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 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

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

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

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?

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

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

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

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

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

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