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April 2007 Somatic Disorders Elizabeth Harris

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April 2007 Somatic Disorders Elizabeth Harris

  1. 1. Somatic Disorders Elizabeth Harris PSYC 2621H - Spring 2007
  2. 2. Overview <ul><li>“soma” = body </li></ul><ul><li>“somatic” = relating to the soma </li></ul><ul><li>Pathological concerns with the appearance or functioning of the body, usually in the absence of any identifiable medical condition </li></ul>
  3. 3. Overview (continued) <ul><li>Formerly known as “hysterical neurosis” </li></ul><ul><ul><li>thought to be found primarily in women since the time of the Ancient Greeks & Egyptians </li></ul></ul><ul><li>Freud suggested “conversion hysteria” </li></ul><ul><ul><li>due to the process of unconscious emotional conflicts being “converted” into physical symptoms </li></ul></ul>
  4. 4. Hypochrondriasis <ul><li>Current Diagnostic Criteria </li></ul><ul><ul><li>preoccupation with fears of having a serious disease </li></ul></ul><ul><ul><li>preoccupation persists despite appropriate medical evaluation and reassurance </li></ul></ul><ul><ul><li>preoccupation is not of a delusional intensity and is not restricted to concern over physical appearance </li></ul></ul><ul><ul><li>clinically significant distress or impairment because of preoccupation </li></ul></ul><ul><ul><li>duration of at least 6 months </li></ul></ul>
  5. 5. Hypochrondriasis (cont.) <ul><li>Etiology / Causes / Risk Factors </li></ul><ul><ul><li>hypersensitivity to “normal” situations/changes </li></ul></ul><ul><ul><li>inability to accept “non-findings” </li></ul></ul><ul><ul><li>tends to run in families, possible learned behaviors (“sick” role) </li></ul></ul><ul><ul><li>can begin in reaction to a stressful life event </li></ul></ul><ul><ul><li>comorbidity with anxiety & depression is high </li></ul></ul><ul><li>Prevalence / Incidence Rates </li></ul><ul><ul><li>no gender difference in occurrence rates seen </li></ul></ul><ul><ul><li>studies show 1% - 14% prevalence, rates higher in older population </li></ul></ul><ul><ul><li>cultural effects must be considered </li></ul></ul>
  6. 6. Hypochrondriasis (cont) <ul><li>Course / Prognosis </li></ul><ul><ul><li>chronic due to nature of not accepting results showing nothing wrong </li></ul></ul><ul><ul><ul><li>acute onset, mild symptoms, identifiable general medical condition and no comorbid condition are indicators for full recovery </li></ul></ul></ul><ul><ul><li>Patients tend to move from provider to provider to seek answers/support </li></ul></ul><ul><ul><li>patients tend to have a higher than average appraisal of risk than non-affected </li></ul></ul><ul><li>Current Issues in regards to DSM V development </li></ul><ul><ul><li>suggestions to wider the scope of diagnosis, that current is too narrow </li></ul></ul><ul><ul><li>time requirement may be limiting </li></ul></ul><ul><ul><ul><li>patients get “set in their ways” by the 6 month point </li></ul></ul></ul>
  7. 7. Somatization Disorder <ul><li>Current Diagnostic Criteria </li></ul><ul><ul><li>History of many physical complaints beginning before the age of 30 that occur over years and result in treatment being sought or significant impairment in important areas of functioning </li></ul></ul><ul><ul><li>each of the following: </li></ul></ul><ul><ul><ul><li>Four pain symptoms </li></ul></ul></ul><ul><ul><ul><li>two gastrointestinal symptoms other than pain </li></ul></ul></ul><ul><ul><ul><li>one sexual symptom </li></ul></ul></ul><ul><ul><ul><li>one pseudoneurologic symptom </li></ul></ul></ul><ul><ul><li>physical complains cannot be fully explained by </li></ul></ul><ul><ul><ul><li>a known general medical condition </li></ul></ul></ul><ul><ul><ul><li>the effects of a substance </li></ul></ul></ul><ul><ul><ul><li>or where there is a general medical condition, the physical complains or impairment are in excess of what would be expected </li></ul></ul></ul><ul><ul><li>complaints or impairment are not intentionally produced or feigned </li></ul></ul><ul><ul><ul><li>Rule out factitious disorder and malingering disorder </li></ul></ul></ul>
  8. 8. Somatization Disorder (cont) <ul><li>Etiology / Causes / Risk Factors </li></ul><ul><ul><li>Evidence of biological and psychosocial contributions </li></ul></ul><ul><ul><ul><li>Freud assumed a “constitutional diathesis” existed in patients </li></ul></ul></ul><ul><ul><ul><li>Family patterns are possible, as well as history of illness in patient/family member </li></ul></ul></ul><ul><ul><li>comorbidity with anxiety and depression common </li></ul></ul><ul><ul><ul><li>also some Personality Disorders are sometimes present (anti-social, histrionic, borderline) </li></ul></ul></ul><ul><li>Prevalence / Incidence Rates </li></ul><ul><ul><li>Dutch study found a prevalence of .5% in general practice patients, rose to 13% </li></ul></ul><ul><ul><li>for undifferentiated somatization disorder, American rates between 4.4 – 20% </li></ul></ul><ul><ul><li>prevalence rates rise as age factors in </li></ul></ul><ul><ul><li>gender differences are high, studies put female: male ratio between 3:2 and 3:1 </li></ul></ul><ul><ul><li>cultural differences in prevalence are great </li></ul></ul>
