Somatic Symptom Disorders

Question 1

Somatic symptom(s) that are distressing or disruptive to functioning
Excessive thoughts, feelings, or behaviors related to symptoms: disproportionate thoughts about severity, persistently high anxiety about health or symptoms, excessive time/energy devoted to symptoms
Symptomatic state persists (more than 6 months), individual symptoms may fluctuate
May coexist with other diseases, focus is on response to symptoms
Specifiers: with predominant pain, persistent, severity
5-7% of population, females more than males, genetic patterns
onset before age 30, often in adolescence
chronic course with exacerbations
variation in pain sensitivity, abnormal serotonin function, inflammation, culture
treated to optimize functioning (not eliminate symptoms), avoid harmful interventions, recognize and validate suffering
patient-doctor rapport, regular appointments, avoid mega-workups, rule out self-medication, psychotherapy, antidepressants

Answer 1

Somatic symptom disorder

Question 2

Preoccupation with having or acquiring a serious illness for more than 6 months
Mild or absent somatic symptoms
High level of anxiety about health (disproportionate)
Excessive health-related behaviors (care-seeking or care-avoidant)
2-5% primary care patients, equally common in men and women
adult onset often following experience with disease, higher in families with OCD
chronic or recurrent course
lower threshold for physical sensation, social learning model (sick role), psychodynamic model (repressed aggression to physical symptoms)
schedule frequent visits, avoid harmful interventions, manage anxiety, psychotherapy, SSRI

Answer 2

illness anxiety disorder

Question 3

Symptoms of altered voluntary motor or sensory function
Incompatible with known conditions
Stressor is not required
Sensory symptoms: diplopia, blindness, deafness, numbness
Motor symptoms: dysphasia, ataxia, tremor, aphonia, seizures
.01-.3% of general population, 5-10% hospital psychiatric consults
more common in females than males, ages 10-35 years, genetic component
symptoms serve to resolve conflict, psychoanalytic (repressed conflict causes anxiety), learning theory (maladaptive behaviors), sociocultural (expression of emotion prohibited), biological and neuro factors
90% of episodes resolve, remission may associated with resolution of stressor, 20% relapse
reassurance of no serious illness, assistance addressing stressors, psychotherapy, psychopharmacology, physical therapy

Answer 3

Conversion disorder

Functional Neurological Symptom disorder

Question 4

Psychological or behavioral factors adversely affect medical condition
Close temporal association between psychological factors and development or exacerbation of condition, factors interfere with treatment, factors add known health risk, factors influence underlying pathophysiology
Psychotherapy, no judgement

Answer 4

Psychologic factors affecting other medical conditions

Question 5

Imposed on self:
Falsified physical or psychological sign/symptoms with identified deception
Presents self as ill, impaired, or injured
Absence of external incentives
Imposed on another:
Patients presents another as ill, impaired, or injured
1-2% of general hospital patients
more frequent in healthcare workers, gender ratio depends on subtype
onset in adolescence, majority seen 20-45
chronic, patient seeks care elsewhere
often with history of child abuse/neglect, comorbid borderline personality disorder, child victims may perpetuate abuse
prevent harm, avoid shaming or punishment, promote insight, manage symptoms

Answer 5

Factitious disorder

Question 6

Less than 6 months or failure to meet criteria of other somatic symptom disorder
Brief somatic symptom disorder, brief illness anxiety disorder, illness anxiety disorder without excessive health-related behaviors, pseudocyesis

Answer 6

Other specified somatic symptom and related disorder

Question 7

Symptoms characteristic of a somatic symptoms or related disorder predominate but do not meet full criteria
Unusual situation in which there is insufficient information to make a more specific diagnosis

Answer 7

Unspecified somatic symptom and related disorder

Question 8

Not a psychiatric diagnosis
Intentional production of false or grossly exaggerated physical/psychological symptoms motivated by external incentives
Suspect with: legal issues, discrepancy between claims and findings, lack of cooperation, antisocial personality disorder

Answer 8

Malingering

Question 9

Preoccupation with perceived defect in appearance (excessive)
Repetitive behaviors or mental acts in response to defect
Not an eating disorder
1-2% of general population, equal in men and women
adolescent/young adult onset, associated with family OCD, chronic course
psychotherapy, psychopharmacology

Answer 9

Body dysmorphic disorder