somatic symptoms and related disorder

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Somatic Symptom and Related Disorders “I have a headache…I must have a brain tumor!” Presented by Ms. Arjane & Fr. Biju

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Somatic Symptoms and related disorder

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Page 1: Somatic Symptoms and Related Disorder

Somatic Symptom and Related Disorders

“I have a headache…I must have a brain tumor!”

Presented by

Ms. Arjane & Fr. Biju

Page 2: Somatic Symptoms and Related Disorder

•Changes in DSM 5 •New Criteria•Differential Diagnosis•Causal Factors•Treatment

Agenda Today

Page 3: Somatic Symptoms and Related Disorder

• Somatic : A Greek word meaning “of the body”

• Symptom : subjective experience of disease by an individual. E.g.

Pain, anxiety fatigue.

• Disorder : to disturb the regular or normal functions

Page 4: Somatic Symptoms and Related Disorder

• One feature that all these Disorders share is, the existence of Somatic symptom/s (pain, fatigue etc.) associated with significant distress and impairment.

• In other words, distressing somatic symptoms with abnormal thoughts, feelings and behaviours in response to those symptoms, constitute Somatic Symptom and Related Disorders

Somatic Symptom and Related Disorder

Page 5: Somatic Symptoms and Related Disorder

DSM-V Changes

• MUS (medically unexplained symptoms)

• Overlapping of Diagnoses• Difficult for Non-Psychiatric

physicians to apply• Reduction of Stigma

Page 6: Somatic Symptoms and Related Disorder

DSM-V• SOMATIC SYMPTOM & RELATED DISORDER

– SOMATIC SYMPTOM DISORDER– ILLNESS ANXIETY DISORDER– CONVERSION DISORDER– PSYCHOLOGICAL FACTORS AFFECTING OTHER

MEDICAL CONDITIONS– FACTITIOUS DISORDER– OTHER SPECIFIED SOMATIC SYMPTOM AND RELATED

DISORDER– UNSPECIFIED SOMATIC SYMPTOM AND RELATED

DISORDER

Page 7: Somatic Symptoms and Related Disorder

Somatic Symptom Disorder

• Combination of somatization, pain disorder and hypochondriasis

• Presence of Symptom, medically explained or not

• Health Concern is a central role in their life.

Page 8: Somatic Symptoms and Related Disorder

Key Criteria:• One or more Somatic symptoms• Excessive thoughts, feelings or behavior• The state of being symptomatic is persistent

(typically more than 6 months)• Specify if:

with predominant painPersistentMild, Moderate or severe

Somatic Symptom Disorder

Page 9: Somatic Symptoms and Related Disorder

Differential Diagnosis• PANIC DISORDER = symptoms and anxiety occur in acute episode

• GAD = the main focus is not the somatic symptoms

• ILLNESS ANXIETY DISORDER = minimal somatic symptoms

• CONVERSION DISORDER = loss of function

• BODY DYSMORPHIC DISORDER = Preoccupied by fear on appearance

• OCD = Repetitive Behavior

Page 10: Somatic Symptoms and Related Disorder

Illness Anxiety Disorder

• Formerly Hypochondriasis

• Excessive worry or reaction on physical symptoms

• Not normal health concerns

Page 11: Somatic Symptoms and Related Disorder

Illness Anxiety Disorder

Key Criteria:

• Preoccupation with having or acquiring a serious illness.

• Somatic symptoms are not present or, if present, are only mild in intensity.

• high level of anxiety about health, easily alarmed about personal health status.

• performs excessive health-related behaviors • Illness preoccupation has been present for at

least 6 months.• The illness-related preoccupation is not better

explained by another mental disorder.

