Week 10 Lecture 10b) Somatic Symptom Disorders (Formerly Somatoform Disorders) - Peter Enticott - (DN) 39:00 Flashcards Preview

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Flashcards in Week 10 Lecture 10b) Somatic Symptom Disorders (Formerly Somatoform Disorders) - Peter Enticott - (DN) 39:00 Deck (23):
0

What were the DSM-5 Somatic Symptom Disorders formerly known as in the DSM-IV-TR?

DSM-IV-TR Somatoform Disorders
DSM-5 Somatic Symptom Disorders

2

What has changed from DSM-V-TR to DSM-5?

Moved from 7 to 3 conditions

1. Somatic Symptom Disorder
2. Illness Anxiety Disorder
3. Conversion Disorder (Functional Neurological Symptom Disorder)

Subsumed DSM-IV-TR categories
1. Somatisation Disorder (hysteria)
2. Undifferentiated Somatoform Disorder
3. Conversion Disorder
4. Pain Disorder
5. Hypochondriasis
6. Body Dysmorphic Disorder
7. Somatoform Disorder NOS

39:30

3

Describe some features of Body Dysmorphic Disorder.
Where has this been relocated in the DSM-5

Relocated to OCD and related conditions

- preoccupied with an exagerated or imagined deficit in bodily appearance
e.g., nose, arms,
left side of face (interesting as assoc. with right parietal cortex, where we assemble our bodily representation)
- disabling, hours in mirror, avoiding others
- comorbid disorders

4

Why do plastic surgeries rarely solve the problem in patients with Body Dysmorphic Disorder?

because the problem is in the brain. No matter the reality, the brain will continue to see ..........and will never be satisfied with outcomes e.g., Michael Jackson was thought to have BDD

5

How does Somatic Symptom Disorder (SSD) differ from DSM-IV's Somatoform Disorder?

Why did DSM-5 make this change?

DSM-IV Somatoform Disorder - involved bodily symptoms similar to SSD, but focus was on underlying 'psychological cause'

DSM-5 Somatic Symptom Disorder - excessive concern (preoccupation) about 'physical symptoms' or health

because it is literally impossible to distinguish between a symptom that has a medical cause & one that has no identifiable medical cause. Just because we can't find the medical cause, does not mean it doesn't exist.
42:20

6

Pain Disorder (DSM-IV)

- disabling pain, but can't figure out cause
- onset, continuation & severity thought to be underpinned by psychological factors
- typically following a stressful or traumatic event
- description more vague in terms of location, sensation & triggers

44:05

7

Somatisation disorder (DSM-IV)

..

8

Hypochondriasis (DSM-IV)

...

9

Which three DSM-IV conditions have been subsumed under
'Somatic Symptom Disorder' in DSM-5

Somatisation
Pain Disorder
Hypochondriasis (if accompanied by somatic symptoms)

10

DSM-5 criteria for 'Somatic Symptom Disorder'

- 1 or more somatic symptoms causing DISTRESS or DISRUPTION on persons life
- Individual devotes excessive time, energy, experiences anxiety, & concern to somatic symptom/s
- Persistent (at least 6mnths)

Specifiers
- With predominant pain (previously pain disorder)
- Severity: mild, moderate, severe

Its about the person's experience with their somatic complaints, rather than what might have caused them
this moves away from having psychological trauma/states as the basis for these symptoms as it is really difficult to quantify

11

DSM-5 criteria for 'Illness Anxiety Disorder'

- preoccupation with fears of having illness even though no more than mild somatic symptoms
- high anxiety about health
- excessive health-related behaviours
- at least 6 months

- rare to see this without moderate or severe somatic complaints

SPECIFIER
care seeking or care avoidant
48:15

12

Conversion Disorder (DSM-IV)

prevalence unclear - 3%, higher for inpatients?
- sudden onset of symptoms e.g.,
sensory: tunnel vision, tingling, loss of feeling, vision, hearing
motor: paralysis, seizures

- develops in adolescence/early adulthood
- comorbid depression, anxiety
- diagnosis is difficult: is the cause not there because it is absent or because we can't find it

13

DSM-5: Conversion Disorder (Functional Neurological Symptom Disorder)

- Neurological symptoms WITHOUT medical cause
IMPT: they need to be
- Inconsistent with medical tests or a recognised neurological disorder (needs to be fairly atypical)
- Causes FUNCTIONAL impairment across various domains

50:30

14

What questions exist with regard to Conversion Disorder?

Is it medical.......is it psychological....
Is it not there because its not there or because we can't find it

15

What is the difference between
Malingering and Factitious Disorder?

Malingering: faking psychological or somatic symptoms for gain
Factitious disorder: faking symptoms, but without evidence of gain

51:15

16

Other Specified/Unspecified Somatic Symptom and Related Disorder

features exist, but dont meet diagnostic criteria (i.e., sub-clinical)
including:
- brief somatic symptom disorder (less than 6mnths)
- brief illness anxiety disorder (less than 6mnths)
- illness anxiety disorder without excessive health-related behaviours
- Pseudocyesis (false belief of pregnancy with objective signs and reported symptoms of pregnancy)

52:00

17

What two explanatory models were covered?

- Psychodynamic - repressed emotion (unconscious), manifest physically (Freud)
lacks empirical support
- Recent 'Dynamic Models' - consider disruption of consciousness, altered awareness of sensory/motor inputs/outputs
- 'Motivation'
- Sociocultural

18

Briefly outline the Psychodynamic models and more recent interpretations?

- Psychodynamic - repressed emotion (unconscious), manifest physically (Freud)
lacks empirical support
- Recent 'Dynamic Models' - consider disruption of consciousness, altered awareness of sensory/motor inputs/outputs

19

How may have Socio-cultural experiences/situations contributed to these conditions?

- reduced prevalence over past century
- sexual repression of 1800's
- restrictions on psychological expression (e.g., World Wars)

20

Somatoform Disorders: Aetiology

- minimal genetic role
-

55:10

21

Why is treatment for Somatic Disorders so difficult?

Reluctance to see mental health professionals
- dont want to be delegitimise their physical symptoms

Psychodynamic: lack of controlled studies

Comorbidities: need to address also

55:55

22

What is the focus of CBT on Somatic Disorders?

Focus on changing:
- emotions
- reinforcing cognitions
- behaviour (e.g., blocking reinforcement for their 'role' as ill patient)

23

What treatments are generally used for
Pain
Hypochondriasis
Somatisation

Pain: antidepressants, relaxation training
Hypochondriasis: CBT, alter attentional processes, change negative incorrect cognitions
Somatisation: CBT

56:55

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