somatic disorders Flashcards
(30 cards)
somatization
tendency to experience and communicate psychological distress as physical symptoms in absence of identifiable pathology
*symptoms are neither feigned nor under voluntary control of patient, so they seek medical condition bc they think they have a real disease
consequences of MUPS (medically unexplained physical symptoms)
psychosocial distress, decreased QOL, inc rates depression and anxiety
medical dangers: invasive procedures, unnecessary surgery, drug trials, cost of care
general symptoms of somatic symptom and related disorders
physical sx that may or may not be explained by medical condition
psychosocial stress may or may not = somatic distress
heightened awareness or misinterpretation of normal body functions
not consciously produced or feigned
alexithymia - difficulty expressing emotions verbally
general treatment issues of somatic symptom and related disorders
regular follow-ups, brief physical exam at visit, look closely for objective signs of disease, avoid unnecessary tests or treatments, avoid insulting explanations (“all in your head”) but explain that stress can cause symptoms, set limits for contact outside of visits, limit workups to objective findings
“psychologization” and somatic symptom and related d/o
may not entirely explain somatization
many patients don’t have other psychiatric conditions, and sometimes physical symptoms don’t respond well to psychological treatments
how to approach patients with somatization d/o’s
- set goal as restoration of normal function
- reassure patient that symptoms are common but not serious
- inquire about abuse- up to 2/3 pts have hx of abuse
somatoform d/o in DSM5 vs DSM4
5: emphasis on disproportionate affect, behavior, cognition related to physical sx
4: overemphasized centrality of medically unexplained sx
somatization d/o criteria
1- hx of physical complaints over several years resulting in tx-seeking or impaired fxn, before 30 yo
2- 4 pain sx, 2 GI sx, 1 sexual sx, 1 pseudoneurological sx
3- sx cannot be explained by known medical condition/substance, or when related to medical condition complaints or impairment»_space; expected
4- sx not intentionally produced or feigned
hypochondriasis criteria
1- preoccupied w fears of having serious dz based on misinterpretation of bodily sx
2- persists despite medical evaluation and reassurance
3- beliefs not of delusional intensity
4- distress or impairment
5- at least 6 months
6- not better accounted for by another mental d/o
factors contributing to somatic symptom and related d/o
- genetic/biological vulnerability - inc sensitivity to pain
- early traumatic experiences
- learning - gain attention from illness, no reinforcement of non-somatic expressions of distress
- cultural/social norms - stigma of psychological suffering
somatic symptom d/o criteria
1- 1+ somatic sx, distressing or impairing
2- excessive thoughts or behaviors related to sx; disproportionate/persistent thoughts about seriousness of sx, persistently high anxiety about sx, or excessive time/energy to sx or health concerns
3- symptomatic (w 1 or multiple sx) for >6 mos
risk factors for somatic sx d/o
environmental- lower education, SES, unemployment
gender, age, childhood adversity, chronic physical and/or psychiatric illness
social stress, reinforcing social factors (illness benefits)
course of somatic sx d/o
high use of medical care that doesn’t alleviate concerns, multiple doctors seen
unresponsive to interventions, sensitive to medication side effects
feel that care and tx are inadequate
illness anxiety d/o criteria
1- preoccupied w having or acquiring serious illness
2- no somatic sx, or mild sx
3- high level of anxiety about health, disproportionate worry about risk for dev dz
4- excessive health-related behaviors or maladaptive avoidance
*at least 6 mos of worries, focus illness may change
risk factors for illness anxiety d/o
env: precipitated by major life stress or threat to health, hx childhood abuse or serious childhood illness
features supporting diagnosis of illness anxiety d/o
- more frequent in medical vs mental health setting
- consult many physicians for same problem
- medical attention may lead to paradoxical exacerbation of anxiety or iatrogenic complications
tx for somatic sx and illness anxiety d/o
reassurance, reattribution (include physical and psych factors), normalization (address patient’s concerns, don’t just say “normal” results)
SSRI, CBT (time-limited)
conversion disorder (functional neurological symptom) criteria
1- 1+ sx of altered voluntary motor or sensory function
2- evidence of incompatibility b/t sx and recognized neuro/med conditions
3- sx or deficit not d/t other medical or mental d/o
4- sx or deficit causes distress or impairment or warrants medical evaluation
subtypes of conversion d/o
1- motor sx or deficits: involuntary mvmts, tic, seizure, paralysis, weakness
2- sensory sx or deficits: anesthesia, blindness/ tunnel vision, deafness
theoretical goals of conversion sx
1- sx produced may provide partial solution to intrapsychic problem or conflict (pt unaware of it)
2- may be unconsciously motivated to play “sick role” and seek associated privileges (release from obligations)
risk factors for conversion disorder
temperamental- identification
env- hx child abuse/neglect, stressful life events
physiological- prior medical illness w similar/same sx
tx conversion d/o
general: reassurance, physical and occupational therapy
psychotherapies
hypnosis
pseudocyesis
false belief of being pregnant a/w objective signs and reported sx of pregnancy including: abd enlargement, reduced menstrual flow, amenorrhea, feeling of fetal mvmt, nausea, breast engorgement/ secretion, labor pains at expected delivery date
factitious disorder criteria
1- falsification of physical or psych sx or induction of injury/dz a/w identified deception
2- presents self to others as ill, impaired, injured
3- deceptive behavior evident in absence of external reward for behavior (motivation = sick role)
4- not d/t another mental d/o
