Chapter 6 (Somatic Symptom Disorders)

Explain the primary/secondary gains in conversion disorder.

Primary: not dealing with emotions/anxiety. Secondary gain: sympathy.

What are the diagnostic criteria for somatic symptom disorder? (4)

1) One or more somatic symptoms (no physical cause) that are distressing/result in significant disruption of daily life 2) Excessive thoughts, feelings, or behaviours related to somatic symptoms/health concerns 3) Somatic symptoms are present for more than 6 months 4) Qualifiers

What are the diagnostic criteria for illness anxiety disorder? (6)

1) Preoccupation with having or acquiring a serious illness 2) Somatic symptoms not present (or only mild if present); if another medical condition is present or there is a risk of developing one (heredity) the preoccupation is excessive/disproportionate 3) High anxiety about health -- easily alarmed about health 4) Illness preoccupation present for 6+ months 5) Not better explained by another medical condition 6) Qualifiers

Explain how psychological factors affect a medical condition?

1) Presence of a diagnosed medical condition 2) Condition is adversely affected by psychological or behavioural factors (ie. having an anxiety disorder than worsens the experience of pain)

What are the three qualifiers of somatic symptom disorder?

1) With predominant pain 2) Persistent (6+ months) 3) mild, moderate, severe

What are the defining features of somatic symptom disorder? (4)

1) extended history of physical complaints (without medical basis) 2) substantial impairment in social and occupational functioning 3) concern over symptoms themselves, not what they might mean 4) symptoms become person's identity

What are the diagnostic criteria for factitious disorders? (4)

1) falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception 2) the individual presents themselves to others as ill, impaired, or injured 3) the deception is evident even in the absence of obvious external rewards 4) the behaviour is not better accounted for by another mental disorder

What are the defining features of illness anxiety disorder? (4)

1) formerly known as hypochondriasis 2) focused on the idea of being sick 3) strong disease conviction 4) medical reassurance does not seem to help

What are some defining features of conversion disorder? (4)

1) malfunctioning often involves sensory-motor areas 2) persons show la belle indifference to symptoms 3) retain most normal functions, but without awareness of this ability 4) can be very difficult to diagnose

What are the causes of somatic symptom and illness anxiety disorder? (3)

1) misinterpretation of symptoms (distorted cognitions) with strong emotional reaction 2) too much focus on symptoms >> increased arousal >> brings on more symptoms >> more focus >> misinterpretation 3) "better safe than sorry" mentality about symptoms

What are the diagnostic criteria for conversion disorder? (4)

1) on or more symptoms of altered voluntary motor or sensory function 2) incompatibility between the symptom and recognized neurobiological or medical condition 3) the symptom of deficit is not better explained by another medical or mental disorder 4) the symptom or deficit causes clinically significant distress or impairment, or warrants medical evaluation

What are the three things emphasized in conversion disorder?

1) trauma 2) conversion 3) primary/secondary gains.

Give some examples of somatic symptoms.

Back pain, stomach pain, numbness, seizures.

What are the biological, environmental, and psychological causes of somatic symptom and illness anxiety disorders?

Biological: runs in families -- tendency towards anxiety and alarm response. Environmental: see the world as unpredictable, often in relation to stressful events; receive reinforcement of "sick role". Psychological: "learned" --> tend to get symptoms similar to family members

What are the qualifiers of illness anxiety disorder?

Care-seeking type, care-avoidant type

What is the treatment for somatic symptom and illness anxiety disorders?

Challenge illness-related misinterpretations through CBT; reduce supportive consequences of talk about physical symptoms; minimize help-seeking behaviours; provide more substantial and sensitive reassurance and education -- spend more time "attending" to meaning of symptoms; stress management and coping strategies.

What is the treatment method for conversion disorder?

Core strategy is attending to the trauma (catharsis/re-living); removal of secondary gain; reduce supportive consequences of talk about symptoms

What is malingering?

Faking. Can be tested using the Test of Memory Malingering; people SHOULD pass, would have to be trying hard in order to fail.

In what groups is conversion disorder more prevalent?

Low educated, low SES groups and soldiers. (chronic, intermittent course)

What is factitious disorder (munchausen's syndrome)?

Making self sick; no real reward other than the "sick role" (attention).

What is the main defining feature of somatic symptom disorders?

No identifiable medical condition causing physical complaints (somatic symptoms) OR true medical cause of symptoms but emotional distress/level of impairment is excessive and can make the condition worse

What is the Medically Unexplained Symptoms Clinic is Halifax?

Offers intensive short-term diagnostic psychotherapy for somatic symptom disorders. Looks at the underlying (unconscious) factors that relate to the physical symptoms -- what emotions are not being felt and are leading to symptoms?

What is the onset/course of illness anxiety disorder?

Onset at any age,, but always runs a chronic course.

What are the symptoms of conversion disorder?

Paralysis, blindness, difficulty speaking, psychogenic seizures, difficulty balancing without a physical/organic problem

What are the 5 types of somatic symptom/related disorders?

Somatic symptom disorder, illness anxiety disorder, psychological factors affecting medical condition, conversion disorder, factitious disorder.

What are the causes of conversion disorder?

The Freudian psychodynamic view is still popular -- trauma leads to unconscious emotional conflict, which causes anxiety and subsequent conversion. Detachment from the trauma and negative reinforcement seem critical.

What are some examples of excessive thoughts, feelings, or behaviours related to somatic symptoms/health concerns?

Thoughts about seriousness of symptoms, high levels of anxiety about symptoms and excessive time devoted to symptoms/health concerns.

What is factitious disorder imposed on another (munchausen's by proxy)?

Usually a parent making a child sick -- parents are often unsuspected of this. When suspected, child will be moved into hospital with video surveillance or separated from parent.

What is onset of somatic symptom disorder?

Usually adolescence; often persists into old age (chronic course).