PS280 Lecture Notes - Lecture 10: Functional Neurological Symptom Disorder, Somatic Symptom Disorder, Factitious Disorder
Somatic Symptom Disorders
→ person is really focused on somatic symptom
● DSM-IV somatoform
● DSM-5 somatic symptom
○ Somatic symptom disorder
■ Pain
○ Illness anxiety disorder
○ Conversion disorder
○ Factitious disorder
Clinical Description
● Somatic symptom(s)
● Excessive
○ Thoughts - worry thoughts related to somatic symptom
○ Anxiety - catastrophizing what symptom means, hard to determine how much
health anxiety is normal
○ Behaviours
● Specifier: with predominant pain
● Prevalence: about 5%
● Gender difference: more common in women
● Cultural differences: different symptoms eg burning in head, too much heat in body
● Onset: used to say by age 30, now recognized that they can occur at any age
● Comorbidity: physical and mental health problems
Illness Anxiety Disorder
Clinical description
● Preoccupation with serious disease
● Health anxiety
● No somatic symptoms - have concern about health disorder but are not overly
concerned about bodily symptoms
● Excessive behaviours or avoidance
○ Care-seeking vs care-avoidant (avoid because don’t want to find out anything
bad)
● 6 months, illness they are concerned about could change
● Was called hypochondriasis in DSM-IV - was ok if you were preoccupied with symptoms,
so those people are not now necessarily diagnosed as illness anxiety, likely somatic
symptom
● Prevalence: about 5%, community vs medical patient samples, gender(?), onset early to
middle adulthood
Somatic Symptom and Illness Anxiety Disorders
Etiology
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● Family link (families usually have higher prevalence of illness, disease)
● Link to anxiety - catastrophic misinterpretation of physical sensations
● Attention for sick behaviour
Treatment
● Decrease reassurance seeking (maintains anxiety over time)
● Reduce secondary gain (getting out of school/work/chores etc)
● Modify illness perceptions/decatastrophize
● Evoke physical sensations (eg spinning in chair, tensing muscles)
Conversion Disorder
● Other terms: hysteria, functional neurological symptom disorder
Clinical description
● Physical malfunctioning
○ Voluntary motor or sensory functioning
○ Looks like neurological disease but…
■ Symptoms are incompatible with neurological disease
● Examples
○ Seizures or convulsions
○ Motor symptoms
○ Sensory symptoms
● Prevalence and onset
○ Rare, even less than 1%
○ 2 or 3 times more common in women
○ Onset often in response to trauma
● Other considerations
○ Malingering - pretending to have symptoms for some sort of gain (financial/legal)
■ La Belle Indifference - usually have indifference to their symptoms, are
not overly concerned about it
○ Factitious disorder
■ Imposed on self
■ Imposed on another (factitious disorder by proxy - learned munchausen
syndrome in crim - parent making child sick - like attn they get for ‘caring’
for their child)
■ Faking symptoms but not for gain
Etiology
● Trauma
● Little to no evidence for genetics
● Some neurophysiological evidence (usually have symptoms on left side of body, left side
is caused by right/emotional side of brain)
Treatment
● Referral to mental health professional?
● Address the traumatic event
● Remove sources of secondary gain
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Person is really focused on somatic symptom. Thoughts - worry thoughts related to somatic symptom. Anxiety - catastrophizing what symptom means, hard to determine how much health anxiety is normal. Cultural differences: different symptoms eg burning in head, too much heat in body. Onset: used to say by age 30, now recognized that they can occur at any age. No somatic symptoms - have concern about health disorder but are not overly concerned about bodily symptoms. Care-seeking vs care-avoidant (avoid because don"t want to find out anything bad) 6 months, illness they are concerned about could change. Was called hypochondriasis in dsm-iv - was ok if you were preoccupied with symptoms, so those people are not now necessarily diagnosed as illness anxiety, likely somatic symptom. Family link (families usually have higher prevalence of illness, disease) Link to anxiety - catastrophic misinterpretation of physical sensations. Decrease reassurance seeking (maintains anxiety over time) Reduce secondary gain (getting out of school/work/chores etc)
