Somatic Symptom, Conversion Disorder, Illness Anxiety Disorder, Body Dysmorphic Disorder

Somatic Symptom Disorder

"hypochondriasis" Characterized by *6* or more months of preoccupation with fears of having, or the idea that one has, a serious disease-causes distress

Sings and Symptoms of conversion disorder

*Most common: weakness or paralysis, sensory symptoms, visual symptoms* Nonepileptic seizures Movement disorders Speech disturbances Globus sensation (lump in your throat) Cognitive symptoms

Treatment of Somatic Symptom Disorder

-Single identified provider as primary caretaker -regular scheduled visits -Visits should be brief -Labs and diagnostic procedures should be avoided unless objective findings warrant them -Psychotherapy -Pharmacological treatment aimed at treating depression or anxiety

Prognosis of conversion disorder

Prognosis is generally poor Symptoms persist, or worsen, in 40-66%

Differential Diagnosis for Somatic Symptom Disorder

1. Other medical conditions 2. panic disorder 3. generalized anxiety disorder 4. depressive disorders 5. illness anxiety disorder 6. conversion disorder 7. delusional disorder 8. body dysmorphic disorder 9. OCD

Risk Factors of illness anxiety disorder

80% of patients have co-exiting depressive or anxiety disorders Occurs more frequently in less educated

What is illness anxiety disorder characterized by

Characterized by a general and nondelusional preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms (minimal to no symptoms, somatic symptom disorder has a ton of symptoms)

Etiology of body dysmorphic disorder

Cause is unknown Pathophysiology of the disorder may involve serotonin and may be related to other mental disorders

Body dysmorphic disorder

Characterized by the preoccupation with an imagined defect in appearance that causes clinically significant distress or impairment in important areas of functioning

Prognosis of Somatic Symptom Disorder

Chronic and relapsing disorder, rarely remits completely Estimated that 33-50% eventually improve significantly

Signs and symptoms of body dd in men

Desire to bulk up and develop a large muscle mass

Factors associated with a positive outcome for conversion disorder

Early diagnosis Good response to initial treatment Comorbid anxiety or depression Good therapeutic alliance with provider

Risk Factors for Somatic Symptom Disorder

Female gender, hx of physical/sexual abuse Associated with depression, anxiety

Treatment of conversion disorder

First-line tx: education about the illness Psychotherapy - CBT Consider referral to Psychiatry Alternatives - pharmacotherapy (depression or anxiety), hypnosis (Telling patients their symptoms are imaginary often makes them worse)

Epidemiology of conversion disorder

Found in 5% of individuals referred to neurology clinics Women are 2-10x more effected than men Onset rare before age 10 or after age 35

Conversion Disorder

Functional Neurological Symptom Disorder (DSM-5) Characterized by neurologic symptoms that are inconsistent with neurologic disease, causing distress and/or psychosocial impairments

Risk factors for body dd

High comorbidity with depressive disorders, anxiety disorder Female Unmarried

Good prognosis of Somatic Symptom disorder associated with what?

High socioeconomic status Absence of personality disorder Treatment responsive anxiety/depression

Biological factors of conversion disorder

Hypometabolism of the dominant hemisphere of the brain Hypermetabolism of the nondominant hemisphere

Characteristics of Somatic Symptom Disoder

Many somatic complaints with long & complicated medical histories-vague, imprecise, inconsistent, disorganized patients always believe they are sick and don't believe the negative evaluations The symptoms are dramatic and emotional-anxiety and depression prevalent early onset & chronic course-no physical signs or abnormalities

Signs/symptoms of body dd

More common concerns involve facial flaws (nose) Other body parts of concern are hair, skin, eyes Many have ideas/delusions of reference, believing that other people take special notice of them or mock them because of how they look May be associated with anxiety or depressive symptoms

Differential diagnosis for illness anxiety disorder

Must rule out non-psychiatric medical conditions Adjustment disorders, somatic symptom disorder, anxiety disorders, OCD, major depressive disorder

Differential Diagnosis of conversion disorder

Often difficult to completely rule out a medical disorder Neurological disorders brain tumors basal ganglia disease somatic symptom disorder factitious disorder and malingering dissociative disorders body dysmorphic disorder depressive disorders panic disorder

Characteristics of illness anxiety disorder

Patient believe that they have a serious disease that has not been detected Persist despite negative lab results & reassurance Concern about the illness is central feature of persons life& consult multiple physicians Transient episodes can occur after major stresses

Epidemiology of Somatic Symptom Disorder

Prevalence is around 2-11% in the general population Most commonly appears age 20-30 More common in females

Illness Anxiety Disorder

Previously called hypochondriasis (DSM IV)

Etiology of conversion disorder

Psychoanalytic factors Due to the repression of unconscious intrapsychic conflict Conversion of anxiety into a physical symptom Learning theory Classically conditioned learned behavior

Etiology of Somatic Symptom Disorder

Psychosocial factors Biological factors

Risk Factors for conversion disorder

Psychosocial stressors Possible association with hx childhood sexual abuse More common in patients with depressive disorders, anxiety and panic disorders More common with borderline, histrionic and narcissistic personality disorders

Treatment of Body dd

Treatment with surgery, dermatological treatment, dental, or other medical procedures is unsuccessful Antidepressants can reduce symptoms

Etiology of illness anxiety disorder

Unclear genetic factors Possible neurochemical factors

Treatment for illness anxiety disorder

first-line tx is psychotherapy Group therapy often is beneficial Pharmacotherapy can be considered (only SSRIs have been studied) Most will be resistant to having the psychotherapy

Plastic surgery in body dd

higher prevalence of BDD in men seeking penile enlargement and women seeking cosmetic surgery of the labia or the lips

Prognosis of body dd

not great, continuous, chronic issue, not likely to have any prolonged symptoms free periods, increased risk of suicide

Epidemiology of Body dd

occurs in 2.4% of the general population Most common age of onset is between is 15-30 years Affects women slightly more than men