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Somatic Symptom and Related Disorders Introduction

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Prior to the release of the DSM-5, these disorders were called Somatoform Disorders and also commonly known as Conversion Disorders. They included Conversion Disorder, Hypochondriasis, and Somatization Disorder. Those with one of these conditions have bodily or physical symptoms, not mental health ones. They usually see a medical doctor first for treatment.

This category now includes 5 major disorders including:

  • Somatic Symptom Disorder
  • Illness Anxiety Disorder
  • Conversion Disorder
  • Psychological Factors Affecting Other Medical Conditions
  • Factitious Disorder
  • Other Specified Somatic Symptom and Related Disorder (for people that have some of the symptoms of the other disorders, but don't technically meet the criteria for any of them in full.)

Those with these disorders aren't diagnosed by the symptoms that they are having. Instead, it is by the way that they are showing those symptoms and h...More

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What are Somatic Symptom and Related Disorders?

  • Prior to the release of the DSM-5, these disorders were called Somatoform Disorders and also commonly known as Conversion Disorders. They included Conversion Disorder, Hypochondriasis, and Somatization Disorder.
  • Those with one of these conditions generally have bodily or physical symptoms, not mental health ones. They usually see a medical doctor first for treatment.
  • This category now includes 5 major disorders including Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder, Psychological Factors Affecting Other Medical Conditions, and Factitious Disorder. There is also a disorder called Other Specified Somatic Symptom and Related Disorder (for people that have some of the symptoms of the other disorders, but don't technically meet the criteria for any of them in full.)
  • Those with these disorders aren't diagnosed by the symptoms that they are having. Instead, it is by the way that they are showing those symptoms and how they explain them.
  • People used to think that someone with one of these disorders wasn't having "real" physical symptoms and that it was "all in their head."
  • In all of the conditions, except Factitious Disorder, people are not faking their symptoms.
  • It is not all in their head. The symptoms are causing a lot of stress and problems in their daily lives.

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What is Somatic Symptom Disorder?

  • Somatic Symptom Disorder is diagnosed when the following symptoms are ongoing and typically last more than 6 months: A - One or more somatic (bodily/physical) symptoms are distressing or result in significant disruption of daily life. These symptoms are either not related to any medical condition or if they are symptoms that could be expected, they are much worse than would normally be present in that condition. B - Excessive thoughts, feelings, or behaviors are related to the physical symptoms and include one of the following: 1) Excessive, unreasonable and ongoing thoughts about how serious the symptoms are; 2) Ongoing high levels of anxiety about personal health or symptoms; 3) Excessive time and energy spent focusing on health and symptoms.
  • This condition can be diagnosed as "Somatic Symptom Disorder with predominant pain". This was previously known as pain disorder and this description is used when the physical symptoms are primarily involving pain in the body.
  • The exact prevalence rate is not known, but is estimated to be in the range of 5-7% of the adult population.
  • One of the highest risk factors is if the person has high levels of worry, anxiety, loneliness, or depression about life and the world around them.
  • This condition commonly happens with depression or anxiety.  It can also happen with medical conditions that may be related to the symptoms, but aren't enough to cause how severe the symptoms being reported are.
  • Having a doctor that the person trusts and can communicate with is very important for treatment.  The goal will be to improve daily living and functioning, not necessarily about managing the physical symptoms.

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What is Illness Anxiety Disorder?

