{"id":152199,"date":"2024-03-03T14:48:43","date_gmt":"2024-03-03T19:48:43","guid":{"rendered":"https:\/\/effectsofanxiety.net\/archives\/152199"},"modified":"2024-03-03T14:48:43","modified_gmt":"2024-03-03T19:48:43","slug":"health-anxiety-and-illness-related-psychological-distress-somatic-symptom-disorders-dsm-5-tr","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/152199","title":{"rendered":"Health Anxiety, and Illness Related Psychological Distress | Somatic Symptom Disorders | DSM 5 TR"},"content":{"rendered":"
https:\/\/www.youtube.com\/watch?v=hy46OtDsjpI<\/div>Hello everybody and welcome to this week’s ceu\u00a0 class on health anxiety and illness related\u00a0\u00a0 psychological distress in the dsm this is\u00a0 the category of somatic symptom disorders\u00a0\u00a0 i’m your host dr donnelly snipes in this\u00a0 presentation you’re going to learn about\u00a0\u00a000:00:18<\/a>the category of somatic symptom disorders in the\u00a0 dsm-5tr we’ll explore the diagnostic criteria\u00a0\u00a0 for the disorders in this category as outlined\u00a0 in the dsm-5tr and identify risk factors and\u00a0\u00a0 co-occurring issues as identified in the dsm-5-tr\u00a0 as well as in clinical research i.e from pubmed00:00:44<\/a>of the disorders in the somatic symptom disorder\u00a0 section are focused mainly on somatic symptoms or\u00a0\u00a0 illness anxiety although in the dsm-5 they tried\u00a0 to more effectively differentiate the disorders\u00a0\u00a0 there is still a great deal of overlap\u00a0 and you’ll see that when we get in there\u00a0\u00a000:01:03<\/a>interestingly the dsm notes that non-psychiatric\u00a0 physicians and mental health clinicians\u00a0\u00a0 found the dsm-4 diagnostic criteria\u00a0 difficult to apply which is why they\u00a0\u00a0 revised it in the dsm-5 by reducing the\u00a0 number of disorders and sub-categories\u00a0\u00a000:01:20<\/a>so in the dsm-4 it was even harder to\u00a0 differentiate and differentially diagnose\u00a0\u00a0 it’s important to remember that many mental\u00a0 disorders initially present with primarily\u00a0\u00a0 physical or somatic symptoms and in some cultures\u00a0 that somatic presentation may always predominate\u00a0\u00a000:01:43<\/a>previous criteria for somatic symptom disorders\u00a0 over emphasized the importance of symptoms being\u00a0\u00a0 unexplained by a physiological exam it is noted\u00a0 in the dsm 5tr that it is not appropriate to give\u00a0\u00a0 an individual a mental disorder diagnosis solely\u00a0 because there is a lack of physiological findings\u00a0\u00a000:02:07<\/a>that is an important note that we need to\u00a0 remember when making these diagnoses risk\u00a0\u00a0 factors for somatic symptom disorders include\u00a0 genetic and biological vulnerabilities that cause\u00a0\u00a0 differential pain perception well that makes\u00a0 sense when somebody is more sensitive to pain\u00a0\u00a000:02:30<\/a>or less reactive to pain it can present as\u00a0 different symptoms neurological disorders or\u00a0\u00a0 chronic pain issues or somatic symptoms trauma is\u00a0 also a risk factor for somatic symptom disorders\u00a0\u00a0 if you’ll remember from other presentations\u00a0 vanderkulk has said repeatedly that a lot of times\u00a0\u00a000:02:57<\/a>trauma is remembered in the body it’s remembered\u00a0 as a somatic sensation not necessarily as a an\u00a0\u00a0 overt memory additionally people who are in\u00a0 situations in which the sick role is reinforced\u00a0\u00a0 may be more likely to present with somatic\u00a0 illnesses as well as situations in which\u00a0\u00a000:03:21<\/a>there is not any reinforcement for mental\u00a0 health presentations of distress again in\u00a0\u00a0 some cultures and even in some families mental\u00a0 distress is ignored minimized pathologized and\u00a0\u00a0 somatic symptoms or physical symptoms are the\u00a0 only thing that is recognized and