Conversion disorder and somatic symptom disorder are both categorized as somatic symptom and related disorders (previously termed somatoform disorders).
Somatic symptom and related disorders are psychiatric conditions where patients experience distressing physical symptoms associated with abnormal thoughts, feelings, and behaviors in response to these symptoms. They may result from psychological stress that is unconsciously (without awareness) expressed somatically, though the underlying cause is not fully understood.
Risk factors include being female, having a history of abuse or adverse childhood events, and having personality traits of alexithymia (difficulty expressing emotions) or neuroticism. Symptoms that persist with an external focus of control, and without awareness of the psychological and stress-related interplay, can lead to considerable functional impairment and distress.
Diagnosis is made by clinical interview, behavioral observation, physical exam suggestive of pseudoneurologic causes, and tests to rule out medical or neurologic causes. The diagnosis should not be made solely on the basis of medically unexplained symptoms; rather, it should be based on evidence from the clinical exam and the patient’s abnormal thoughts, feelings, and behaviors in response to the medically unexplained symptoms.
Good doctor-patient relationships and validation of the patient's suffering are essential for effective management. Treatment includes cognitive behavioral therapy, physical therapy, and avoiding unnecessary medicines, tests, and procedures. Diagnosis and treatment of associated comorbid psychiatric conditions benefit overall functioning and recovery.
Long-term management involves interrupting perpetuating factors, maintaining the same doctor, and providing strategies for self-efficacy, distress tolerance, coping, and modulating the interaction of anxiety, stress, and physical symptoms.
Conversion disorder and somatic symptom disorder are psychiatric conditions that fall under the somatic symptom and related disorders category of the DSM-5 (previously termed somatoform disorders). Somatic symptom and related disorders are those with prominent physical symptoms associated with significant distress and impairment of function.
Conversion disorder is characterized by voluntary motor or sensory function deficits that suggest neurologic or medical conditions but are rather associated with clinical findings that are not compatible with such conditions. Somatic symptom disorder is characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life. To meet DSM-5 criteria, these patients must have excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: disproportionate and persistent thoughts about the seriousness of one’s symptoms; persistently high levels of anxiety about health or symptoms; excessive time or energy devoted to these symptoms or health concerns. Importantly, even if any one somatic symptom is not continuously present, the state of being symptomatic is persistent (typically more than 6 months).
A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?
Nội dung chính
- What is somatic symptom disorder?
- What is the most important target for treatment in somatic symptom disorder?
- What is the reason for somatization disorder?
- Which of the following is a necessary condition for a diagnosis of somatic symptom disorder?
a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion."
b. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I'm getting seriously dehydrated."
c. "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage."
d. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."
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2
The patient says,
"None of my doctors listen to me."
3
The patient names six current health care providers providing care.
4
The patient complains of abdominal pain and swollen lymph nodes.
5
The patient complains of being unable to care for children because of headaches.
Somatic symptom disorder is characterized by a combination of distressing symptoms and an excessive or maladaptive response or associated health concerns without significant physical findings and medical diagnosis.
The predominance of women is significant, particularly younger women. There may be a high level of medical care use, which rarely alleviates the patient's concerns. The most common symptoms are chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness. Some patients feel that their medical assessment and treatment have been inadequate, leaving them feeling discounted or misunderstood.
Text Reference - pp. 316-317
1
Patients
typically experience high levels of functional impairment.
2
Chest pain, dizziness, and headache commonly are reported symptoms.
4
Medical and psychosocial histories are vital to achieving an accurate diagnosis.
5
The health care provider's perception of the patient is a factor in the diagnosis process.
Somatic symptom disorder is characterized by a combination of distressing symptoms and an excessive or maladaptive response or associated health concerns without
significant physical findings and medical diagnosis. Patients' suffering is authentic and they typically experience a high level of functional impairment. Somatic symptom disorder is difficult to distinguish from physical disorders with organic causes, and the patient's history is extremely important for accurate diagnosis. The most common symptoms for visits to primary health care providers are chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia,
abdominal pain, and numbness. Studies show that the strongest predictor of misdiagnosing somatic disorders is the primary health care provider's dissatisfaction with the clinical encounter. The predominance of women with somatization is significant.
Text Reference - pp. 316-317
2
"Since getting a divorce, I've had crushing chest pain, but I don't think it really means anything."
In conversion disorder, the individual may be expressing a forbidden thought or wish by
converting it into physical symptoms that are more appropriate and acceptable, and which also provide sympathy, care, and attention from others. Individuals exhibit one or more symptoms that affect voluntary motor or sensory function. These symptoms appear to be related to a neurologic or general medical condition but are not caused by a general medical condition, or the direct effects of a substance, or a culturally sanctioned behavior or experience. The symptom is not intentionally produced
and is not limited to pain or sexual dysfunction. The conversion symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Common symptoms are blindness, paralysis, deafness, seizures, anesthesia, or abnormal motor movements
Text Reference - p. 317
What is somatic symptom disorder?
Somatic symptom disorder is diagnosed when a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning. The individual has excessive thoughts, feelings and behaviors relating to the physical symptoms.
What is the most important target for treatment in somatic symptom disorder?
Management and Treatment The goal of treating somatic symptom disorder is to manage physical symptoms, as well as psychological symptoms using psychotherapy (talk therapy) and sometimes medications that treat underlying anxiety and depression.
What is the reason for somatization disorder?
The exact cause of somatic symptom disorder isn't clear, but any of these factors may play a role: Genetic and biological factors, such as an increased sensitivity to pain. Family influence, which may be genetic or environmental, or both.
Which of the following is a necessary condition for a diagnosis of somatic symptom disorder?
Somatic Symptom Disorder Disproportionate and persistent thoughts about the seriousness of one's symptoms. Persistently high level of anxiety about health or symptoms. Excessive time and energy devoted to these symptoms or health concerns.