Trans 065: Somatic Symptom and Related Disorder Flashcards
malingering vs factitious disorder?
Malingering - goal is for material or concrete gain
factitious disorder - goal is to assume the patient role
If it’s UNCONSCIOUS AND UNINTENTIONAL it is more of
somatic symptom disorder.
- Deep seated neurosis that produces bodily symptoms
- Culturally sanctioned
- Index of a disease or disorder, indication of psychopathology
- Leads to functional impairment, disability days, use of health care services
SOMATIZATION AS DIMENSION OF DISTRESS
Tendency to experience somatic sensations as intense, noxious or disturbing.
somatosensory amplification
3 elements of somatosensory amplification?
o Hypervigilance to bodily sensations
o Predisposition to select out and concentrate on weak or infrequent bodily sensations
o Reaction to sensations with cognitions and affect that intensify them to make them more alarming
Parang when they feel that there’s something wrong with their body it’s like a big problem agad that needs to be addressed.
illness vs disease?
• Illness – response of the individual and his/her family to symptoms
• Disease – defined by the physician, associated with pathophysiological processes and documentable lesions
Some people say “hay, sama ng pakiramdam ko, I don’t feel well”, then that is illness.
Once it’s diagnosed, there’s lab result to back it up, then it becomes a disease.
• May have a genetic component
• Developmental Factors:
o Roots in early family experience where physical symptoms are a major form of interpersonal communication
o Childhood exposure to parental chronic illness or abnormal illness behavior increases risk of somatization in later life
o Children with poor awareness of emotional experiences are more likely to experience unexplained somatic symptoms
o Anxious attachment behavior
these etiology may indicate what disesase?
Somatoform disorder
• Cognitive Theories:
o Cognitive distortion
• Personality Characteristics:
o Introspectiveness (tendency to think about oneself)
o Negative affectivity (negative mood, poor self-concept, pessimism)
• Psychodynamic Factors:
o Bodily symptoms interpreted as metaphors through which a patient expresses emotional distress or psychic conflict
o Bodily preoccupations as attempt to restore a sense of integration
these charachteristics are associated with what disorder?
Somatoform disorder
• Physical and Sexual Abuse:
o Poorly understood mechanism of association
o Sexual abuse negatively affects “embodiment” (experience of the self in and through the body)
o Tendency towards dissociation – increased physical symptoms
• Sociocultural Factors:
o Ubiquitous across cultures
• Iatrogenesis:
o Health care insurance and disability systems may foster somatization by providing reinforcement
o Unnecessary diagnostic testing and treatments by well intentioned but uninformed actions of physicians
these characteristics are associated with what disorder?
somatoform disorder
some physiological mechanisms of somatization?
autonomic arousal muscle tension Hypervent Vascular changes cerebral information processing physiological effects of inactivity sleep disturbance Brain cytokines
- At least 6 or more months of a general and non delusional preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms
- Belief persists despite negative lab tests, benign course of disease over time, and reassurances of the doctors
Somatic Symptom Disorder (hypochondriasis)
what disorder?
• Prevalence: 4-6%, M=F, 20-30 years old
o Happens in 3% of medical students, usually in the first 2 years, but generally transient
o 80% may have existing depressive or anxiety disorder
o Multiple consults with doctors, misuse of healthcare system
o Develop in the context of a stressful life event involving death or illness.’
SOMATIC SYMPTOM DISORDER (hypochondriasis)
• Develop in the context of a stressful life event involving death or illness
• Disproportionate incidence of disease in the family
o Strong memories of illness that could become the focus of anxiety
these are etiology of what disorder?
Somatic Symptom Disorder (hypochondriasis)
Social Learning
• Symptoms are viewed as request for admission to the sick role made by a person facing seemingly insurmountable problems, used to avoid and escape obligations
This is unconscious. Hindi sya deliberately thought by the patient.
• Getting attention if sick
Somatic Symptom Disorder (hypochondriasis)
Psychodynamic
• Aggressive and hostile wishes toward others are transferred into physical complaints
• Defense against guilt, a sense of innate badness, expression of low self-esteem and a sign of excessive self-concern
• Pain and suffering as means of atonement and undoing, and as deserved punishment for wrongdoing and sense of wickedness and sinfulness
Somatic Symptom Disorder (hypochondriasis)
Genetics
• Linked to antisocial personality disorder
o Neurologically based disinhibition characterised by impulsive behaviour
o Short term gains at the expense of long-term problems
• Runs in families
Somatic Symptom Disorder (hypochondriasis)
Course and prognosis of Somatic Symptom Disorder (hypochondriasis)
• Episodic, lasts from months to years
• Somatic symptoms associated with psychosocial stressors
• Good prognosis is associated with:
o High socioeconomic status
o Treatment-responsive anxiety or depression
o Sudden onset of symptoms
o Absence of a personality disorder
o Absence of a related non psychiatric medical condition