considered\u00a0\u00a000:03:43<\/a>a valid complaint so the presentation may\u00a0 of mental illness or mental health issues\u00a0\u00a0 may vary based on culture and family acceptance\u00a0 of mental health symptoms differences in\u00a0\u00a0 cultural expectations and explanations\u00a0 for physical symptoms or somatic symptoms\u00a0\u00a000:04:10<\/a>and the differences in the management of symptoms\u00a0 may also be a risk factor or a differentiating\u00a0\u00a0 factor for diagnosis of somatic symptom disorder\u00a0 so let’s talk about somatic symptom disorder and\u00a0\u00a0 it is obviously the primary disorder in this\u00a0 category that is titled somatic symptom disorders\u00a0\u00a000:04:38<\/a>in somatic symptom disorder the person has\u00a0 to have one or more physical symptoms that\u00a0\u00a0 result in clinically significant\u00a0 distress okay that’s pretty broad criteria number two they must exhibit\u00a0 excessive thoughts feelings or behaviors\u00a0\u00a000:04:58<\/a>related to the physical symptom now\u00a0 excessive is what differentiates it from\u00a0\u00a0 quote normal or expected anxiety or behaviors\u00a0 and there is no objective definition of excessive\u00a0\u00a0 the excessive thoughts or feelings or behaviors\u00a0 can be characterized by one or more of the\u00a0\u00a000:05:25<\/a>following a disproportionate persistent thought\u00a0 about the seriousness of the illness so if\u00a0\u00a0 somebody has i have a strong history of cancer in\u00a0 my family particularly melanoma so i’m regularly\u00a0\u00a0 checking my my freckles and my moles um now if i\u00a0 were disproportionately obsessed with you know oh\u00a0\u00a000:05:48<\/a>this mole looks a little strange and it suddenly\u00a0 consumed what i was doing then that might qualify\u00a0\u00a0 persistently high level of anxiety about the\u00a0 symptoms so if i had a lot of anxiety about\u00a0\u00a0 the fact that you know some of my moles\u00a0 are slightly different colors or whatever\u00a0\u00a000:06:09<\/a>that could also be a symptom but again it has\u00a0 to be excessive and who defines excessive that’s\u00a0\u00a0 one of the things we’re going to talk about and\u00a0 finally excessive time and energy is devoted to\u00a0\u00a0 these symptoms or concerns so let’s switch gears\u00a0 you know cancer is something people worry about\u00a0\u00a000:06:30<\/a>viruses or something people worry about but\u00a0 menopause hot flashes okay that is a physical\u00a0\u00a0 symptom that can result in clinically significant\u00a0 distress if you’ve ever had hot flashes you know\u00a0\u00a0 it can wake you up in the middle of\u00a0 the night hot flashes can be really\u00a0\u00a000:06:50<\/a>um disruptive to your life and they’re real\u00a0 they they exist a lot of times when you have\u00a0\u00a0 hot flashes your heart is also racing a little bit\u00a0 it can increase up to 20 beats a minute they say\u00a0\u00a0 a person may spend a lot of time and energy trying\u00a0 to figure out what can i do to control these\u00a0\u00a000:07:11<\/a>hot flashes so i can sleep through the freaking\u00a0 night and they’re looking at different mattresses\u00a0\u00a0 and different solutions and they’re looking at\u00a0 different herbs and consulting different doctors\u00a0\u00a0 is that excessive when the physical symptoms\u00a0 are preventing them from being able to sleep\u00a0\u00a000:07:30<\/a>i’m not saying one way or another however\u00a0 i think it’s important for us to consider\u00a0\u00a0 what is the impact the symptom is having on the\u00a0 person and how much is it the symptom itself\u00a0\u00a0 being um functionally disruptive for them and as\u00a0 a result of that is the time and energy devoted to\u00a0\u00a000:07:56<\/a>the concerned or alleviating the concerns\u00a0 excessive it may not be we need to be really\u00a0\u00a0 really careful about pathologizing people’s\u00a0 desire to have a reasonable quality of