Horizon Degree and Commerce College Chakwal

Psychopathology

Assignment no. 1

Somatic Symptom and Related Disorders

Submitted to: Miss Urooj Fatima Submitted by: Iqra Akhtar

HOD Psychology department BS-PSY 6

 Table of contents

 Definition of Somatoform Disorders

 Types
 Explanation and Examples
 Diagnostic criteria (symptoms)
 Levels
 Duration
 Etiology
 Epidemiology
 Comorbidity
 Treatment
 Somatoform disorders

The somatoform disorders are a group of psychiatric disorders in which patients present
with a myriad of clinically significant but unexplained physical symptoms. They include
somatization disorder, undifferentiated somatoform disorder, hypochondriasis,
conversion disorder, pain disorder, body dysmorphic disorder, and somatoform disorder
not otherwise specified. These disorders often cause significant emotional distress for
patients

Somatoform disorder is diagnosed when a person has a significant focus on physical

symptoms, such as pain, weakness or shortness of breath, to a level that results in major
distress and/or problems functioning. The individual has excessive thoughts, feelings and
behaviors relating to the physical symptoms.

Types

1. Somatic symptom disorders

Definition:

Somatic symptom disorder (SDD) is a mental disorder characterized by recurring,

multiple, and clinically significant complaints about physical symptoms. Previously
known as somatization disorder or psychosomatic illness, SSD causes such worry and
preoccupation that it interferes with daily living.

Explanation (overview):

Somatic symptom disorder is characterized by an extreme focus on physical symptoms

such as pain or fatigue that causes major emotional distress and problems functioning.
People with SSD may or may not have another diagnosed medical condition associated
with these symptoms, but their reaction to the symptoms is not normal.
They often think the worst about symptoms and frequently seek medical care, continuing
to search for an explanation even when other serious conditions have been excluded.
Health concerns may become such a central focus of their life that it's hard to function,
sometimes leading to disability.

People with SSD may perceive routine medical procedures or conditions as life-
threatening. The feelings and behaviors associated with the concern over illness are not
relieved by receiving normal test results.

Example:

A person tells that his wife has been diagnosed with somatic symptom disorder, doctors
cannot find anything physically wrong with her and say that “it is all in her head” but she
feels that doctors are wrong and she is actually going through physical ailment.

Diagnostic Criteria:

The diagnostic criteria for Somatic Symptom Disorder noted in DSM 5 are:

A. One or more somatic symptoms that are distressing or result in significant

disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or
associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s
symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of
being symptomatic is persistent (typically more than 6 months).

Specify if:

With predominant pain (previously pain disorder): This specifier is for individuals
whose somatic symptoms predominantly involve pain.

Specify if:

Persistent: a persistent course is characterized by severe symptoms, marked impairment,

and long duration
Levels:

Mild: Only one of the symptoms specified in Criterion B is fulfilled.

Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.

Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there
are multiple somatic complaints (or one very severe somatic symptom).

Duration:

Symptoms must be persistent up to 6 months or more.

Etiology:

Temperamental: Personality trait of negativity (neuroticism), which can impact how

you identify and perceive illness and bodily symptoms

Environmental: more common in individuals with few years of education and low
socioeconomic status and in those who have recently experienced stressful life events.

Genetic and biological factors, such as an increased sensitivity to pain

Family influence, which may be genetic or environmental, or both

Decreased awareness of or problems processing emotions, causing physical symptoms

to become the focus rather than the emotional issues
Epidemiology:

The prevalence of SSD in the general adult population may be around 5% to 7%.

Females tend to report more somatic symptoms than do males.

Comorbidity:

Associated with higher rates of comorbidity with medical disorders as well as anxiety,
personality and depressive disorders. Somatoform disorders can also co-occur with
substance abuse, as individuals may attempt to cope with a lack of explanation for their
symptoms with drugs or alcohol. There is a strong association between pain disorder and
opioid dependence, in particular.
 2. Illness Anxiety Disorder

Illness anxiety disorder, previously known as hypochondriasis, involves an excessive

preoccupation with having or acquiring a serious medical illness. The key distinction
between illness anxiety disorder and somatic symptom disorder is that an individual with
illness anxiety disorder does not typically present with any somatic symptoms.
Occasionally an individual will present with a somatic symptom; however, the intensity
of the symptom is mild and does not drive the anxiety. Acquiring a serious illness drives
concerns.

