Title 07 AbPsy - Somatic Symptom and Related Disorders.pdf ✅

07 – Somatic Symptom and Related Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Somatic Symptom Disorder 2. Illness Anxiety Disorder 3. Conversion Disorder 4. Factitious Disorder 5. Other Specified Disorders SOMATIC SYMPTOM DISORDER DIAGNOSTIC CRITERIA ★ Pierre Briquet – described patients who came to see him with seemingly endless lists of somatic complaints for which he could find no medical basis ★ Pain is the most common symptom ★ People with SSD identify with their symptoms A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months) Specify if: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain. Specify if: Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months). Specify current severity: Mild: Only one of the symptoms specified in Criterion B is fulfilled. Moderate: Two or more of the symptoms specified in Criterion B are fulfilled. Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom). TREATMENT Medications ● Paroxetine (aka Paxil) Psychological Treatments ● Reassurance and education ● Reducing the frequency of help-seeking behaviors (e.g., assigning a gatekeeper physician to each patient to screen all physical complaints) ● Cognitive-Behavioral Therapy (CBT) ILLNESS ANXIETY DISORDER DIAGNOSTIC CRITERIA A. Preoccupation with having or acquiring a serious illness. B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate. C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status. D. The individual performs excessive health-related behaviors or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals). E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. F. The illness-related preoccupation is not better explained by another mental disorder Specify whether: Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used. Care-avoidant type: Medical care is rarely used. CAUSES OF SSD AND IAD ● These disorders are basically disorders of cognition or perception with strong emotional contributions ● Individuals with SSD experience physical sensations common to everyone, but they quickly focus their attention on these sensations ● They also tend to interpret ambiguous stimuli as threatening 1 | @studywithky
CONVERSION DISORDER DIAGNOSTIC CRITERIA ★ Functional Neurological Symptom Disorder ★ Popularized by Freud, who believed the anxiety resulting from unconscious conflicts somehow was converted into physical symptoms to find expression ★ Generally has to do with physical malfunctioning without any physical or organic pathology to account for ★ Malingering – intentionally faking one’s illness to get out or gain something A. One or more symptoms of altered voluntary motor or sensory function. B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. C. The symptom or deficit is not better explained by another medical or mental disorder. D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. Specify symptom type: With weakness or paralysis With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait disorder) With swallowing symptoms With speech symptom (e.g., dysphonia, slurred speech) With attacks or seizures With anesthesia or sensory loss With special sensory symptom (e.g., visual, olfactory, or hearing disturbance) With mixed symptoms Specify if: Acute episode; Symptoms present for less than 6 months. Persistent: Symptoms occurring for 6 months or more. Specify if: With psychological stressor (specify stressor) Without psychological stressor ROLE OF THE UNCONSCIOUS MENTAL PROCESSES ● Unconscious cognitive processes seem to a play a role in much of psychopathology ● Case of Anna O. ● We are capable of receiving and processing information in a number of sensory channels without being aware of it ○ Blind Sight / Unconscious Vision: ability of people who are cortically blind to respond to visual stimuli that they do not consciously see CAUSE ● Freudian Conceptualization ○ Trauma, repression, conversion (anxiety reduction, attention/convenience (secondary gain) ● Social and Cultural influences also contribute to CD, and tend to occur in less educated, lower socioeconomic groups ● CD symptoms seem to be part of a larger constellation of psychopathology TREATMENT Psychological Treatments ● Identify and attend to the traumatic or stressful life event, if it is still present (either in real life or memory) ● Reduce any reinforcing or supportive consequences of the conversion symptoms (secondary gain) FACTITIOUS DISORDER DIAGNOSTIC CRITERIA Factitious Disorder Imposed on Self A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents himself or herself to others as ill, impaired, or injured. C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better explained by another mental disorder Factitious Disorder Imposed on Another ★ Previously known as Munchausen Syndrome by Proxy A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception. B. The individual presents another individual (victim) to others as ill, impaired, or injured. 2 | @studywithky
C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better explained by another mental disorder OTHER SPECIFIED DISORDERS ● Brief somatic symptom disorder: duration of symptoms is less than 6 months. ● Brief illness anxiety disorder: duration of symptoms is less than 6 months. ● Illness anxiety disorder without excessive health-related behaviors: Criterion D for illness anxiety disorder is not met. ● Pseudocyesis: false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy REFERENCES American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 Barlow, D., Durand, V., Lalumiere, M., & Hofmann, S. (2018). Abnormal psychology: An integrative approach (8th ed.). Cengage Learning. Hooley, J., Nock, M., & Butcher, J. (2021). Abnormal psychology (18th ed.). Pearson. 3 | @studywithky