life\u00a0\u00a0 and finally for the diagnostic criteria although\u00a0 any particular symptom may not be continuously\u00a0\u00a000:08:18<\/a>present the person exhibits symptoms continuously\u00a0 for at least six months so they may have\u00a0\u00a0 disproportionate or persistent thoughts about the\u00a0 seriousness of a variety of different concerns or\u00a0\u00a0 persist persistently high levels of anxiety about\u00a0 a variety of symptoms that they’re experiencing\u00a0\u00a000:08:38<\/a>or they may spend excessive time and energy\u00a0 devoted to a variety of different symptoms and\u00a0\u00a0 you know for those of you who are older you know\u00a0 as you get older you seem to break a little bit\u00a0\u00a0 more and there is a and younger people who\u00a0 are going through growth spurts may have\u00a0\u00a000:08:59<\/a>um aches and pains and changes that uh vary\u00a0 over the course of several months so we do\u00a0\u00a0 want to consider you know what’s going\u00a0 on and is this excessive for the person somatic symptom disorder can be diagnosed\u00a0 with or without a medical explanation and\u00a0\u00a000:09:23<\/a>i’m going to spend most of the time in this\u00a0 presentation on somatic symptom disorder since\u00a0\u00a0 it is the primary diagnosis and the one with\u00a0 the most research behind it in this category but\u00a0\u00a0 so somatic symptom disorder can develop in\u00a0 somebody after they’ve had a heart attack they may\u00a0\u00a000:09:45<\/a>be hyper vigilant to signs of another heart attack\u00a0 well that kind of makes sense now we want to look\u00a0\u00a0 at is there concern and is are there feelings\u00a0 about this fear about having another heart attack\u00a0\u00a0 is it disruptive to their life and you know it’s\u00a0 really this is where it kind of starts getting\u00a0\u00a000:10:07<\/a>really dicey to differentially diagnose\u00a0 between somatic symptom disorder and\u00a0\u00a0 anxiety um and illness related anxiety\u00a0 but i digress superventricular tachycardia\u00a0\u00a0 is another one of those things it’s\u00a0 kind of like when you take your car\u00a0\u00a000:10:25<\/a>to the mechanic and there’s this sporadic squeak\u00a0 or issue that you’re having the mechanic can’t\u00a0\u00a0 find it so they said there’s nothing wrong\u00a0 it’s you know all in your head svt is one\u00a0\u00a0 of those that we’re going to talk about that is\u00a0 really difficult a lot of times for doctors to\u00a0\u00a000:10:45<\/a>catch because it occurs so sporadically you can\u00a0 have multiple in a day and then go weeks or months\u00a0\u00a0 without having one supraventricular\u00a0 tachycardia is when your heart rate goes from\u00a0\u00a0 normal for you to all of a sudden just jumping\u00a0 up to you know 170 180 200 and it feels like it’s\u00a0\u00a000:11:09<\/a>going to pound out of your chest and it hurts\u00a0 so supraventricular tachycardia is one of those\u00a0\u00a0 that people may be more hyper vigilant about after\u00a0 they’ve had an episode because it’s terrifying\u00a0\u00a0 but it’s also one that is often dismissed\u00a0 by doctors that say well if it resets on\u00a0\u00a000:11:30<\/a>its own it’s not a big deal well what\u00a0 happens if it doesn’t reset on its own\u00a0\u00a0 if somebody has had a death of a loved one\u00a0 from fill in the blank cancer heart attack\u00a0\u00a0 stroke whatever then they may become more\u00a0 hyper vigilant when they have similar symptoms\u00a0\u00a000:11:50<\/a>i already talked about menopause that can\u00a0 be something that comes on and it comes on\u00a0\u00a0 at different ages for different people but it\u00a0 can cause a variety of physiological symptoms\u00a0\u00a0 that may be disruptive to the person’s\u00a0 life that they may spend a lot of time\u00a0\u00a000:12:07<\/a>trying to figure out how to manage the virus and\u00a0 i can’t say the c word because the youtube algos\u00a0\u00a0 