Somatoform disorders Flashcards
definition of somatic?
- of or relating to the body, especially as distinct from the mind
Summary of what somatoform disorders are?
- soma: means body
- overly preoccupied with health or body appearance
- physical complaints w/o medical condition
Types of DSM-V somatoform disorders?
- somatic sx disorder
- conversion disorder
- illness anxiety disorder
- other specified somatic sx and related disorder
Define somatic symptom disorder?
-one or more somatic sxs that are distressing or result in significant disruption of daily life
- excessive thoughts, feelings or behaviors related to the somatic sxs of assoc health concerns as manifested by at least one of the following:
1. disproportionate and persistent thoughts about seriousness of one’s sxs
2. persistently high level of anxiety about health or sxs
3. excessive time and energy devoted to these sxs or health concerns
- although any one somatic sx may not be continuously present, the state of beign sx is persistent (typically more than 6 months):
specify if: w/ predominant pain
specify if: persistent: a persistent course is characterized by severe sxs, marked impairment, and long duration (more than 6 months)
specify current severity: mild, moderate, or severe
What are somatoform sxs?
- sxs suggest a physical disorder
- sxs cannot adequately be explained physiologically
- sxs are often (but not always) described in dramatic ways
- other disorders, such as anxiety disorders, mood disorders, and personality disorders, often co-exist
- sxs: SOB, anxiety, shallow breathing, muscle tension, more shortness of breath leads to tiredness, and less energy to do things and this leads to increased anxiety - back to SOB (cyclical)
Characteristics of somatization disorders?
- reports of multiple physical sxs w/o medical basis
- runs in families: probably heritable basis
- relatively uncommon - most prevalent in unmarried women in low socioeconomic groups
- onset usually in adolescence: often persists into old age
- causes: continual development of new sxs - immediate sympathy and attention which leads to eventual social isolation
-tx: very hard to tx
CBT - provide reassurance, reduce stress and minimize help seeking behaviors
- therapy to broaden basis for relating to others
Prevalence of somatization disorder? Course, culture?
- 5-7% of general pop
- more common in women (gender differences smaller in some cultures)
- difficult to say prevalence in men, in the past they have typically been dx with antisocial personality disorder
- age of onset: older - natural aging, kids - tummy aches
- course: chronic, rarely cured
- culture: cultural influences appear to affect the gender ratios and body locations of somatoform d/o (Greek and Puerto Rican cultures report higher rates among men than in US)
sxs vary across cultures (burning hands and feet, worms in head, ants under skin - common in Africa and South Asia) - lower levels of somatization d/o with higher education levels
PP of somatization disorder?
- need to be sick - becoming physically sick is less stressful than being unsuccessful or dealing with whatever is going on with that person
Causes of somatization disorder?
- family hx of illness
- relation with antisocial personality disorder
- weak behavioral inhibition system
Tx of somatization disorder?
- no tx proves superior effectiveness
- however, we need to reduce visits to numerous medical specialists
- assign one main PCP - have pt f/u in 1 -3 months
- reduce supportive consequences of talk about sxs
- try to get mental health professionals involved - only if pt won’t get defensive
What is conversion disorder?
- physical sxs suggesting neuro problems:
sensory impairment: any modality
paresthesias, blindness, paralysis - sudden onset, sudden termination, sudden reappearance
- mostly women, men in combat
- often misdx
- La belle indifference: 1/3 of cases seem indifferent, come in complaining they went blind but they don’t seem all that concerned
Prevalence and course, culture of conversion disorder?
- prevalence: 0.01-0.5% in general pop
- gender: 2-10x more common in women
- age of onset: late childhood - early adulthood rarely b/f 10 or after 35
- can be common in soldiers as well (under extreme stress)
- course: onset acute or sudden, sxs remit after about 2 weeks, but recur approx 25% of the time
- culture: more common in rural areas, lower SES, and lower education levels
Criteria for conversion disorder?
A. one or more sxs or deficits affecting voluntary motor or sensory fxn that suggests a neuro or other general medical condition
B. psychological factors are judged to be assoc with the sx of deficit b/c the initiation or exacerbation of the sx or deficit is preceded by conflicts or other stressors
C. the sx or deficit is not intentionally feigned (as in factious disorder or malingering) - its real for these pts
D. sx or deficit can’t after approp investigation be fully explained by general medical condition, or by direct effects of a substance, or as culturally sanctioned behavior or experience
E. the sx or deficit causes clinically sig. distress or impairment in fining
F. the sx or deficit is not limited to pain or sexual dysfxn, doesn’t occur extensively during course of somatization disorder, and isn’t better accounted for by another mental disorder
Causes of conversion disorder?
- freudian psychodynamic view still popular - childhood experiences crucial in shaping us as adults
- focus on past trauma and conversion
- address primary and secondary gain
- detachment from the trauma
Tx of conversion disorder?
- similar to somatization disorder - CBT
- core strategy is attending to the trauma
- remove success of secondary gain
- reduce supportive consequencs of talk about sxs
- Remember these pts truly belived they are sick