Diagnostic criteria:

The diagnostic criteria for Illness Anxiety Disorder noted in DSM 5 are:

A. Preoccupation with having or acquiring a serious illness.

B. Somatic symptoms are not present or if present, are only mild in intensity. If
another medical condition is present or there is a high risk for developing a
medical condition (e.g., strong family history is present), the preoccupation is
clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed
about personal health status.
D. The individual performs excessive health-related behaviors (e.g., repeatedly
checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g,
avoids doctor appointments and hospitals).
E. Illness preoccupation has been present for at least 6 months, but the specific
illness that is feared may change over that period of time.
F. The illness-related preoccupation is not better explained by another mental
disorder, such as somatic symptom disorder, panic disorder, generalized anxiety
 disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional
disorder, somatic type.

Types:

Duration:

Illness preoccupation has been present for at least 6 months, but the specific illness that is
feared may change over that period of time.

Etiology:

The exact etiology of illness anxiety disorder remains largely unknown. However,
multiple risk factors have been implicated in the development of this disorder.

 People with IAD may be uncomfortable experiencing normal body sensations,

and they may label the subtle bodily changes as pathological.
 If a person is raised in a family where health anxieties are frequently discussed or
if parents were disproportionately concerned about health-related issues, IAD may
develop.
 A person might be at increased risk of developing IAD if they experienced serious
illness in their childhood or their parent(s) or siblings suffered from a serious
medical condition.
 People with underlying anxiety disorders (e.g., generalized anxiety disorder) are
also at an increased risk of developing IAD.
  If a person spends an exorbitant amount of time reviewing health-related
materials on the internet, he or she may be at an increased risk of developing IAD.

Epidemiology:

The 1 to 2 year prevalence of IAD in community surveys and population based samples
ranges from 1.3% to 10%. In medical populations, the 6 month to 1 year prevalence rates
are between 3% and 8%. This disorder is equally common in males and females.

Comorbidity:

Because it is a new disorder, exact comorbidities are unknown. However, symptoms of

generalized anxiety disorder, panic disorder, OCD and depressive disorders may also
occur. Approximately two-third of individuals with IAD are likely to have at least one
other comorbid major mental disorder.

3. Conversion disorder

(functional neurological symptom disorder)

Conversion disorder occurs when an individual presents with one or more symptoms of
voluntary motor or sensory function that are inconsistent with a medical condition. A
conversion disorder is generally the result of trauma and impacts a person’s senses and
movement. The symptoms are not feigned or controlled by the individual.

Diagnostic criteria:

The diagnostic criteria for Conversion Disorder noted in DSM 5 are:

A. One or more symptoms of altered voluntary motor or sensory function.

 B. Clinical findings provide evidence of incompatibility between the symptom and
recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental
disorder.
D. The symptom or deficit causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning or warrants medical
evaluation.

Specify symptom type:

 With weakness or paralysis

 With abnormal movement
 With swallowing symptoms
 With speech symptom (dysphonia, slurred speech)
 With attacks or seizures
 With anesthesia or sensory loss
 With special sensory symptom (visual, olfactory or hearing disturbance)
 With mixed symptoms

Duration:

Specify if:

Acute episode: Symptoms present for less than 6 months.

Persistent: Symptoms occurring for 6 months or more.

Etiology:

Certain factors put a person at higher risk of developing conversion disorder. These
include:5

 Experiencing a stressful or traumatic event

 Being female or having a first-degree female relative with the condition
 Having a mood disorder

Temperamental: maladaptive personality traits are commonly associated.

Environmental: there may be a history of childhood abuse and neglect. Stressful life
events are often, but not always present.

Genetic and physiological: the presence of neurological disease that causes similar
symptoms is a risk factor.
Epidemiology:

It is found in approximately 5% of referrals to neurology clinics. The incidence if

individual persistent conversion symptoms is estimated to be 2-5/100,000 per year.

Comorbidity:

Anxiety disorders, especially panic disorder and depressive disorders commonly co-occur
with conversion disorder. SSD, psychosis, substance use disorder and alcohol misuse are
uncommon while personality disorders are more common in individuals with conversion
disorder than in general population.