would like completely lose their ever-loving mind\u00a0 but getting sick with a virus can be uh can also\u00a0\u00a0 prompt somatic symptom disorder or health anxiety\u00a0 or i’m sorry they call it illness anxiety um00:12:33<\/a>in people when they start getting a sniffly nose\u00a0 they start thinking oh my gosh i must have this\u00a0\u00a0 virus when they have a cough that’s sort of\u00a0 quote unexplained they may worry about it\u00a0\u00a0 especially when that particular disorder whatever\u00a0 it is is regularly presented to the people\u00a0\u00a000:12:56<\/a>and there are a lot of diffuse\u00a0 symptoms that can characterize it then it can become easier for people to\u00a0 develop somatic symptom disorder and become\u00a0\u00a0 hyper vigilant to a lot of those symptoms oh do\u00a0 i have a headache oh i wonder what that means\u00a0\u00a000:13:14<\/a>fibromyalgia and pots fibromyalgia was actually\u00a0 initially identified in 1904 but it wasn’t\u00a0\u00a0 recognized by the american college of rheumatology\u00a0 until 1990 pots postural orthostatic tachycardia\u00a0\u00a0 syndrome was originally identified i believe in\u00a0 1984 i had the reference later in the presentation\u00a0\u00a000:13:40<\/a>but there are a lot of doctors that still don’t\u00a0 believe that it truly exists now interestingly\u00a0\u00a0 enough fibromyalgia and pots both have clinically\u00a0 identifiable symptoms in fibromyalgia it’s through\u00a0\u00a0 an mri and through blood tests and pots\u00a0 there’s a variety of other tests that can\u00a0\u00a000:14:04<\/a>identify whether somebody meets criteria but\u00a0 despite that for the longest time fibromyalgia was\u00a0\u00a0 dismissed as being something that was not a\u00a0 real diagnosis now that now we know it is and\u00a0\u00a0 you know potts is still trying to\u00a0 establish itself despite there being\u00a0\u00a000:14:30<\/a>clinical centers of excellence like the one\u00a0 at vanderbilt that are actively studying it\u00a0\u00a0 chronic fatigue is another one of those syndromes\u00a0 or issues that people can have that has long been\u00a0\u00a0 pathologized if you will and stigmatized\u00a0 because it’s what they call a diagnosis of\u00a0\u00a000:14:56<\/a>exclusion there is no test for chronic\u00a0 fatigue it’s just a person who presents with\u00a0\u00a0 a certain set of symptoms that aren’t explained\u00a0 by anything else must have chronic fatigue hyperparathyroid and this one um i bring\u00a0 up specifically because i have known a\u00a0\u00a000:15:18<\/a>couple of people who’ve had it and it has gone\u00a0 they’ve gone years without it being diagnosed\u00a0\u00a0 but people with hyperparathyroid may experience\u00a0 fatigue and depressive like symptoms as well as\u00a0\u00a0 quote according to the mayo clinic frequent\u00a0 complaints of illness with no apparent cause\u00a0\u00a000:15:38<\/a>so this is another one that often probably got\u00a0 pushed off as a mental health issue when in\u00a0\u00a0 actuality there was a an actual dysfunction within\u00a0 the hyperparathyroid gland oh my gosh and both of\u00a0\u00a0 these people once they had their hyperparathyroid\u00a0 gland removed they were asymptomatic imagine that\u00a0\u00a000:16:03<\/a>and then i did find another article that\u00a0 was interesting that indicated that ptsd\u00a0\u00a0 uh often has a lot of somatic symptoms quote\u00a0 somatic symptoms are ubiquitous especially are\u00a0\u00a0 a ubiquitous aspect of the clinical presentation\u00a0 of ptsd therefore we need to recognize\u00a0\u00a000:16:27<\/a>that people with ptsd often have somatic\u00a0 symptoms now that’s not really highlighted a lot\u00a0\u00a0 in the diagnostic criteria so a lot of times\u00a0 people with ptsd and concurrent somatic symptoms\u00a0\u00a0 or people with depression and concurrent somatic\u00a0 symptoms are given somatic symptom disorder\u00a0\u00a000:16:51<\/a>diagnosis in