Page 12: Somatic Symptoms and Related Disorder

Differential Diagnosis

• SOMATIC SYMPTOM DISORDER = Somatic Symptoms is present

• ANXIETY DISORDER = anxiety is very acute and espisodic

• OCD = not focused on fears of getting a disease

• PSYCHOTIC DISORDER = no delusion on IAD

Page 13: Somatic Symptoms and Related Disorder

Conversion Disorder

• Functional neurological symptoms disorder

• Freud’s Conversion hysteria

• Dramatic loss of function resembling a serious neurological disorder.

Page 14: Somatic Symptoms and Related Disorder

Conversion Disorder(Functional Neurological Symptom Disorder)

Key Criteria:• One or more symptoms of altered voluntary

motor or sensory function.• Clinical findings provide evidence of

incompatibility between the symptom and recognized neurological or medical conditions.

• The symptom or deficit is not better explained by another medical or mental disorder.

• The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Page 15: Somatic Symptoms and Related Disorder

Differential Diagnosis

• SOMATIC SYMPTOM DISORDER = Criterion B

• FACTITIOUS DISORDER = illness is intentionally produced

• BODY DYSMORPHIC DISORDER = Preoccupied by fear on appearance

• DEPRESSIVE DISORDER = presence of depressive symptoms

Page 16: Somatic Symptoms and Related Disorder

Psychological factors affecting other medical conditions

• Psychological Factors: The psychological factor can be a mental disorder (e.g., major depressive disorder aggravating coronary artery disease (CAD)), a psychological symptom (e.g., anxiety exacerbating asthma), a personality trait or coping style (e.g., type A behaviour contributing to the development of CAD), maladaptive health behaviours (e.g., unsafe sex in a person with human immunodeficiency virus (HIV) infection), a stress-related physiological response (e.g., tension headache), or other or unspecified psychological factors.

Page 17: Somatic Symptoms and Related Disorder

Psychological factors affecting other medical conditions

• Psychological factors affecting other medical conditions is diagnosed when psychological or behavioral factors (like stress, anxiety etc.) adversely affect the course or outcome of an existing medical condition (e.g. asthma, heart disease, pain etc.)

E.g. Psychological factors, particularly anxiety & Stress, play an important role in the precipitation and aggravation of asthma. E.g., Asthma symptom severity increased in New York City following the terrorist attacks on September 11, 2001.

• It includes denial of the significance or severity of symptoms

and poor adherence to prescribed testing and treatment. E.g. Denial of treatment for acute chest pain. Denial of taking

insulin by a brittle diabetic to show themselves as normal.

Page 18: Somatic Symptoms and Related Disorder

Psychological Factors Affecting Medical Condition

• New Mental Disorder

• Previously Other conditions that may be a focus of clinical attention

Page 19: Somatic Symptoms and Related Disorder

Psychological Factors Affecting Other Medical Conditions

Key Criteria:• A medical symptom or condition (other than a mental disorder) is

present.• Psychological or behavioral factors adversely affect the medical

condition in one of the following ways:1. The factors have influenced the course of the medical

condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.

2. The factors interfere with the treatment of the medical condition (e.g., poor adherence).

3. The factors constitute additional well-established health risks for the individual.

4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.

Page 20: Somatic Symptoms and Related Disorder

Psychological Factors Affecting Other Medical Conditions Cont.• The psychological and behavioral factors in Criterion B

are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder).

Specify current severity:Mild: Increases medical risk (e.g., inconsistent adherence

with antihypertension treatment).Moderate: Aggravates underlying medical condition (e.g.,

anxiety aggravatingasthma).Severe: Results in medical hospitalization or emergency

room visit.Extreme: Results in severe, life-threatening risk (e.g.,

ignoring heart attack symptoms

Page 21: Somatic Symptoms and Related Disorder

Differential Diagnosis• Mental disorder due to another medical condition Vs

PFAOMC: in MDDAMC medical condition is causing mental disorder whereas in PFSOMC psychological factors is causing a medical condition.

• SSD Vs PFAOMC: People with somatic symptom disorder have physical symptoms that may or may not be accountable by a medical condition; they also have maladaptive thoughts, feelings, and behaviors. PFAOMC, there is the presents of a psychological factor leading to a medical problem.

