely affect the medical condition by:

   

  1. Close temporal association
  2. Interference with treatment
  3. Well-established health risks
  4. Influencing underlying pathophysiology
Examples:
  • Lack of positive coping strategies
  • Psychological distress
  • Maladaptive health behaviors
  • Negative interpersonal interactions
Psychophysiological disorders

= Physical disorders/symptoms worsened by psychological factors

Examples:

  • Headaches
    • Migraines
    • Tension
  • Gastrointestinal
    • Ulcers
    • Irritable bowel syndrome (IBS)
  • Insomnia
  • Cardiovascular
  • Hypertension

Treatments include:

  1. Relaxation training
  2. Biofeedback
  3. Hypnosis
  4. Group therapy