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The Somatic Symptom and Related Disorders

The Somatic Symptom and Related Disorders. When our concerns over physical symptoms go overboard. Reconsidered in DSM 5 . In DSM IV this type of disorder were defined by physical symptoms with no know cause Labeled Somatoform because these symptoms took the form of bodily (soma) complaints

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The Somatic Symptom and Related Disorders

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  1. The Somatic Symptom and Related Disorders When our concerns over physical symptoms go overboard

  2. Reconsidered in DSM 5 • In DSM IV this type of disorder were defined by physical symptoms with no know cause • Labeled Somatoform because these symptoms took the form of bodily (soma) complaints • But it is next to impossible to decide whether or not these complaints are biologically based • Now Somatic Symptom disorder includes somatic symptoms irrespective of any medical explanation

  3. Now three • Somatic Symptom Disorder – excessive energy expended or distress over health or somatic symptoms • Illness Anxiety Disorder – fears about a medical condition without somatic symptoms • Conversion Disorder – unexplained neurological symptoms • Also malingering and factitious disorder

  4. Wasted $$, Time, and Resources • SS patients run up huge medical bills, see lots of MDs, take lots of meds • Estimated $256 billion lost • Ironically, they are very dissatisfied w/ care • So they seek new MDs, treatments, drugs • Some can’t work

  5. Criticism of Diagnoses • Lots of variation among patients some have anxiety problems, others no some have real medical issues, others no • Some of the criteria are subjective “excessive”, “high level” • Diagnosis can be stigmatizing – rarely given Will clinicians continue to ignore?

  6. Course • Not much research for newer disorders • Seem to start in early adulthood • Symptoms can wax and wane • Illness anxiety seems more chronic • Often found with mood, anxiety, substance abuse and personality disorders

  7. Somatic Symptom Disorder • Three main criteria 1) one or more somatic symptoms that are very distressing and time-consuming 2) excessive amounts of anxiety or time 3) duration of at least 6 months • Symptoms might arise after big stressor • But no insight, symptoms are physical • Focus is on the distress and behavior

  8. Pain • For some, it’s pain that dominates • Big risk of painkiller addiction • Chronic pain costs billions • Responsible for much lost work and disruption

  9. Illness Anxiety Disorder • Obsessed with fear of having a disorder with no significant symptoms • This leads to excessive care or • Maladaptive avoidance behaviors • Must persist for 6 months • Lack of physical symptoms distinguishes it from former DSM condition hypochondriasis • Often seen with anxiety and mood disorders

  10. Conversion Disorder • Patient suddenly develops strange neurological complaints which cannot be verified by testing • Complaints include paralysis, seizures, blindness, tingling, anesthesia • Even impossible symptoms – tunnel vision • Some seem unconcerned – le belle indifference

  11. Conversion Reaction II • Condition has long history, even back to Hippocrates and hysteria • Symptoms must cause great distress, impairment, or medical intervention • Usually develops after a major stressor in adolescence or early adulthood • Condition may stop and then return • Found with other somatic problem or DID

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