addition to the other uh in addition\u00a0 to the other diagnosis because the mind-body\u00a0\u00a0 dualism is still not really well integrated in\u00a0 the dsm 66 to 75 percent of people who previously\u00a0\u00a0 were diagnosed with hypochondriasis i know\u00a0 that’s like dr dragging your fingernails down\u00a0\u00a000:17:18<\/a>a blackboard to hear it are now diagnosed\u00a0 with somatic symptom disorder the rest are\u00a0\u00a0 diagnosed with illness anxiety hypochondriasis is\u00a0 no longer a diagnosis in the dsm-5 or the dsm-5tr a distinct characteristic of people with somatic\u00a0 symptom disorder is not the somatic symptoms per\u00a0\u00a000:17:41<\/a>se but instead the way they present or interpret\u00a0 them they may have a symptom which is either\u00a0\u00a0 a normal bodily symptom or a what many people\u00a0 would consider a minor pain or a minor symptom\u00a0\u00a0 and they are perceiving it as far more dangerous\u00a0 and intense now that can be for a variety of\u00a0\u00a000:18:07<\/a>reasons part of it could be because of perceptual\u00a0 differences and i really didn’t find much on\u00a0\u00a0 the comorbidity of somatic symptom disorder\u00a0 and other mental health issues that involve\u00a0\u00a0 sensory differences like autism spectrum\u00a0 disorders or adhd but i would wonder if\u00a0\u00a000:18:33<\/a>there’s a higher comorbidity there in those\u00a0 especially in those that are hypersensitive\u00a0\u00a0 to sensory stimulation i’m just hypothesizing\u00a0 however the fact that we even say that it’s not\u00a0\u00a0 the symptom that’s the problem it’s\u00a0 the way that you’re interpreting it\u00a0\u00a000:18:54<\/a>often causes invalidation of the person the\u00a0 doctors often say it’s all in your head or\u00a0\u00a0 you’re overreacting well how invalidating is that\u00a0 how hopeless and helpless do i feel if i’ve got\u00a0\u00a0 this chronic symptom that is impairing my\u00a0 quality of life and my medical providers00:19:16<\/a>talk to me like i’m an idiot you know\u00a0 that’s very invalidating so a lot of people\u00a0\u00a0 who receive that reception from their physician\u00a0 often go to the internet to try to self-diagnose\u00a0\u00a0 and self-treat their issues anybody who’s\u00a0 gone on the internet to try to self-diagnose\u00a0\u00a000:19:37<\/a>knows that the information out there\u00a0 varies widely in credibility and it\u00a0\u00a0 very easily promotes catastrophic\u00a0 perceptions you know you can go to just about\u00a0\u00a0 um like on mayo clinic or webmd and look up just\u00a0 about any symptom and under each one of them\u00a0\u00a000:20:01<\/a>it will say there’s a small chance that it\u00a0 could be cancer okay so then the person that\u00a0\u00a0 has somatic symptom disorder or health related\u00a0 anxiety now they have that in their head and\u00a0\u00a0 it becomes terrifying for them so a lot of\u00a0 times ins by invalidating and dismissing\u00a0\u00a000:20:23<\/a>patients doctors are actually increasing\u00a0 the severity of their their anxiety and\u00a0\u00a0 their hyper vigilance towards symptoms well what\u00a0 does this do aside from create more mental health\u00a0\u00a0 and dysphoria it keeps that hpa axis excessively\u00a0 triggered and we know when that happens that00:20:49<\/a>increased cortisol and persistently can lead\u00a0 to increased inflammation and can start causing\u00a0\u00a0 dysfunction and other bodily\u00a0 symptoms so not only is invalidating patients perceptions increasing their\u00a0 their mental health issues it’s also\u00a0\u00a000:21:12<\/a>probably increasing their physical health issues somatic symptom disorder that occurs with\u00a0 other mental health issues often results\u00a0\u00a0 in more functional impairment\u00a0 and more difficulty in treatment00:21:29<\/a>the more symptoms that are there the more systems\u00a0 that are probably involved and feeding off of each\u00a0\u00a0 