Transcript The Somatic Symptom and Related Disorders

The Somatic Symptom and
Related Disorders
When our concerns over physical
symptoms go overboard
Reconsidered in DSM 5
• In DSM IV this type of disorder were defined
by physical symptoms with no know cause
• Labeled Somatoform because these symptoms
took the form of bodily (soma) complaints
• But it is next to impossible to decide whether
or not these complaints are biologically based
• Now Somatic Symptom disorder includes
somatic symptoms irrespective of any medical
explanation
Now three
• Somatic Symptom Disorder – excessive energy
expended or distress over health or somatic
symptoms
• Illness Anxiety Disorder – fears about a
medical condition without somatic symptoms
• Conversion Disorder – unexplained
neurological symptoms
• Also malingering and factitious disorder
Wasted $$, Time, and Resources
• SS patients run up huge medical bills, see lots
of MDs, take lots of meds
• Estimated $256 billion lost
• Ironically, they are very dissatisfied w/ care
• So they seek new MDs, treatments, drugs
• Some can’t work
Criticism of Diagnoses
• Lots of variation among patients
some have anxiety problems, others no
some have real medical issues, others no
• Some of the criteria are subjective
“excessive”, “high level”
• Diagnosis can be stigmatizing – rarely given
Will clinicians continue to ignore?
Course
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Not much research for newer disorders
Seem to start in early adulthood
Symptoms can wax and wane
Illness anxiety seems more chronic
• Often found with mood, anxiety, substance
abuse and personality disorders
Somatic Symptom Disorder
• Three main criteria
1) one or more somatic symptoms that are
very distressing and time-consuming
2) excessive amounts of anxiety or time
3) duration of at least 6 months
• Symptoms might arise after big stressor
• But no insight, symptoms are physical
• Focus is on the distress and behavior
Pain
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For some, it’s pain that dominates
Big risk of painkiller addiction
Chronic pain costs billions
Responsible for much lost work and disruption
Illness Anxiety Disorder
• Obsessed with fear of having a disorder with
no significant symptoms
• This leads to excessive care or
• Maladaptive avoidance behaviors
• Must persist for 6 months
• Lack of physical symptoms distinguishes it
from former DSM condition hypochondriasis
• Often seen with anxiety and mood disorders
Conversion Disorder
• Patient suddenly develops strange
neurological complaints which cannot be
verified by testing
• Complaints include paralysis, seizures,
blindness, tingling, anesthesia
• Even impossible symptoms – tunnel vision
• Some seem unconcerned – le belle
indifference
Conversion Reaction II
• Condition has long history, even back to
Hippocrates and hysteria
• Symptoms must cause great distress,
impairment, or medical intervention
• Usually develops after a major stressor in
adolescence or early adulthood
• Condition may stop and then return
• Found with other somatic problem or DID