SOMATIC SYMPTOM AND
RELATED DISORDERS
Soma = BodyPreoccupation with health or
appearancePhysical complaints No identifiable medical condition
SOMATIC SYMPTOM AND RELATED
DISORDERS
Types of disorders:
Somatic symptom disorder (somatization D/O) Illness anxiety disorder (hypochondriasis)
Psychological Factors affecting medical condition
Conversion disorder
Factitious disorder
Somatic Symptom and Related Disorders
formerly Briquet’s syndromeContinually feel weak and illSevere pain
Physical symptoms
Somatic Symptom Disorder
Somatic Symptom Disorder Criteria
formerly known as hypochondriasis”
Less concerned with any specific physical symptom and more worried about the idea that she/he was either ill or developing an illness
Reassurances from numerous doctors ____________________
ILLNESS ANXIETY DISORDER
ILLNESS ANXIETY DISORDER
Statistics 1% to 5% prevalence 6.7% median prev of medical patients Female : Male = 1:1 Onset at any age
Peaks: adolescence, middle age, elderly
Chronic course
ILLNESS ANXIETY DISORDER
CAUSES Disorder of cognition or perception
Physical signs and sensations
Cause is unlikely to be found in isolated biological or psychological factors
Familial history of illness and learning
Three factors that may contribute to etiology _______________________________ High family disease incidence _______________________________
Psychodynamic ___________________________ Limited efficacy data
Educational & supportive _______________________________
____________________________________________________________________________________________________________________________
ILLNESS ANXIETY DISORDER
ILLNESS ANXIETY DISORDER
Cognitive-behavioral
Identify and challenge misinterpretations
“Symptom creation” – enhance control and empowerment
Stress-reduction
Psychological Factors Affecting Medical Condition
The essential feature of this disorder is the presence of a diagnosed medical condition such as asthma, diabetes or severe pain
Behavioral or psychological factors would have a direct influence on the course or perhaps the treatment of the medical condition
Functional Neurological Symptom Disorder:
Conversion Disorder Conversion disorders generally have to do
with physical malfunctioning, such as paralysis, blindness, or difficulty speaking (aphonia), without any physical or organic pathology
Conversion Disorder Clinical description
Physical malfunctioning Sensory-motor areas
Lack physical or organic pathology
Lack awareness “La belle indifference”
Possible, but not always Intact functioning at other
times Often seen as malingering
(faking)
Conversion Disorder
Conversion Disorder
Statistics Rare in MH settings but… Prevalence depends on setting Female > male Onset = adolescence Chronic, intermittent course
Unconscious mental processes Anna O = Bertha Pappenheim DID?
Conversion Disorder
Special populations Soldiers Children
Better prognosis?
Cultural considerations Religious experiences Rituals
Causes Freudian and psychodynamic view
Trauma, conflict experience Repression “Conversion” to physical
symptoms Primary gain
Attention and support Secondary gain
Causes
Behavioral view
Family/social/cultural factors
Treatment Similar to somatic symptom disorder Attending to trauma Remove secondary gain Reduce supportive
consequences Reward positive health
behaviors
Treatment No “cures”
Cognitive-behavioral interventions
Initial reassurance Stress-reduction Reduce frequency of help-seeking behaviors
“Gatekeeper” physician Reduce visits to numerous specialists
Munchausen’s Intentionally produced symptoms No obvious benefit
Sick role?
Factitious disorder imposed on another known previously as Munchausen syndrome by proxy Intentionally produced symptoms in another
person
Is this behavior malingering?
Factitious Disorders
Factitious Disorders
Detection and Treatment?
Factitious Disorders
Top Related