other so as one symptom or one condition gets\u00a0 worse it probably worsens the other conditions\u00a0\u00a0 likewise when one symptom starts getting better\u00a0 hopefully it also improves the other symptoms\u00a0\u00a000:21:52<\/a>the more category b symptoms\u00a0 of somatic symptom disorder\u00a0\u00a0 that is the more they perseverate on the\u00a0 seriousness of the disorder the more they\u00a0\u00a0 have anxiety about having the disorder\u00a0 and the more time and energy they spend\u00a0\u00a000:22:07<\/a>trying to address the disorder likely the\u00a0 more severe the somatic symptom disorder is\u00a0\u00a0 people with somatic symptom disorder have\u00a0 a high frequency of medical visits which\u00a0\u00a0 rarely alleviate their concerns and it even\u00a0 states in the dsm that a lot of times doctors\u00a0\u00a000:22:26<\/a>are very dismissive and invalidating\u00a0 of people’s presentation additionally the people may get to a doctor that says okay\u00a0 well we can try to treat you with this if the\u00a0\u00a0 treatment doesn’t work then the person feels\u00a0 helpless and hopeless and sometimes the doctor\u00a0\u00a000:22:47<\/a>says well if that was the problem that treatment\u00a0 should have worked so that must not be the problem\u00a0\u00a0 ergo it must be all in your head and not all\u00a0 doctors do this you know i do want to emphasize\u00a0\u00a0 the fact that there are good doctors out there\u00a0 but unfortunately this happens my experience um\u00a0\u00a000:23:10<\/a>and with personally and with friends and\u00a0 family this happens more often than not\u00a0\u00a0 there was a 2015 article\u00a0 that was relatively scathing\u00a0\u00a0 about the somatic symptom disorder and it\u00a0 said the new dsm-5 this was before the tr\u00a0\u00a000:23:27<\/a>somatic symptom disorder over psychologizes\u00a0 chronic pain it has low sensitivity and\u00a0\u00a0 specificity and contributes to misdiagnosis and\u00a0 stigma so think about people with fibromyalgia who up until recently were falling through\u00a0 the cracks it was i believe in 201700:23:53<\/a>maybe a 2007. i can’t remember right offhand\u00a0 but very very recently they recognized that a\u00a0\u00a0 lot of people with fibromyalgia were not\u00a0 getting diagnosed because the criteria\u00a0\u00a0 were actually too restrictive so they changed\u00a0 the criteria now all those people that quote fell\u00a0\u00a000:24:13<\/a>through the cracks actually had fibromyalgia and\u00a0 were denied treatment because it was considered\u00a0\u00a0 they were considered to have it as a somatic\u00a0 symptom issue or something else who knows\u00a0\u00a0 so i think it’s really important that we take\u00a0 people’s perceptions of their physical symptoms\u00a0\u00a000:24:38<\/a>very very seriously we may not understand it we\u00a0 may not see it but it’s important to recognize how\u00a0\u00a0 it impacts their quality of life and recognize\u00a0 that we don’t know every disorder that exists\u00a0\u00a0 like i said pots just recently started being\u00a0 diagnosed you know compared to other things um\u00a0\u00a000:24:58<\/a>and are being identified back when i was in high\u00a0 school you know to kind of put it into perspective associated features of somatic symptom disorder\u00a0 catastrophic interpretation of normal bodily\u00a0\u00a0 sensations when somebody has a sensation they\u00a0 think oh my gosh this is it this is the big one00:25:22<\/a>my grandmother when after my grandfather died\u00a0 now they had been married for 50 plus years and\u00a0\u00a0 they had a very traditional marriage where he took\u00a0 care of things she took care of the house when he\u00a0\u00a0 passed on all of the stuff that he did fell onto\u00a0 her and it wasn’t something that she was used to\u00a0\u00a000:25:42<\/a>so she had high levels of anxiety and occasionally\u00a0 would have a vasovagal response and fall