Transcript Somatic Symptom and Related Disorders


Soma = Body
Preoccupation with health or
appearance
 Physical complaints
 No identifiable medical condition
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Types of disorders:
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Somatic symptom disorder (somatization
D/O)
Illness anxiety disorder (hypochondriasis)
Psychological Factors affecting medical
condition
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Conversion disorder
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Factitious disorder
formerly Briquet’s syndrome
Continually feel weak and ill
Severe pain
Physical symptoms
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formerly known as hypochondriasis”
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Less concerned with any specific
physical symptom and more
worried about the idea that she/he
was either ill or developing an
illness
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Reassurances from numerous
doctors ____________________
ILLNESS ANXIETY DISORDER
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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
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ILLNESS ANXIETY DISORDER
CAUSES
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Disorder of cognition or perception
 Physical signs and sensations
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Cause is unlikely to be found in isolated
biological or psychological factors
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Familial history of illness and learning
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Three factors that may contribute to
etiology
 _______________________________
 High family disease incidence
 _______________________________
ILLNESS ANXIETY DISORDER
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Psychodynamic
 ___________________________
 Limited efficacy data
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Educational & supportive
 _______________________________
_______________________________
_______________________________
_______________________________
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ILLNESS ANXIETY DISORDER
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Cognitive-behavioral
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Identify and challenge
misinterpretations
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“Symptom creation” – enhance
control and empowerment
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Stress-reduction
 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
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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
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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
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Statistics
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Rare in MH settings but…
Prevalence depends on setting
Female > male
Onset = adolescence
Chronic, intermittent course
Unconscious mental processes
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Anna O = Bertha Pappenheim  DID?
Conversion Disorder
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Special populations
 Soldiers
 Children
 Better prognosis?
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Cultural considerations
 Religious experiences
 Rituals
Causes
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Freudian and psychodynamic view
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Trauma, conflict experience
Repression
“Conversion” to physical symptoms
 Primary gain
Attention and support
 Secondary gain
Causes
Behavioral view
Family/social/cultural factors
Treatment
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Similar to somatic symptom
disorder
Attending to trauma
 Remove secondary gain
 Reduce supportive consequences
 Reward positive health behaviors
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Treatment
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No “cures”
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Cognitive-behavioral interventions
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Initial reassurance
Stress-reduction
Reduce frequency of help-seeking behaviors
“Gatekeeper” physician
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Reduce visits to numerous specialists
 Munchausen’s
 Intentionally produced symptoms
 No obvious benefit
 Sick role?
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Factitious disorder imposed on another known
previously as Munchausen syndrome by proxy
 Intentionally produced symptoms in another
person
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Is this behavior malingering?
Factitious Disorders
Detection and Treatment?