Somatic Disorders

 

What is a somatic disorder?

Soma means body, and the problems preoccupying these people seem initially to be physical disorders. 

Somatic symptoms are physical sensations or experiences that are connected to emotions or stress. They an include things like headaches, stomachache, muscle tension or fatigue and they often happen when someone is feeling anxious or upset. These symptoms are real and can affect how someone feels physically even though they are connected to emotions or stress rather than a physical illness. 

What the somatic symptom disorders have in common is that that there is an excessive or maladaptive response to physical symptoms or to associated health concerns. These disorders are sometimes grouped under the short-hand label of 'Medically unexplained physical symptoms', but in some cases the medical cause of the presenting physical symptoms is known but the emotional distress or level of impairment in response to the symptom is clearly excessive and may even make the condition worse. 

Treatment: 

PSYCHOLOGICAL TREATMENT:-

Catharsis: identify and attend to the traumatic and stressful life events. 

Cognitive-Behavioral programs

Psychodynamic Psychotherapy 

Reassurance and education 

Below you will find a list of different Somatic Disorders:

1. Somatic Symptom Disorder (SSD) 

Previously known as- Briquet's syndrome

Diagnostic Criteria:

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 it:

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

    Specify it:

    Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).

    Specify current severity:

• 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).

Diagnostic features: 

1.    People do not always feel the urgency to take action but continually feel weak and ill and they avoid exercising thinking it will make them worse. 

2.    Symptoms may be specific (e.g., localized pain) or relatively non-specific (e.g., fatigue).

3.    The individual's suffering is authentic whether or not it is medially explained. 

4.    When asked directly about their distress, some individuals describe it in relation to other aspects of their lives, while others deny any source of distress other than the somatic symptoms. 

5.    Seems unresponsive to medical interventions.

6.    Some individuals seem unusually sensitive to medication side-effects. 

7.    Some feel their medical assessment and treatment have been inadequate.

8.    Cognitive features: attention focused on somatic symptoms, attribution of normal bodily sensation to physical illness, worry about illness, fear that any physical activity may damage the body.

9.    Behavioral features: repeatedly body checking for abnormalities, repeated seeking of medical help and reassurance, avoidance of physical activity.

10.    May refuse mental healthcare. 

Prevalence:

NOT KNOWN

Development and Course:

Most common symptoms in children- abdominal pain, headache, fatigue, nausea.

Etiology:

Temperamental: Negative effectivity (Neuroticism), Comorbid anxiety and depression is common. 

Environmental: Frequent in individuals with few years of education and low socio-economic status. 

2. Illness Anxiety Disorder (IAD) 

Previously known as- Hypochondriasis 

Illness anxiety disorder, sometimes called hypochondria, is when someone constantly worries about having a serious illness, even if they don't have any symptoms or their symptoms are very mild. They might obsessively check their body for signs of illness, constantly research symptoms online, or visit the doctor frequently, even when they're reassured that they're healthy. 

Diagnostic Criteria:

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 300.7 (F45.21) 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.

    Specify whether:

    Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.

    Care-avoidant type: Medical care is rarely used.

Diagnostic features: 

1. Anxiety is focused on the possibility of having or developing a serious disease. 

2. Individuals are easily alarmed about illness such as by hearing about someone else, falling ill or reading a health related news story. 

3. Illness becomes a central feature of the individual's identity and self-image, a frequent topic of social discourse, and the characteristic response to stressful life events.  

Prevalence:

1-2 year prevalence: 1.3% to 10% 

Development and Course:

Age of onset- early or middle adulthood. 

Etiology:

Environmental: major life stress, childhood abuse, serious childhood illness. 

3. Conversion Disorder (CD) 

Now known as- Functional Neurological Symptom Disorder

Functional refer to symptom without an organic cause. 

The term conversion was popularized by Freud, who believed the anxiety resulting from unconscious conflicts somehow was 'converted' into physical symptoms to find expression. 

Diagnostic Criteria:

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.

    Coding note: The ICD-9-CM code for conversion disorder is 300.11, which is assigned regardless of the symptom type. The ICD-10-CM code depends on the symptom type (see below).

    Specify symptom type:

• (F44.4) With weakness or paralysis
• (F44.4) With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait disorder)
• (F44.4) With swallowing symptoms
• (F44.4) With speech symptom (e.g., dysphonia, slurred speech)
• (F44.5) With attacks or seizures
• (F44.6) With anesthesia or sensory loss
• (F44.6) With special sensory symptom (e.g., visual, olfactory, or hearing disturbance)
• (F44.7) With mixed symptoms

    Specify it:

• Acute episode: Symptoms present for less than 6 months.
• Persistent: Symptoms occurring for 6 months or more.

    Specify if:

• With psychological stressor (specify stressor)
• Without psychological stressor

Diagnostic features: 

1. History of multiple similar somatic symptoms.

2. Often associated with dissociative disorders.

3. The diagnosis should be based on the overall clinical picture and not on a single clinical finding.

4. Most conversion symptoms suggest that some kind of neurological disease is affecting sensory motor systems, although conversion symptoms can mimic the full range of physical malfunctioning. 

5. Conversion symptoms may include blindness, paralysis, and aphonia, total mutism and the loss of the sense of touch. Some people have seizures, which may be psychological in origin, because no significant electroencephalogram (EEG) changes can be documented. These "seizures" are usually called psychogenic non-epileptic seizures. Another relatively common symptom is globus hystericus, the sensation of a lump in the throat that makes it difficult to swallow, eat, or sometimes talk

Prevalence:

NOT KNOWN

Development and Course:

Age of onset: anytime 

Etiology:

Temperamental: Maladaptive personality traits

Environmental: Childhood abuse & neglect, stressful life events

Genetic & Physiological: presence of neurological diseases

Closely related Terms:

Malingering- Faking

La belle indifférence- is a psychological term used to describe a lack of concern or emotional response to physical symptoms or disabilities, particularly in conversion disorder or somatization disorder. It refers to a seemingly calm or unconcerned attitude despite experiencing distressing symptoms, which can be puzzling to healthcare providers.

Factitious disorder- (between malingering and conversion disorder) an individual voluntarily produces the symptoms for no obvious reason except to assume the sick role and receive attention.