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Somatic Symptoms Disorder

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katrina floyd

on 20 May 2016

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Transcript of Somatic Symptoms Disorder

Somatic Symptoms & Related Disorders



FONTS
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder

Major Diagnosis: Somatic Symptom Disorder
made on the basis of positive symptoms and signs
distressing somatic symptoms
abnormal thoughts, feelings, behaviors in response to these symptoms
rather than the absence of a medical explanation for somatic symptoms
Not the somatic symptoms but the way they PRESENT THEM
Distinctive Characteristic
DSM-IV
referred to as Somatoform Disorders
DSM-V
Somatic Symptoms and Related Disorders
The prominence of somatic symptoms associated with significant distress and impairment.
Commonly encountered in primary care and/or other medical settings
Less commonly encountered in psychiatric and other mental health settings
Common Feature
5 basic
Somatoform Disorders
Somatization disorder
Hypochondriasis
Pain disorder
Conversion disorder
Body dysmorphic disorder
Somatic Symptom
&
Related Disorders
Somatic symptom disorder
Illness anxiety disorder
Functional neurological symptom disorder
Psychological factors affecting other medical conditions
Factitious disorder
T he DSM-IV term Somatoform Disorders was confusing
Great deal of overlap across the Somatoform disorders
Lack of clarity about the boundaries of diagnoses
Better reflection between mental & physical health


History of Somatic Symptoms Disorders
Freud Hysteria 1800's
What Happened to the girls in LeRoy?
DSM-V
Diagnostic Criteria
A. Have multiple, current, somatic symptoms that are distressing
*specific / *non-specific

B. Excessive thoughts, feelings, or behaviors
*may/may not be associated with another medical condition
*frequently occur together

C. Symptoms may not be conitinously present (more than 6 months)
*high levels of worry about illness
Development
Causes? Theories?
Etiology
Biological
*not well known
*history of physical/sexual abuse

Pathological concern of individuals with the appearance or functioning of their bodies, usually in the abscence of any identifiable medical condition
Somatic Symptoms Disorder
*attention focused on somatic symtoms

*fear/avoidance of physical activity

*repeated bodily checking for abnormalities

*repeated seeking medical help
Prevalence
Higher than more restrictive DSM-IV somatization disorder
< 1%
Females tend to report more somatic symptoms than males
Prevalence is higher in Females
General adult population may be around
5% - 7%
*somatic symptoms & concurrent medical illnesses are common
*underdiagnosed in older adults
*concurrent depressive disorder

Adults
Children
*most common are recurrent abdominal pain
*headache, fatigue, nausea
*a single symptom more prominent
*do not worry about illness
*Parents' response is important
Defense
*due to stress/anxiety
(childhood trauma or illness)

Physical Sensitivity
* awareness to minor
discomforts (inherited/learned)

Catastrophic thinking
*negative beliefs
*exaggerated fears
(anxiety)
Environmental
*Few years of education
*Low SES
*Stressful life events
*History of physical/sexual abuse
*Greater in African American/Latino
(Puerto-Rico)

Cognitive/Emotional
*Sensitization to pain
*Heightened attention to bodily symptoms
Panic Disorder
Comorbidity
Anxiety
Major Depressive Disorder
Delusional Disorder
Other medical diagnoses
*Irritable Bowel Syndrome
Fibromyalgia
High in cancer patients w/pain & or depression
People w/ Irritable bowel syndrome
Fibromyalgia
Symptoms
Pain
Menstrual
Sexual
Gastrointestinal
Neurological
Treatment
Referral to mental health
Reduce symptoms
Cognitive Behavioral Therapy
Sometimes antidepressants
Illness Anxiety Disorder
DSM - IV
Hypochondriasis
DSM -V
Illness Anxiety Disorder
Classified as having somatic symptoms disorder
Hypochondria was the region below the ribs
"Greeks"

Severe anxiety is focused on the possibility of having a serious disease
Threat seems real
A. Preoccupation with having or acquiring a serious illness
B. Somatic symptoms are not present
C. High level of anxiety about health
D. Excessive health behaviors

E. Preoccupation for at least 6 months
F. Not better explained by another mental disorder
Diagnostic Criteria
DSM-V
Illness Anxiety Disorder
Encountered far more frequently in medical than mental health
Similar in males and females
1% - 5% of general population
Precipitated by a major life stress
History of childhood abuse
Health concerns interfere with
personal relationships
Comorbid
Exact comordities are unknown
Popular Movies
Little shop of Horrors - Seymours Mom
Extensive yet unsatisfactory medical care
Consult multiple physicians for the same problem
Physicians can be dismissive
resulting in a failure to diagnose
2% -7% Primary care outpatients
Begin at any age, onset in early adulthood
chronic
Serious childhood illness
Having close family member with it
Having neglectful or abusive parents

disrupt family life
damage employment
Co-occurs with anxiety disorders
panic disorder
OCD
Depressive disorders
Ferris Buellers Day Off - Cameron
My Girl - Vada
Boy Meets World- Cory
Conversion Disorder
mental health condition in which a person has blindness, paralysis, or other nervous system symptoms
Tremors
non-epilectic seizures
absent speech volume
Symptoms begin suddenly after a stressful situation
Not malingering symptoms
physical symptoms to resolve internal conflict
Factitious Disorder
between malingering and conversion disorder
symptoms under voluntary control
may extend to other members of family
assume sick role/attention seeking
Munchausen syndrome
comorbid anxiety and mood disorders
References
American Psychiatric Association: and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA:
American Psychiatric Associaton, 2013.
Durand, V.M. & Barlow, DH (2013). Somatoform Disorders. Essentials of Abnormal Psychology (6 ed, pp. 164-178). Belmont: Wadsworth Cengage Learning.
www.nlm.nih.gov
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