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Flashcards in Somatoform disorders Deck (28):
1

definition of somatic?

- of or relating to the body, especially as distinct from the mind

2

Summary of what somatoform disorders are?

- soma: means body
- overly preoccupied with health or body appearance
- physical complaints w/o medical condition

3

Types of DSM-V somatoform disorders?

- somatic sx disorder
- conversion disorder
- illness anxiety disorder
- other specified somatic sx and related disorder

4

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

5

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)

6

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

7

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

8

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

9

Causes of somatization disorder?

- family hx of illness
- relation with antisocial personality disorder
- weak behavioral inhibition system

10

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

11

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

12

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

13

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

14

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

15

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

16

What is illness anxiety disorder?

- no physical sxs are necessary
- severe anxiety - possibility of having a disease
- preoccupied with possibility that normal sensations are sxs of serious disease
- frequent visits to providers
- persists despite medical reassurance
- over-report bodily sensations
- pt has a disease of having disease, has no insight, is resistant, and this causes fxnl losses

17

Criteria for illness anxiety disorder?

- preoccupation with having or acquiring a serious illness
- somatic sxs are not present or if present are only mild in intensity
- there is a high level of anxiety about health, and the individual is easily alarmed about personal health status
- the individual performs excessive health related behaviors or exhibits maladaptive avoidance
- illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over time
- the illness related preoccupation isn't better explained by another mental disorder

18

Prevalence, age of onset, course and associations of illness anxiety disorder?

- prev: 1-10% in community
- gender - equal
- age of onset - any age, most common early adult
- course: chronic, but waxes and wanes
- associations: fears of aging and death, doctor shopping, poor relationships with providers, past experience with disease, family and work problems

19

Causes and tx of illness anxiety disorder?

- causes:
cognitive perceptual distortions, familial hx of illness
- biological factors: one sign of anxiety is an increased level of cortisol - cortisol levels are elevated in pts with somatization disorder
- right hemisphere may be implicated conversion disorder - sxs are more likely to be on left side of body
- tx:
challenge illness-related misinterpretations, provide more substantial and sensitive reassurance

20

What are other specified somatic symptom and related disorder (DSM V)?

- 1. brief somatic sx disorder: less than 6 months
- 2. brief illness anxiety disorder: less than 6 months
- 3. illness anxiety disorder w/o excessive health related behaviors: criteria D for illness anxiety disorder isn't met
- 4. pseudocyesis: false belief you are pregnant

21

What is unspecified somatic symptom and related disorder?

- they cause stress, but they don't fit anywhere else
- don't use unless there are decidely unusual situations where there is insufficient information to make a more specific dx

also have somatoform disorder NOS:
-pseudocyesis (false pregnancy) - all of the s/s of pregnancy except for the presence of a fetus
-hypochondriacal sxs for less than 6 months

22

Etiology of somatoform disorders?

-psychoanalytic theory (freud): controlling sexual urges - displaced anxiety or secondary gain
sackeim: deny knowledge but use info
- behavior theory:
malingering
social learning and reinforcement
secondary gain

23

What is body dysmorphic disorder?

- previously described in DSM III as somatoform d/o
- DSM V - obsessive compulsive spectrum
- excessive concern with real or imagined defects in appearance, especially facial marks or features
- frequent visits to plastic surgeons
- culturally influenced, but not culturally bound
- may be sx of more pervasive disorders: obsessive compulsive or delusional disorder

24

Criteria for body dysmorphic disorder?

- preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive
- preoccupation causes clinically significant distress or impairment in fining
- preoccupation isn't better accounted for by another mental disorder

25

Characteristics of body dysmorphic disorder?

- either fixation with or avoidance of mirrors
- suicidal ideation and suicidal behavior are common

26

Prevalence of body dysmorphic disorder, course, associations?

- fairly common, 1.7-2.4% of pop
- gender: equally common in men and women
-age of onset: usually starts in adolesence
- course: chronic
- associations: excessive checking/grooming, removal of mirrors, social isolation, surgical procedures, suicide
- probably greatly undx

27

Causes and tx of body dysmorphic disorder?

- causes:
unknown, likely intricate through an interaction of multiple factors:
genetic
developmental
psychosocial
social
cultural
- shares similarities with OCD
- tx:
-parallels that for OCD
- CBT
- SSRIs may provide relief
-*** plastic surgery isn't helpful

28

Impt take home pts for somatoform disorders?

- always do complete H&P
- the disease is real to pt
- be respectful, pt has not chosen this illness (not malingering)
- resist urge to drive up costs for pt
- frequent, short visits
- pain contracts are impt!
- tx whole pt, watch for comorbidities