SOMATIC SYMPTOM

RELATED DISORDERS
 OVERVIEW - SOMATIC SYMPTOM DISORDER
● Somato - body

● Group of Psychological disorders in which a patient experiences physical

symptoms that cannot be explained by underlying medical or neurological

condition

● Medically unexplainable cases - 25 to 50%

● No control over their sym

● Primary gain and secondary gain

 DSM 5
(1) disproportionate and persistent thoughts about the seriousness of one’s
symptoms;

(2) persistently high level of anxiety about health or symptoms; and/or

(3) excessive time and energy devoted to these symptoms or health concerns

● (1) Hypochondriasis, (2) Somatization disorder, and (3) Pain disorder comes
under Somatic Symptom disorder
 HYPOCHONDRIASIS
● Physical symptoms are not experienced currently or are very mild

● Preoccupation with the idea of being sick rather than the actual symptoms

● Repeated reassurances are not enough

● Quick to observe any discomfort or symptoms

● Often co occurs with anxiety and mood disorders

● Misinterpreting normal physical sensations

● Vague symptoms - fatigue and pain

● Doctor shopping

● Disease conviction even after being shown evidences

● Panic disorder - fear of an immediate symptom related catastrophe

STATISTICS

● Affects 1 % - 5% of the population

● In a primary care setting - 6.7% to 16.6%

● Myth - prevalent among the elderly

● Chronic in nature

● Demographics - women, unmarried, low SES

CAUSES Focus on
sensations

Focusing sensations

Increased Increased
symptoms arousal

Increased Physical
Anxiety sensations seem
more intense

Misinterpretation
as symptoms
●

● Cognitive error: “Bodily changes are a sign of serious disease”

● Ambiguous stimuli as threatening

● Research study - clients showed enhanced perceptual sensitivity

● Attentional bias for illness related information: looking for confirming evidence

● Family history of illness and strong memories associated with it

● View life events as uncontrollable - Therefore I should be on guard

● Triggers - Stressful life events

● Is the internet making it any better?

TREATMENT

● Assess people’s beliefs about illness and modify misinterpretations of bodily

symptom

● Behavioural techniques - inducing symptoms in a controlled environment

● Response prevention - stopping the urge to check for symptoms and

reassurance

● General stress management skills

● Psychoeducation and reassurance from mental health professionals

 SOMATIZATION DISORDER
● Marked by several physical ailments that cannot be explained

● 4 pain symptoms, 2 gastrointestinal symptoms, 1 sexual symptom and 1

pseudoneurological symptom

● Hypochondriasis is characterized by one or two symptoms but SD - multiple

symptoms

● Hypochondriasis is also marked by severe anxiety of the possibility of getting

a disease
STATISTICS

● 0.2% - 2 % in women and less than 0.2 % in men

● Co-occurs with mood and anxiety disorders

● Chronic condition with poor prognosis

CAUSES

● Familial linkage - runs in the family. ASPD in men and SD in women

● Neurotic individuals with certain family backgrounds

● Perceptual amplification i.e., bodily changes are seen as somatic symptoms

● Catastrophizing minor bodily changes - constantly thinking themselves as

weak having low tolerance to stress

● Elevated levels of cortisol in response to stress leading to increased

symptoms
TREATMENT

● Regular visits, physical examinations and minimal use of medications and

therapy

● Substantial decrease in symptoms and improved functioning

● CBT - Coping strategies and discouraging symptom checking

● Psycho-educating family and physicians about secondary gain

 PAIN DISORDER
● Persistent and severe pain in 1 or more areas that is not feigned

● Acute (>6 months) or chronic (=<6 months)

● Nature of pain - Vague and personal

● Pain behaviours - avoiding usual activities, physical activities and social

isolation
STATISTICS

● Common among pain clinics

● Women more than men

● Comorbid with anxiety and mood disorders

TREATMENT

● CBT - Relaxation training, activity scheduling and reinforcement for “no pain”

behaviours

● Antidepressant medication - tricyclic antidepressants

 CONVERSION DISORDER
● Symptoms affect sense or motor movements that suggest neurological
problems
● Blindness, deafness, partial paralysis, seizures
● Early observations by freud - la belle indifference - currently accounts to 20%
● Conversion hysteria - symptoms are an expression of repressed sexual
energy
● Reduction in anxiety - primary gain
● Sympathy and attention - secondary gain
PREVALENCE

● 0.005% in general population

● Prevalent among low SES because they are more uneducated

● More often in women than in men

● Early adolescence and early adulthood

● Often reoccurs even if the original stressor is removed

● Co-occurs with other anxiety, mood or somatic symptom disorders

1. Sensory symptoms (deafness, blindness, numbness)

● Symptoms that do not conform to anatomical pathways

● Glove anesthesia

● Blind but navigating a room without bumping into any furniture

● Deaf but orienting themselves appropriately upon hearing their name

2. Motor Symptoms

● Loss of function is specific in nature

● Hand numbness - unable to write but able to scratch

● Ability to walk in case of emergencies

● Aphonia - whispers only but can cough

3. Seizures

● Mimicking epileptic seizures but can be distinguished

● EEG abnormalities, confusion and loss of memory - true epileptic seizures

● Excessive thrashing and rarely loses controls over bladder or bowels
Mrs. Chatterjee, a 26-year-old patient, attends a clinic in New Delhi, India, with
complaints of “fits” for the last 4 years. The “fits” are always sudden in onset and
usually last 30 to 60 minutes. A few minutes before a fit begins, she knows that it
is imminent, and she usually goes to bed. During the fits she becomes
unresponsive and rigid throughout her body, with bizarre and thrashing
movements of the extremities. Her eyes close and her jaw is clenched, and she
froths at the mouth. She frequently cries and sometimes shouts abuses. She is
never incontinent of urine or feces, nor does she bite her tongue. After a “fit” she
claims to have no memory of it. These episodes recur about once or twice a
month. She functions well between the episodes. Both the patient and her family
believe that her “fits” are evidence of a physical illness and are not under her
control. However, they recognize that the fits often occur following some stressor
such as arguments with family members or friends .
She is described by her family as being somewhat immature but “quite social” and
good company. She is self-centered, she craves attention from others, and she
often reacts with irritability and anger if her wishes are not immediately fulfilled. On
physical examination, Mrs. Chatterjee was found to have mild anemia but was
otherwise healthy. A mental status examination did not reveal any abnormality and
her memory was normal. An electroencephalogram showed no seizure activity.
TREATMENT

● Behavioural approach - removing reinforcements for abnormal motor

behaviours

● CBT has also been proved to be effective

● Hypnotherapy can also been beneficial

ILLNESS ANXIETY DISORDER
● 75% of individuals previously diagnosed with hypochondriasis are now

subsumed under somatic symptom disorder

● The remaining 25% have high health anxiety in the absence of somatic

symptoms