Week 6: Somatic Symptom and Related Disorders

Question 1

Individuals are commonly encountered in primary care and other medical settings but are less commonly encountered in psychiatric and other mental health settings.

Answer 1

Somatic Symptom and Related Disorders

Question 2

These reconceptualized diagnoses, based on a reorganization of DSM-IV somatoform disorder diagnoses, are more useful for primary care and other medical (nonpsychiatric) clinicians.

Answer 2

Somatic Symptom and Related Disorders

Question 3

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

Major diagnosis in this diagnostic class.

Answer 3

Somatic Symptom Disorder

Question 4

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

Emphasizes diagnosis made on the basis of the presence of symptoms and signs (distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms) rather than the absence of a medical explanation for them.

Answer 4

Somatic Symptom Disorder

Question 5

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

A distinctive characteristic of many individuals with this disorder is not the somatic symptoms per se, but instead the way they present and interpret them.

Answer 5

Somatic Symptom Disorder

Question 6

IDENTIFICATION | SOMATIC SYMPTOM DISORDER:

Example:
Two people both feel stomach pain:
Person A: Thinks it’s just gas or something they ate - moves on.
Person B: Believes it’s cancer, panics, keeps visiting doctors, Googles symptoms for hours, can’t focus on anything else.

Which of these people may have Somatic Symptom Disorder?

Answer 6

Person B - not because of the pain, but because of how they interpret and respond to it.

Question 7

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

The principles behind the changes in the somatic symptom and related diagnoses from DSM-IV are crucial in understanding the DSM-5 diagnoses.

For instance, the DSM-IV term ___________________ ___________ was confusing and was replaced by somatic symptom and related disorders.

Answer 7

somatoform disorders

Question 8

TRUE OR FALSE | SOMATIC AND RELATED DISORDERS:

In DSM-IV there was a great deal of overlap across the somatoform disorders and a lack of clarity about the boundaries of diagnoses. Although individuals with these disorders primarily present in medical rather than mental health settings, nonpsychiatric physicians found the DSM-IV somatoform disorders difficult to understand and use. The current DSM-5 classification recognizes this overlap by reducing the total number of disorders as well as their subcategories.

Answer 8

TRUE

Question 9

A number of factors may contribute to somatic symptom and related disorders:

Answer 9

• Genetic and biological vulnerability (e.g., increased sensitivity to pain)
• Early traumatic experiences (e.g., violence, abuse, deprivation)
• Medical iatrogenesis (e.g., reinforcement of the sick role, excessive referrals and diagnostic testing)
• Learning (e.g., lack of reinforcement of nonsomatic expressions of distress)
• Sociocultural norms that minimize or stigmatize psychological suffering as compared with physical suffering

Question 10

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

Can be considered either a somatic symptom and related disorder or an anxiety disorder.

Answer 10

Illness Anxiety Disorder

Question 11

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

Because of the strong focus on somatic concerns, and because this disorder is most often encountered in medical settings, for utility it is listed with the somatic symptom and related disorders.

Answer 11

Illness Anxiety Disorder

Question 12

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

The majority of individuals with this disorder have extensive yet unsatisfactory medical care.

Answer 12

Illness Anxiety Disorder

Question 13

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

They generally have elevated rates of utilization of medical and mental health services compared with the general population.

Answer 13

Illness Anxiety Disorder

Question 14

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

In a minority of cases, individuals are too anxious to seek medical attention and avoid medical health care.

Answer 14

Illness Anxiety Disorder

Question 15

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

They often consult multiple physicians for the same problem and obtain repeatedly negative diagnostic test results.

Answer 15

Illness Anxiety Disorder

Question 16

IDENTIFICATION | SOMATIC SYMPTOM DISORDER VS ILLNESS ANXIETY DISORDER:

• Involves one or more actual physical symptoms (e.g., pain, fatigue)
• The symptoms may or may not have a medical cause
• The focus is on the distress caused by the symptoms
• Person spends excessive time and energy worrying about the symptoms
• Physical complaints are present and prominent

Answer 16

Somatic Symptom Disorder (SSD)

Question 17

IDENTIFICATION | SOMATIC SYMPTOM DISORDER VS ILLNESS ANXIETY DISORDER:

• Involves minimal or no physical symptoms
• The main concern is having or developing a serious illness
• The focus is on health anxiety, not on specific symptoms
• Person frequently checks body or avoids medical care altogether
• Worry is about illness despite little or no symptoms

Answer 17

Illness Anxiety Disorder (IAD)

Question 18

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

The key to diagnosis is neurological symptoms that can be demonstrated, on the basis of positive clinical examination features, to be incompatible with recognized pathophysiology.