  • The symptoms of this disorder include:
    • being preoccupied with having or getting a serious illness.
    • bodily symptoms are not present or, if present, are very mild.
    • the person having a high level of anxiety about health and being easily alarmed about the status of his/her health or illness in general.
    • performing excessive health-related behaviors, such as checking their body for signs of illness, constantly going to the doctor's office or requesting tests/procedures be done (known as the care-seeking type of illness anxiety disorder). Or the person may be avoiding health-related circumstances, such as not ever going to see the doctor or not entering a hospital, even though the person believes they have a serious medical condition (the care-avoidant type of illness anxiety disorder).
    • the obsession with illness has been present for at least 6 months. The illness the person is worrying about may change over that period, but the worry about illness in general has been present for at least that long.
  • Current statistics are based on past estimates of hypochondriasis and are believed to be in the range of 1.3 to 10%.
  • This condition can sometimes happen after a stressful event in a person's life.  It can also happen after the person has been ill with a mild or non-life threatening illness.  Childhood abuse or having a serious illness as a child may also be a risk for developing this condition.
  • Having a doctor that the person trusts and can communicate with is very important for treatment.  The goal will be to improve daily living and functioning, and to reduce the level of worry and anxiety being experienced.

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What is Conversion Disorder?

  • This condition is also called Functional Neurological Symptom Disorder.  It involves having physical symptoms that appear after stress or a traumatic event has taken place.
  • The symptoms of this disorder include:
    • one or more symptoms involving motor or sensory functions. These may include problems such as weakness or paralysis; tremors or seizures; loss of balance or walking oddly; having trouble swallowing; and being unresponsive, among many others.
    • the symptoms being displayed could not be caused by a medical condition that the person has
    • the symptoms or problems also can't be explained by any other medical condition
    • the symptoms are causing significant distress or impairment in the person's social, occupational, or other areas of daily functioning.
  • According to the DSM-5, persistent conversion disorder is found in 2 to 5 people out of 100,000 per year.
  • Risk factors can include the person's general temperament or personality, as well as history of child abuse or neglect.  Having stressful life events happen or having a brain disease that causes similar symptoms can also be a risk.  For example, a person with epilepsy may then have non-epilepsy related seizures after a traumatic event has happened.
  • Anxiety disorders, especially panic disorder, and depression are both common.
  • Symptoms of conversion disorder often go away on their own.  If they don't, physical therapy can be used for symptoms such as having trouble walking or muscle weakness.
  • Psychotherapy can be very helpful in order to look at and change the thoughts that may be affecting the person.  It can also reduce the levels of worry and anxiety, as well as any depression that the person may be having.
  • Stress management techniques can be used to help deal with and treat the stress that may have caused the symptoms.

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What is Psychological Factors Affecting Other Medical Conditions?

  • The symptoms of this disorder include:
    • having a medical symptom or condition, other than a mental disorder
    • having psychological or behavioral factors that negatively affect the medical condition - either by:
      • making it worse or stopping recovery
      • affecting the treatment of the condition
      • having stress or showing unhealthy behaviors. This could include saying symptoms aren't happening or not doing what the doctor tells you to do.
  • There is not currently clear research data on how common this disorder is. According to some insurance data, it appears to be more common than somatic symptom disorder. The disorder can occur at any age, including in children and the elderly.
  • Treatment includes the person learning about the effects of their thoughts and behaviors on their medical condition.  It also includes psychotherapy to help the person deal with their condition and to follow treatment recommendations for the medical condition.

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What is Factitious Disorder?

  • This condition used to be called Munchausen syndrome.  Symptoms include:
    • pretending to have physical or psychological symptoms; causing the injury or disease yourself, or describing actually present symptoms as much, much worse than they really are
    • telling other people that you are ill, impaired or injured when this is not the case
    • there are no obvious external reasons for this lying or self-injury behavior
    • the faking behavior is not better explained by another mental disorder
  • The condition can be a single episode or can be ongoing.
  • The condition can also be diagnosed as Factitious Disorder Imposed on Another.  This used to be called Factitious Disorder by Proxy).  In this situation, a person lies about illness or injury in another person.  For example, a parent might say their child is sick, or an adult child might lie about their elderly parent.
  • Estimates are that 1% of those in the hospital may have this disorder.
  • Treatment does not focus on the symptoms that the person says they have.  These symptoms are either not really there at all or are mild ones that don't require treatment.
  • Instead psychotherapy, especially cognitive-behavioral therapy (CBT), is used to help the person look at and change the thoughts that may be leading to the deceptive and faking behavior.

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