Somatic Symptom And Related Disorders

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Somatic Symptom Disorder

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a chronic relapsing condition which is difficult to treat. The disorder commonly begins during late adolescence, although it may start up during the 30s. These clients tend to repress childhood memories and do not volunteer the fact they may have suffered from child abuse. They find emotional expression difficult, if not impossible, and tend to somatize painful memories and emotions. Individuals with this disorder often have complicated medical histories rather than emotional complaints and report vague and inconsistent medical symptoms that are often associated with psychological problems such as anxiety, substance abuse, and personality disorders.

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Somatic Symptom Disorder: Sx and DX

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Symptoms of somatic symptom disorder include gastrointestinal complaints such as vomiting, nausea, bloating, and diarrhea, pain in at least four different places on the body, one sexual symptom, and one pseudoneurological symptom such as fainting or blindness.

Such symptoms cannot be related to a diagnosable medical disorder, do not have to occur at the same time, cannot be feigned out of an effort to gain attention, and they cannot be deliberately induced.

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Somatic Symptom and Related Disorders: Include

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somatic symptom disorder, illness anxiety disorder, conversion disorder, psychological factitious disorder, other specified somatic symptom and related disorders, and unspecified somatic symptom and related disorder

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Somatic Symptom Disorder: Assessment

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-Imperitive for MH professionals to request Cl medical record and have a collaborative relationship with his or her doctor

When the mental health professional sees the client during subsequent interviews or therapy sessions, symptoms may vary and change with time, depending on the client’s level of emotional distress. When the client presents a new physical symptom, he or she is communicating an emotional need, saying, “I hurt” or “I am in distress.” Rarely do new symptoms represent the onset of a new illness

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Somatic Sx: Comorbidity

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body dysmorphic, undifferentiated somatization, hypochondriasis, monohypochondriasis, and physical defects

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Somatic Sx:

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Clients with this disorder tend to congregate in primary care and hospital settings because they perceive themselves to be very ill.

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Somatic Sx: Instrumentation

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Prime-MD -measures several categories of physical and emotional symptoms in clients – mood, anxiety, alcohol use, eating behavior, and somatoform disorders.

A History and Severity of Traumatic Events and Twelve Theme Assessment of Post-Traumatic Symptoms -assesses the prevalence of traumatic histories and the severity of post-traumatic symptoms.

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Somatic Sx: Treatment

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Cl should remain with one physician and continue collaborative relationships

CBT

Group treatment to improve socialization and coping skills

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Conversion Disorder

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This disorder may have one or more symptoms, motor, sensory, episodes, unresponsiveness, absence of speech volume, articulation, and diplopia (APA, 2013).

This diagnosis is to assess for unexplained motor or sensory functions and is to be devoid of a neurological disease and clear evidence is required.

The functional neurological symptom disorder symptom specifiers include weakness, abnormal movement, swallowing, speech, seizures, sensory loss, special sensory, and mixed symptoms.

The assessor is to specify if acute episode or persistent and with psychological stressor or without psychological stressor

A neurological examination is emphasized and the recognition of the importance of relevant psychological factors present at the time of diagnosis.

Treatment:

1.Hypnosis and stress management counseling has been used in hospitalized clients (Oakley, 2001).

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Factitious Disorder: Def an sx

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a falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified person

Physical symptoms may be fabrication, self-infliction, or an exaggeration of a pre-existing physical condition.

NOT EASY TO DIAGNOSE

Specific criteria for factitious disorder imposed on self or another are:

Criterion A: imposed on self are falsifications of physical or psychological signs or sympotoms or induction of injury or disease in another, associated with the identified client.

Criterion B: the client presents another person to others as ill, impaired or injured

Criterion C: the deceptive behavior is evident in the absence of obvious external rewards Criterion

D: behavior is not better explained by another mental disorder (p. 324-325).

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Factitious Disorder: Malingerer

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The malinger presents symptoms deceitfully to obtain secondary gain such as avoiding work, obtaining drugs, getting lighter criminal sentences, trying to get out of going to school, or simply to attract attention or sympathy.

The factitious disorder patient feigns symptoms in order to receive care and habitually enters one hospital after another. When pressed for details, he or she will become very vague although possessing considerable knowledge of medical practices, terms, routines and diagnostic tests in order to manipulate admission to a hospital

When confronted with or hoping to avoid the truth about exaggerated or faked symptoms, the patient will self-discharge and often enter another hospital the same day. He or she will angrily discontinue care from a physician or therapist who begins to question in a confrontational manner about distortions or exaggerations and seek a different therapist or physician.

A careful review of this individual’s previous medical record and history of physical or psychological care likely would reveal a variety of diagnoses.

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Factitious Disorder: Munchausen syndrome

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Munchausen syndrome by proxy is the applied term when parents fabricate or induce physical illnesses in their children.

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Factitious Disorder: Assessment

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Relies mainly on physician's findings and medical report

Need a collaborative relationship with Dr.

Important to assess for depression because there is a high rate of suicide with Cl with this disorder

It is important for the physician or counselor to secure information from available friends, relatives, or other sources to verify the facts of the physical or psychological illness.

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Differences between Malingerer and Factitious Disorder

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The malingerer intentionally makes false or grossly exaggerated physical or psychological symptoms to obtain secondary gain while the client with factitious disorder may be deliberately self-injurious but with a different intent – to obtain attention through self-injurious behavior or express a negative emotional response such as anger in a physically self-injurious way.

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Etiology of Factitious Disorder

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Conflicts from childhood

Physical symptoms become an indirect means to obtain medical attention as a substitute for love and affection because desired parent-child relationships were either unavailable or repeatedly broken.

However, these clients repeatedly fail to resolve their conflicts because they tend to provoke caregivers and experience rejection, repeating a pattern experienced as children.

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Factitious Disorder-Instrumentation

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Prime-MD-used by physicians to quickly diagnose major psychiatric disorders often overlooked

History and Severity of Traumatic Events and Twelve Theme Assessment of Post-Traumatic Symptoms

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Factitious Disorder: Treatment

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A treatment framework is recommended that includes avoiding unnecessary hospitalization.

recommended that the therapist be empathic and gently confrontative while reducing or avoiding dependency.

Individual therapy is recommended if the client is old enough and has a capacity for insight.

Using a co-therapist may help to deal with denial and other resistance more effectively while family therapy can be used to help individuals with supportive families regain some degree of autonomy