Answer 18

Functional Neurological Symptom Disorder

Question 19

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

The symptoms are real, not faked.

Answer 19

Functional Neurological Symptom Disorder

Question 20

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

Diagnosis is now based on “positive signs” - things a trained doctor can observe or test that show the symptom is inconsistent with known medical conditions.

Answer 20

Functional Neurological Symptom Disorder

Question 21

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

A psychological trigger (like stress or trauma) is not required anymore for diagnosis - because it’s not always present or clear.

Answer 21

Functional Neurological Symptom Disorder

Question 22

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

There may be a history of other functional somatic symptoms or disorders, especially involving pain and fatigue.

Answer 22

Functional Neurological Symptom Disorder

Question 23

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

Onset may be associated with stress or trauma, either psychological or physical in nature. The potential etiological relevance of this stress or trauma may be suggested by a close temporal relationship.

Answer 23

Functional Neurological Symptom Disorder

Question 24

IDENTIFICATION | SOMATIC AND RELATED DISORDERS:

However, while assessment for stress and trauma is important, it may be absent in up to 50% of individuals, and the diagnosis should not be withheld if none is found.

Answer 24

Functional Neurological Symptom Disorder

Question 25

**IDENTIFICATION | SOMATIC AND RELATED DISORDERS:** Is often associated with dissociative symptoms, such as depersonalization, derealization, and dissociative amnesia, particularly at symptom onset or during attacks.

Answer 25

Functional Neurological Symptom Disorder

Question 26

**IDENTIFICATION | FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER:** The phenomenon of __ _______ _______________ (i.e., lack of concern about the nature or implications of the symptom; a French term that means "the beautiful indifference") has been associated with functional neurological symptom disorder, but it is not specific and should not be used to make the diagnosis. EXAMPLE: *A patient suddenly becomes unable to move her arm. Instead of being alarmed or scared, she casually says, "It's fine. I guess it'll come back eventually," showing no distress.

Answer 26

La belle indifference

Question 27

**TRUE OR FALSE | FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER:** Not all patients with FNSD show la belle indifference; it is not required for diagnosis. It may also appear in other conditions, so it's not specific to FNSD.

Answer 27

TRUE

Question 28

Its essential feature is the presence of one or more clinically significant psychological or behavioral factors that adversely affect a medical condition by increasing the risk for suffering, death, or disability.

Answer 28

Psychological Factors Affecting Other Medical Conditions

Question 29

These factors can adversely affect the medical condition by influencing its *course* or *treatment*, by constituting an additional well-established health risk factor, or by influencing the underlying pathophysiology to precipitate or exacerbate symptoms or to necessitate *medical attention*.

Answer 29

Psychological Factors Affecting Other Medical Conditions

Question 30

**IDENTIFICATION | SOMATIC AND RELATED DISORDERS:** Embodies persistent problems related to illness perception and identity.

Answer 30

Factitious Disorder

Question 31

**IDENTIFICATION | SOMATIC AND RELATED DISORDERS:** In the great majority of reported cases of this disorder, both imposed on self and imposed on another, individuals present with somatic symptoms and expressed medical disease conviction.

Answer 31

Factitious Disorder

Question 32

**IDENTIFICATION | SOMATIC AND RELATED DISORDERS:** If an individual with this disorder imposed on another has also deceptively represented their own illness or injury, both disorders imposed on self and on another can be diagnosed.

Answer 32

Factitious Disorder

Question 33

**IDENTIFICATION | SOMATIC AND RELATED DISORDERS:** Individuals with this disorder imposed on self or X disorder imposed on another are at risk for experiencing great psychological distress or functional impairment by causing harm to themselves and others.

Answer 33

Factitious Disorder

Question 34

**IDENTIFICATION | FACTITIOUS DISORDER:** Factitious disorder is known as ___________________ ___________.

Answer 34

Munchausen Syndrome