Somatic Symptom and Related Disorders - Psychiatry

Snapshot
- A 36-year-old female has been visiting her primary care physician very frequently over the past seven months because she is afraid she has an underlying illness. She has been experiencing mild, nonspecific abdominal pain off and on throughout this time. Despite reasssurances by her doctor, as well as a normal abdominal ultrasound and abdominal CT scan, she is still convinced something is being missed. Because of her fear, she has become socially withdrawn and spends much of her time at home researching diseases on the internet. (Illness anxiety disorder)

Somatic Symptom and Related Disorders
- Definition
  - physical symptoms that cause mental distress
  - in DSM-V, less of an emphasis on whether or not an underlying medical condition has been ruled out as a cause for the physical symptoms
  - historically called "hysteria" or "somatization"
- Epidemiology
  - F > M
  - less educated
  - lower socioecononimc status
  - ethnic minorities
- Types
  - somatic symptom disorder
    
    one or more physical symptoms that cause distress
    
    dysfunctional thoughts, feelings, or behaviors associated with the physical symptoms
    
    dysfunction is present for at least six months
  - pain disorder
    
    chronic pain that causes significant distress or impairment
    
    psychological factors appear to influence the experience of the pain
  - conversion disorder
    
    neurological impairment involving voluntary motor or sensory function with no primary neurological cause
    
    symptoms may include paralysis, blindness, mutism, or seizures
    
    cannot refer to sexual dysfunction or pain
    
    often following an acute stressor
    
    patient is aware of but indifferent toward symptoms, known as "la belle indifference"
    
    more common in adolescents and young adults
  - illness anxiety disorder
    
    fear of having a serious illness
    
    mild or absent physical symptoms
    
    dysfunctional or maladaptive behaviors associated with health
    
    excessive check ups
    
    avoidance of certain behaviors associated with the potential illness
    
    preoccupation with illness despite medical evaluation and reassurance
    
    fear is present for at least six months
  - factitious disorder
    
    deliberately faking or manufacturing symptoms in order to obtain sympathy from others and assume the sick role
    
    injuries
    
    infections
    
    hypogylycemia
    
    no external benefit, such as worker's compensation, time off from work, etc.
    
    often involved with the healthcare industry in some way and has some degree of medical knowledge
    
    extreme subtype is "Munchausen syndrome"
    
    travels to numerous hospitals and clinics to seek treatment
    
    consents to highly invasive procedures
    
    M > F
    
    Munchausen by proxy is where the caregiver induces symptoms in a child/elder under their care in order to assume the sick role by proxy
    
    This is a form of abuse and should be reported
  - malingering
    
    deliberately faking or exaggering symptoms for an external benefit, such as worker's compensation, time off from work, avoidance of criminal prosecution etc.
    
    associated with antisocial personality disorder
  - psychological factors affecting other medical conditions
    
    psychological distress or a maladaptive behavior that triggers, exacerbates, or prevents the treatment of a medical condition

Action	Numeric Key	Letter Key	Function Key
Show Bullets		S	Enter (frontside only)
20%	1	N
40%	2	H
60%	3	F	Enter (backside only)
80%	4	E
100%	5	M
Toss	0	T