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