4. Psychological factors affecting other medical conditions

The diagnostic criteria for Psychological Factors Affecting Other Medical

Conditions noted in DSM 5 are:

A. A medical symptom or condition (other than a mental disorder) is present.

B. 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.
 C. 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).

Levels:

Mild: Increases medical risk (e.g., inconsistent adherence with antihypertension

treatment).

Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating asthma).

Severe: Results in medical hospitalization or emergency room visit.

Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attack symptoms)

Epidemiology:

The prevalence of psychological factors affecting other medical conditions is unclear. In

U.S. private insurance billing data, it is more common diagnosis than SSD.

Comorbidity:

By definition, the diagnosis of psychological factors affecting other medical conditions

entails a relevant psychological or behavioral syndrome or trait and a comorbid medical
condition.

5. Factitious disorder
Factitious disorder, commonly referred to as Munchausen syndrome, differs from the
three previously discussed somatic disorders in that there is deliberate falsification of
medical or psychological symptoms of oneself or another, with the overall intention
of deception. While a medical condition may be present, the severity of impairment
related to the medical condition is more excessive due to the individual’s need to deceive
those around them. Even more alarming is that this disorder is not only observed in the
individual leading the deception— it can also be present in another individual, often a
child or an individual with a compromised mental status who is not aware of the
deception behind their illness (also known as Munchausen by Proxy.
How those with factitious disorder fake illness?

Because people with factitious disorder become experts at faking symptoms and diseases
or inflicting real injuries upon themselves, it may be hard for health care professionals
and loved ones to know if illnesses are real or not.

People with factitious disorder make up symptoms or cause illnesses in several ways,
such as:

 Exaggerating existing symptoms. Even when an actual medical or psychological

condition exists, they may exaggerate symptoms to appear sicker or more
impaired than is true.
 Making up histories. They may give loved ones, health care professionals or
support groups a false medical history, such as claiming to have had cancer or
AIDS. Or they may falsify medical records to indicate an illness.
 Faking symptoms. They may fake symptoms, such as stomach pain, seizures or
passing out.
 Causing self-harm. They may make themselves sick, for example, by injecting
themselves with bacteria, milk, gasoline or feces. They may injure, cut or burn
themselves. They may take medications, such as blood thinners or drugs for
diabetes, to mimic diseases. They may also interfere with wound healing, such as
reopening or infecting cuts.
 Tampering. They may manipulate medical instruments to skew results, such as
heating up thermometers. Or they may tamper with lab tests, such as
contaminating their urine samples with blood or other substances.

Diagnostic criteria:

The diagnostic criteria for Factitious Disorder noted in DSM 5 are:

1. Factitious Disorder Imposed on Self

A. Falsification of physical or psychological signs or symptoms, or induction of

injury or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external
rewards.
D. The behavior is not better explained by another mental disorder, such as
delusional disorder or another psychotic disorder.

Specify:

1. Single episode

2. Recurrent episodes (two or more events of falsification of illness and/or induction of

injury)

2. Factitious Disorder Imposed on another (Previously Factitious Disorder by

Proxy)

A. Falsification of physical or psychological signs or symptoms, or induction of

injury or disease, in another, associated with identified deception.
B. The individual presents another individual (victim) to others as ill, impaired, or
injured.
C. The deceptive behavior is evident even in the absence of obvious external
rewards.
D. 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:

1. Single episode

2. Recurrent episodes (two or more events of falsification of illness and/or induction of

injury)

Duration: unspecified

Etiology:

Several factors may increase the risk of developing factitious disorder, including:

 Childhood trauma, such as emotional, physical or sexual abuse

 A serious illness during childhood
  Loss of a loved one through death, illness or abandonment
 Past experiences during a time of sickness and the attention it brought
 A poor sense of identity or self-esteem
 Personality disorders
 Depression
 Desire to be associated with doctors or medical centers
 Work in the health care field

Epidemiology:

Among patients in hospital settings, it is estimated that about 1% of individuals have

presentations that meet the criteria for factitious disorder.

