Somatic Symptom And Dissociative Disorders Flashcards
Define somatic
Related to the body , especially as instinct of the mind
What are the somatic symptom and related disorders?
- somatic symptom disorder
- Illness anxiety disorder
- Conversion disorder
- Factitious disorder
What are the somatic symptoms and related disorders common features?
Prominence of somatic /health related symptoms associated with significant distress or impairment
What is the epidemiology Somatic Symptom and related disorders ?
- 5-7% in the general population
- female to male ratio of 10:1
What is the onset and course somatic symptom and related disorders?
- Onset in childhood and teen years, but lifetime onset
- 20-25% acute symptom onset develop chronic somatic illness
- experience of fluctuates with stress
What are the associated features of somatic symptom and related disorders?
- Lengthy medical history with unremarkable exam findings
- Psychiatric co-morbidity (major depressive disorder, anxiety, drug dependence, histrionic trait )
What are the diagnostic criteria of Somatic Symptom disorder?
- 1+ distressing/disruptive somatic symptom
- Atleast one indicator of excessive thoughts/feelings/behaviors about the symptoms such as:
1. disproportionate thoughts about the seriousness of the symptom
2. High levels of anxiety about the symptom or health
3. Excessive time/energy devoted to the symptom
Persistent symptomatology(usually 6+ months)
Describe diagnostic criteria of Somatic Symptom disorder (not what it is, just describe)
- diagnosis of SSD focuses on the abnormal behaviors/thoughts/feelings in response to the distressing somatic symptom(s)
- Focus is NOT on whether there is a medical explanation for the somatic symptom(s)
- there could be a medical basis for their symptoms and still have SSD
What are the diagnostic criteria of Illness anxiety disorder?
- preoccupation with having/acquiring a serious illness
- Somatic symptoms are not present or, if present are mild
- Patient performs excessive health-related behaviors or shows maladaptive avoidance
Differentiate SSD and IAD
SSD: patient has a distressing physical complaint with an excessive response to that distressing physical complaint. Might be a medical basis for the illness
IAD: patient does NOT have a distressing physical complaint but nonetheless worries about one’s health and is preoccupied by this worry
What are the general multifactorial causes of SSD and IAD (etiology)?
- genetic predisposition (e.g. sensitivity to pain)
- Personality trait of negativity
- early life/family experiences (childhood physical, sexual, emotional abuse)
- Delayed development of emotional intelligence (emotional trauma manifests as physical pain - emotional neglect)
What are cognitive biases that contribute to IAD and SSD(etiology)?
Cognitive biases
- focus of attention on somatic symptoms
- Negative interpretation of somatic symptoms
- Negative feedback loop of interpretation and further anxious symptoms
What are behavioral biases that contribute to IAD a and SSD(etiology)?
- patient may take on a sick role, leading to worse illness
- reinforced sick role behavior (attention, tangible rewards, avoidance of unpleasant tasks)
How can SSD and IAD be treated?
- Medication -anti-anxiety/antidepressants in extreme cases, to assist with CBT
- CBT
- address delayed develop of delayed e,optional intelligence, especially for patients with long-standing paradigms
How can SSD and IAD be treated with CBT?
- reduce the stress “spiral”(to avoid intensifying systems)
- reduce excessive attention to bodily cues
- Correct cognitive distortions about physical symptoms
- reinforce “non-sick role”
- Reduce avoidance of activities due to uncomfortable physical sensations
- family therapy for dynamics and support
How can SSD and IAD treatment be found in medication?
Anti-anxiety/anti-depressants in extreme cases, to assist with CBT
What are the diagnostic criteria of Conversion disorder?
- Altered voluntary motor or sensory function.
- Symptom examples: weakness or paralysis, loss of balance, difficulty swallowing, abnormal movements, vision problems, hearing problems, speech problems, numbness
- evidence of incompatibility between the symptom and neurological findings
- incompatibility of the symptom with neurological disease a key feature of this diagnosis-rule our neurological cause
What are the conversion disorder subtype?
- with weakness or paralysis
- with abnormal movement
- with swallowing symptoms
- with speech symptoms
- with attacks or seizures
- with anesthesia or sensory loss
- with special sensory symptom (e.g., blindness)
- with mixed symptoms
What is the onset and course of conversion disorder?
Typically sudden, after a major psychological stressor
-Symptoms may be symbolically related to the stressor (e.g., unable to move legs after learning about a friends paralysis)
- Often a “la belle indifference” reaction to the disability that suddenly emerges - usually short duration without recurrence
Explain the etiology of Conversion Disorder
Neural basis: unknown. Perhaps somatosensory/ somatomotor cortex involvement
Psychological: Non-conscious transformation of psychological distress into neurological symptoms
Symptoms may appear suddenly following a stressful event, but not always identified
How can conversion disorder be treated?
CBT
-goal is to elucidate and acknowledge any emotional basis to the symptoms
- learn about conversion disorders in general, not caused by a neurological disorder or disease
- Stress reduction techniques
- Occupational therapies if paralysis, etc.
Hypnosis
Medications - no approved treatment for conversion disorder
What is fictitious disorder?
Feigning physical or psychological symptoms, in self or others, in the absence of obvious external motivation
- Primary gain is attention and being in the sick role
- Imposed on oneself(Munchausen’s Syndrome)
- Imposed on another (Munchausen’s Syndrome by proxy)
What is the typical profile of someone with factitious disorder?
Patient has a past connection to medicine or worked in a health care profession
What are the markers of factitious disorder?
Markers of factitious disorderm
- Unexplained Persistent /recurrent symptoms
- Inconsistent history
- Dramatic presentation of severe symptoms
- Symptoms influenced by observation
- Insistence on a particular treatment
