Somatic Symptom and Related Disorders

Question 1

What is the common feature of patients who have a somatic symptom disorder?

Answer 1

prominence of somatic symptoms associated with significant distress and impairement

Question 2

What is the diagnostic criteria for somatic symptom disorder (SSD)?

Answer 2

1) >1 distressing/disruptive somatic symptom
2) At least one indicator of excessive thoughts/feelings/behaviors about the symptom(s)
3) Persistent symptomatology (usually >6 months)

Question 3

Can an individual have a medical illness and still have SSD?

Answer 3

YES

Question 4

What is the diagnostic criteria for a patient with illness anxiety disorder (IAD)?

Answer 4

1) Preoccupation with having/acquiring a serious illness despite not having any symptoms
2) High anxiety in regards to health
3) Excessive health related behavior are performed or exhibits maladaptive avoidance
4) Illness preoccupation has been present >6 months

Question 5

What are the two specifiers for IAD?

Answer 5

IAD, care seeking type

IAD, care avoidant type

Question 6

What are two differentials for SSD and IAD?

Answer 6

Delusional Disorder (DD), Somatic Type -->belief is held with much higher intensity 
Body Dysmorphic Disorder---> concern is more appearance based

Question 7

There are a number of reasons that some individuals, with SSD and IAD, are more keenly aware of and distressed by physical symptoms, each card will go through one. 1–>

Answer 7

1. Physiological Factors –> Overactivity of key brain regions involved in unpleasantness of bodily sensations

Question 8

2nd reason for more keen awareness of and distress in physical symptoms of SSD and IAD patients. 2–?

Answer 8

2. Cognitive Biases –> over attentiveness to and overly negative interpretations about somatic symptoms

Question 9

3rd reason for more keen awareness of and distress in physical symptoms of SSD and IAD patients, 3–>?

Answer 9

3. Behavioral Consequences –> person may assume the sick role or get reinforced for sick role behavior

Question 10

What are some treatments for SSD and IAD?

Answer 10

Cognitive-Behavioral Therapy:

• reduces stress
• reduces excessive attention to bodily cues
• correct cognitive distortions about physical symptoms
• reinforce non sick role behavior

Question 11

What is the diagnostic criteria for a patient with conversion disorder (functional neurological syndrome)?

Answer 11

1) Altered voluntary motor or sensory function

2) Evidence of incompatibility between the symptom and neuro conditions

Question 12

What is the onset and course for a patient with conversion disorder?

Answer 12

sudden (After a major stressor)
indifference reaction to their disability
short duration without recurrence

Question 13

What is the common etiology for patients with conversion disorder?

Answer 13

some sort of psychological stress that is then converted into neuro symptoms

Question 14

What is the treatment for a patient with conversion disorder?

Answer 14

psychotherapy

Question 15

Describe in general terms factitious disorders

Answer 15

patient fakes/induces physical or psychological symptoms, in self or others, in absence of external rewards

Question 16

What does factitious disorder imposed on self mean?

Answer 16

aka munchausens syndrome

patient fakes symptoms in oneself

Question 17

what does factitious disorder imposed on another mean?

Answer 17

aka munchausens syndrome by proxy

patient fakes symptoms in another person

Question 18

What are some symptoms associated with a person who has factitious disorder?

Answer 18

1) Unexplained persistent/recurrent symptoms
2) Inconsistent medical history
3) Dramatic presentation of history and symptoms
4) Symptoms influenced by observation
5) Insistence on particular treatment
6) Grid abdomen

Question 19

What is the treatment for factitious disorder?

Answer 19

NONE

Question 20

What is the differential diagnosis for a patient with factitious disorder

Answer 20

Malingering

Question 21

In malingering a person also fakes/induces physical or psychological symptoms in self others. What is the difference then in malingering and factitious disorders?

Answer 21

Factitious –> does not seek external reward

Malingering –> person seeks external reward

Question 22

What does malingering by proxy mean?

Answer 22

fakes symptoms in another individual

Question 23

After covering her childs face with a pillow to induce cardiac arrest, a young mother calls 911 to report that her child’s heart inexplicable stopped beating, which required her to perform CPR. What is the diagnosis?

Answer 23

You need more information about the mother’s motivation

Question 24

If in the mother and child CPR example, the question would of mentioned some internal reason (to indirectly assume the sick role by having a sick child) for putting the child in cardiac arrest, what would the diagnosis be?

Answer 24

Factitious Disorder, imposed on another

Question 25

If in the mother and child CPR example, the question would of mentioned some external motivation (to have a good excuse for not going to work the next day) for putting the child in cardiac arrest, what would the diagnosis be?

Answer 25

Malingering, by proxy