Lecture 6 'Somatic Symptoms' Flashcards
What are the two essential features of somatic symptoms and related disorders?
> physical symptoms suggest a physical disorder but there are no demonstratable organic findings or known physiological mechanisms
positive evidence or strong presumption that symptoms are linked with psychological factors/conflicts
Somatic symptoms and related disorders are a,one the most prevalent mental health problems in primary care; functional impairment is comparable with that seen in which other disorders?
Depressive and anxiety disorders
What are the five major somatic symptom disorders in the DSM5?
- Somatic symptom disorder
- Illness anxiety disorder
- Conversion disorder
- Factitious disorder
- Psychological factors affecting other medical conditions
For somatic symptoms and related disorders what are two exclusionary considerations?
Known physical causes must be ruled out
Has a physical cause been overlooked?
Males or females have higher prevalence rates of somatic symptom disorder?
females
What are the key characteristics of somatic symptom disorder?
> Somatic symptoms
Excessive thoughts/behaviours related to symptoms or health concerns
Pain + gastrointestinal complaints
What is the usual age of onset of somatic symptom disorder?
between 30-40 years
What is the difference between somatic symptom disorder and illness anxiety disorder?
Somatic > preoccupation with pain when there is no physical evidence to account for pain or its intensity
Illness anxiety > high level anxiety about having or acquiring a serious illness
Illness anxiety disorder can only be diagnosed when symptoms have been present for at least ________
six months
illness anxiety disorder was previously called?
hypochodriasis
males or females have higher prevalence rates in illness anxiety disorder?
both similar rates
John has been diagnosed with illness anxiety disorder. He complains of a stomach ache and decides it must be caused by a cancerous tumor. This is an example of?
somatosensory amplification
Illness anxiety disorder has high comorbidity rates with what two disorders?
anxiety and major depression
What is conversion disorder?
symptoms mimic neurological disorder or other medical condition (which may make no anatomical sense)
Anna complains of pain insensitivity limited to her hand and fingers, which makes no anatomical sense. Which disorder does she likely suffer from?
conversion disorder
What is the difference between factitious disorder and malingering?
Factitious > deliberately creating symptoms (e.g. MUNCHAUSEN syndrome - repetitive pattern of factitious disorder) which can be imposed on self or on another
Malingering > symptoms created for the purpose of compensation or to avoid a negative event.
Somatic symptom disorders (SSD) are frequently linked with which personality disorder?
How is this information helpful for understanding aetiology?
Antisocial personality disorder (APD)
Biological vulnerabilities:
> Male relatives of people with somatization disorder have higher rates of antisocial PD than controls
> APD more in males, SSD more in females = different manifestation?
Somatic symptom disorders may be caused by neurological abnormalities in the __________
right hemisphere
What are the biological vulnerabilities of somatic symptom disorders? HARD BONUS QUESTION
> > Anti-social PD
- many similarities
- just expressed differently?
> > Neurobiologically based disinhibition syndrome
- weak behavioural inhibition system
> > Neurological
- abnormalities in the right hemisphere
> > Somatosensory amplification
- greater physiological sensitivity
What are three psychodynamic vulnerability theories for somatic symptom disorders?
> Negative feelings repressed and converted into physical symptoms
> Poor self awareness and ability to self regulate
> Less psychologically minded
From the cognitive perspective, what are the two theories of somatic symptom disorder aetiology?
> > Somatoform symptoms = form of communication
Alexithymia (can’t read emotions) strongly correlated with psychosomatic symptoms
People use somatic symptoms e.g. “I have a headache” to explain that they’re not well - they avoid “I feel anxious”
> > Misinterpreted body sensations
More likely to view negative life events as unpredictable, threatening and uncontrollable (same way they interpret ambiguous stimuli)
How may negative affectivity (NA) linked to somatic symptom disorders?
NA linked to: worry, pessimism, fear of uncertainty, poor self esteem, etc.
Greater NA (esp. worry + pessimism) predicts increased severity of somatization
If an individual has somatic symptom disorder and has a history of personal or family illness, why might this information be important in understanding the disorder’s aetiology?
The individual may notice that they/someone else always gets rewarded for being sick.
may be conscious/unconscious or deliberate/non-deliberate
Describe Freud’s four basic processes of stress conversion and related gains in the development of conversion disorder?
- traumatic event
- conflict repressed, made unconscious
- anxiety increases / threatens to push into consciousness and is “converted” into physical symptoms
PRIMARY GAIN = don’t have to deal with the conflict - Increased attention and sympathy is received (SECONDARY GAIN)