• Illness Anxiety Disorder Vs PFAOMC : In IAD, the concern is the individual's worry/anxiety about having a disease But in PFAOMC the psychological factor, worry/ anxiety leads to a physical illness.

Page 22: Somatic Symptoms and Related Disorder

Factitious Disorder

• a form of mental illness where an individual will deliberately produce, or exaggerate symptoms in order to gain sympathy and attention. 

• Divided into:

– Imposed on self– Imposed on another

(Previously by proxy)

Page 23: Somatic Symptoms and Related Disorder

Factitious Disorder Imposed on Self

Key Criteria:• Falsification of physical or psychological signs or

symptoms, or induction of injury or disease, associated with identified deception.

• The individual presents himself or herself to others as ill, impaired, or injured.

• The deceptive behavior is evident even in the absence of obvious external rewards.

• The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

• Specify:• Single episode• Recurrent episode (two or more events of falsification

of illness and/or induction of injury)

Page 24: Somatic Symptoms and Related Disorder

Factitious Disorder Imposed on Another(Previously Factitious Disorder by Proxy)

Key Criteria:• Falsification of physical or psychological signs or

symptoms, or induction of injury or disease, in another, associated with identified deception.

• The individual presents another individual (victim) to others as ill, impaired, or injured.

• The deceptive behavior is evident even in the absence of obvious external rewards.

• The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Note: The perpetrator, not the victim, receives this diagnosis.• Specify.• Single episode• Recurrent episodes (two or more events of falsification of

illness and/or induction of injury)

Page 25: Somatic Symptoms and Related Disorder

Differential Diagnosis• SSD Vs FD : In SSD there may be excessive attention and

treatment seeking for the perceived medical concerns but there is no evidence that the individual is behaving deceptively.

• Malingering Vs FD: in malingering there is a intentional reporting of the symptoms for personal gain (e.g. Money, time off work etc.) but in factitious disorder requires the absence of obvious reward.

• Conversion disorder Vs FD: CD is characterized by neurologic symptoms that cannot be explained by medical evaluation. FD is distinguished from CD by the evidence of deceptive falsification of symptoms.

• Borderline personality Disorder Vs FD: in BPD a deliberate physical self harm can occur in association with other mental disorders but in factitious disorder the induction of injury occur in association with deception or to show others that the person is sick.

Page 26: Somatic Symptoms and Related Disorder

Other Specified Somatic Symptom and Related Disorder• In other specified somatic symptom and related disorders, the

symptoms are of somatic symptom and related disorders that causes clinical significant distress or impairment in social or occupational areas of functioning but do not meet the full criteria for any of the disorder in the somatic symptom and related disorders.

• E.g. A person has the symptoms of a somatic symptom disorder but the duration of the symptom is less than 6 months then it should be counted in other specified somatic symptom and related disorder.

• E.g. Brief somatic symptom disorder, brief illness anxiety disorder, illness anxiety disorder without excessive health – related behaviourPseudocyesis: a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy.

Page 27: Somatic Symptoms and Related Disorder

Other Specified Somatic Symptom and Related Disorder

• 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: A false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy.

Page 28: Somatic Symptoms and Related Disorder

Unspecified Somatic Symptom and Related Disorder

• This category applies to presentations in which symptoms characteristic of a somatic symptom and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the somatic symptom and related disorders diagnostic class.

Page 29: Somatic Symptoms and Related Disorder

Causal Factor

• Early Traumatic Experience (Violence, Abuse, Deprivation)

• Through learning (attention is obtained from illness)

Page 30: Somatic Symptoms and Related Disorder

TREATMENT

• Pharmacotherapy• Family therapy• Cognitive-behavioral therapy

Page 31: Somatic Symptoms and Related Disorder

ThankuSOURCE : DSM 5