  9. 9. Somatization Disorder (cont) <ul><li>Course / Prognosis </li></ul><ul><ul><li>chronic, rarely remits </li></ul></ul><ul><ul><li>stressful events may heighten symptoms </li></ul></ul><ul><ul><ul><li>unconscious defenses block experience of anxiety, expression only comes in the form of physical symptoms </li></ul></ul></ul><ul><li>Current Issues in regards to DSM V development & other </li></ul><ul><ul><li>looking at number of symptoms required for diagnosis, </li></ul></ul><ul><ul><ul><li>possible difference for women and men </li></ul></ul></ul>
  10. 10. Pain Disorder <ul><li>Diagnostic Criteria – Current </li></ul><ul><ul><li>presence of serious pain in one or more anatomical sites </li></ul></ul><ul><ul><li>pain causes clinically significant distress or impairment in functioning </li></ul></ul><ul><ul><li>psychological factors judged to play primary role in onset, severity, exacerbation or maintenance of the pain </li></ul></ul><ul><ul><li>pain is not feigned or intentionally produced </li></ul></ul>
  11. 11. Pain Disorder (cont) <ul><li>Etiology / Causes / Risk Factors </li></ul><ul><ul><li>pain may be a learned behavior from a medical condition, previous or current </li></ul></ul><ul><ul><li>physical and psychosocial factors may be involved (neurotransmitter pathways may become “keyed” and react during stress) </li></ul></ul><ul><li>Prevalence / Incidence Rates </li></ul><ul><ul><li>back pain is cause of 10-15% of disability claims, roughly 50% have no physically identifiable reason </li></ul></ul><ul><ul><ul><li>abdominal pain presents in 75% of general medical practice patients, </li></ul></ul></ul><ul><ul><ul><li>75% of these (50% overall) have no physically identifiable reason (this is most common complaint in children – strong reaction to stress) </li></ul></ul></ul>
  12. 12. Pain Disorder (cont) <ul><li>Course / Prognosis </li></ul><ul><ul><li>If duration is less than 6 months, recovery chances are great, chronicity sets in past that point </li></ul></ul><ul><ul><li>site/location of pain is another factor </li></ul></ul><ul><ul><li>comorbidity with additional psychological syndrome will also negatively affect recovery chances </li></ul></ul>
  13. 13. Conversion Disorder <ul><li>Diagnostic Criteria – Current </li></ul><ul><ul><li>one or more conditions affecting voluntary motor or sensory function that suggest a neurological or general medical condition </li></ul></ul><ul><ul><li>psychological factors are judged to be associated with the condition because of preceding conflicts or other stressors </li></ul></ul><ul><ul><li>condition cannot otherwise be explained by: </li></ul></ul><ul><ul><ul><li>a general medical condition, </li></ul></ul></ul><ul><ul><ul><li>effects of a substance or </li></ul></ul></ul><ul><ul><ul><li>as a culturally sanctioned behavior or experience </li></ul></ul></ul><ul><ul><li>clinically significant distress or impairment caused by condition </li></ul></ul>
  14. 14. Conversion Disorder (cont) <ul><li>Etiology / Causes / Risk Factors </li></ul><ul><ul><li>childhood trauma, family illness behaviors, stressful events (unconscious converts anxiety into physical symptoms) </li></ul></ul><ul><ul><li>the less medical knowledge of the patient, the less plausible are the symptoms; more sophisticated knowledge will present more detailed symptoms </li></ul></ul><ul><li>Prevalence / Incidence Rates </li></ul><ul><ul><li>Rates range from 1-24%, depending on comorbid syndromes, physical symptoms presented </li></ul></ul>
  15. 15. Conversion Disorder (cont) <ul><li>Course / Prognosis </li></ul><ul><ul><li>normally chronic when adult onset; </li></ul></ul><ul><ul><ul><li>children/adolescents see high rate of recovery </li></ul></ul></ul><ul><ul><li>if remission is probable, normally happens within days/weeks of onset </li></ul></ul><ul><ul><li>interpersonal relationships, dealing with stressors is key to recovery </li></ul></ul><ul><ul><li>Comorbidity factors lessen chances for favorable outcome </li></ul></ul>
  16. 16. Treatment options <ul><li>Treatment of all somatoform disorders should be undertaken by a single or communicating group of physicians </li></ul><ul><ul><li>lessen repeated “gains” through repetitive tests and treatment plans </li></ul></ul><ul><li>Reassurance seems to work </li></ul><ul><ul><li>it requires time be spent that many doctors don’t have to spend; </li></ul></ul><ul><ul><li>goal to provide patient with “insight” into validity of symptoms to control unnecessary tests, hospital/doctor visits </li></ul></ul>
  17. 17. Treatment options (cont) <ul><li>Absence of “secondary gain” important to recovery efforts </li></ul><ul><ul><li>lessen gains gathered by assuming “sick role” </li></ul></ul><ul><ul><li>improving skills in interpersonal relationships to make physical symptoms less of a focus for attention gathering, reducing maladaptive attachment style </li></ul></ul><ul><li>Cognitive-behavioral training to focus on stress management </li></ul><ul><ul><li>avoid misinterpretation of stress reactions as “symptoms” </li></ul></ul><ul><li>Course is for management, not curative in nature </li></ul><ul><ul><li>techniques to lessen “pain-related behavior” </li></ul></ul><ul><ul><li>encourage increased activity level </li></ul></ul><ul><ul><li>avoid pain medication reliance </li></ul></ul>

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