Complications (Comorbidity):

People with factitious disorder are willing to risk their lives to be seen as sick. They
frequently have other mental health disorders as well. As a result, they face many
possible complications, including:

 Injury or death from self-inflicted medical conditions

 Severe health problems from infections or unnecessary surgery or other
procedures
 Loss of organs or limbs from unnecessary surgery
 Alcohol or other substance abuse
 Significant problems in daily life, relationships and work
 Abuse when the behavior is inflicted on another

6. Other Specified 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. Examples include:

1. Brief somatic symptom disorder: Duration of symptoms is less than 6 months.

2. Brief illness anxiety disorder: Duration of symptoms is less than 6 months.
3. Illness anxiety disorder without excessive health-related behaviors: Criterion
D for illness anxiety disorder is not met.
4. Pseudocyesis: A false belief of being pregnant that is associated with objective
signs and reported symptoms of pregnancy.

7. Unspecified Somatic Symptom and Related Disorder

Like the specific somatic symptom and related disorders diagnosis, undifferentiated
somatoform disorder applies to individuals who have symptoms characteristic of somatic
disorders that do not meet full criteria for any somatoform disorder. However, the
unspecified somatic symptom and related disorder diagnosis should only be given in
unusual situations, or in situations where there is insufficient information to make a more
specific diagnosis.

Treatment of Somatic Symptom and related disorders

The goal of treatment is to improve your symptoms and your ability to function in daily
life. Psychotherapy, also called talk therapy, can be helpful for somatic symptom and
related disorders. Sometimes medications may be added, especially if you're struggling
with feeling depressed.

Psychotherapy

Because physical symptoms can be related to psychological distress and a high level of
health anxiety, psychotherapy — specifically, cognitive behavioral therapy (CBT) — can
help improve physical symptoms.

CBT:

Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people learn to
identify negative, destructive, and maladaptive thoughts and behaviors. Once identified,
CBT treatment involves techniques to reframe these unhealthy thoughts and behaviors.

It can help you:

 Examine and adapt your beliefs and expectations about health and physical
symptoms
 Learn how to reduce stress
 Learn how to cope with physical symptoms
 Reduce preoccupation with symptoms
 Reduce avoidance of situations and activities due to uncomfortable physical
sensations
 Improve daily functioning at home, at work, in relationships and in social
situations
 Address depression and other mental health disorders

Family therapy may also be helpful by examining family relationships and improving
family support and functioning.

Medication:

Medication is often beneficial to people who are living with illness anxiety disorder,
particularly if they have other comorbid mental health illnesses such as OCD, depression,
or generalized anxiety disorder as well.
The most commonly prescribed types of medications to treat illness anxiety disorder are:

 Selective serotonin reuptake inhibitors (SSRIs)

 Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SSRIs are a class of antidepressants. They work by inhibiting the reuptake of serotonin (a
neurotransmitter), thus increasing the amount of serotonin in the brain.

Examples of SSRIs include:

 Prozac (fluoxetine)
 Celexa (citalopram)
 Lexapro (escitalopram)

Potential side effects of SSRIs include:

 Nausea
 Vomiting
 Diarrhea
 Weight gain
 Sexual side effects
 Sleep difficulties

SNRIs are another class of antidepressants. They work similarly to SSRIs, except that
they inhibit the reuptake of both serotonin and another neurotransmitter called
norepinephrine.

Examples of SNRIs include:

 Cymbalta (duloxetine)
 Effexor (venlafaxine)
 Fetzima (levomilnacipran)
Physical Therapy:

Physical therapy is often used for people with conversation disorders who have
movement disturbances, including problems with coordination, balance, or walking or
weak limbs. It's also important to prevent any secondary complications, including muscle
weakness and stiffness, that result from inactivity.

Coping:

 Practice stress management and relaxation techniques. Learning stress

management and relaxation methods, such as progressive muscle relaxation, may
help reduce anxiety.
 Get physically active. A graduated activity program may have a calming effect
on your mood, reduce your anxiety and help improve your physical functioning.
 Participate in activities. Staying involved in your work, as well as social and
family activities, can provide you with support.
 Avoid alcohol and recreational drugs. Substance use can make your care more
difficult. Talk to your primary care provider if you need help quitting.
 Avoid searching the internet for possible diseases. The vast amount of health
information that may or may not be related to your situation can cause confusion
and anxiety. If you have symptoms that concern you, talk to your primary care
provider at your next scheduled appointment.