out\u00a0\u00a0 and her interpretation of what was going on was\u00a0 it was the good lord calling her up to heaven you\u00a0\u00a0 know that was her catastrophic interpretation\u00a0 of the symptoms of the heart palpitations that\u00a0\u00a000:26:06<\/a>were going on and it was important to examine\u00a0 everything that was going on because this was\u00a0\u00a0 really more a grief and anxiety and anxiety\u00a0 issue for her because she felt overwhelmed\u00a0\u00a0 with everything that was going on and was\u00a0 perpetually stressed out not sleeping well\u00a0\u00a000:26:27<\/a>but i digress associated features also include a\u00a0 self-con concept of bodily weakness they perceive\u00a0\u00a0 themselves as more frail and more likely to\u00a0 get sick intolerance of physical symptoms a lot of us i would venture to say that most\u00a0 everyone has awakened at some point and they’ve\u00a0\u00a000:26:52<\/a>had a kink in their neck from sleeping wrong\u00a0 or they have back pain and they’re not really\u00a0\u00a0 sure where it came from they just wake up\u00a0 and it’s there or they suddenly get this\u00a0\u00a0 ringing in their ears and instead of looking at\u00a0 the most likely explanation did i lift something\u00a0\u00a000:27:12<\/a>wrong did i sleep wrong they cannot\u00a0 tolerate that symptom and they start\u00a0\u00a0 on this you know fast track of catastrophic\u00a0 explanations for what’s going on negative affect\u00a0\u00a0 including a sense of hopelessness and helplessness\u00a0 and quote demoralization straight from the dsm\u00a0\u00a000:27:33<\/a>5tr the person feels hopeless and hopeless that’s\u00a0 a primary description of a depressive symptom\u00a0\u00a0 and they may feel demoralized they may feel like\u00a0 they’re not believed they may feel like nobody’s\u00a0\u00a0 there to help them unsupported because they are\u00a0 regularly being invalidated typically people with\u00a0\u00a000:28:01<\/a>somatic symptom disorders present in a medical\u00a0 setting because they’re concerned about guess what\u00a0\u00a0 a physical symptom you don’t go to a psychologist\u00a0 if you’ve got you know a physical symptom\u00a0\u00a0 reassurance by medical professionals and attempts\u00a0 to refocus the person’s concerns proves futile\u00a0\u00a000:28:21<\/a>and this is important but it is not remember it\u00a0 is not a diagnostic feature it’s just associated\u00a0\u00a0 the reassurance you know the person may have\u00a0 gone to other doctors before and been reassured\u00a0\u00a0 that hey it’s no big deal you don’t need to worry\u00a0 about it but they can’t explain what’s causing it\u00a0\u00a000:28:41<\/a>or the symptoms getting worse or the symptom is\u00a0 causing them clinically significant impairment and\u00a0\u00a0 functioning yet they can’t get any um validation\u00a0 from profession from their professionals to date\u00a0\u00a0 so going to the current professional\u00a0 they may say well you know i only have\u00a0\u00a000:29:03<\/a>a mild belief that this person can\u00a0 be helpful but i’ll try again anyway and attempts to refocus the person’s concerns\u00a0 prove futile when you’re being told that\u00a0\u00a0 okay yes you have this symptom but\u00a0 it’s not that big of a deal you need to\u00a0\u00a000:29:20<\/a>turn your attention to you know stop it stop\u00a0 ruminating about it instead of focusing on what’s\u00a0\u00a0 causing it you need to focus on stop ruminating\u00a0 that can feel extremely invalidating as well the prevalence according to the\u00a0 dsm-5 tr is 7 to 17 percent now\u00a0\u00a000:29:41<\/a>looking on line looking in pubmed\u00a0 there were actually very few uh\u00a0\u00a0 research articles that i found that looked at the\u00a0 prevalence in a in the general population there\u00a0\u00a0 were some that looked at the prevalence in medical\u00a0 students some that looked at the prevalence in um00:30:06<\/a>very very specific\u00a0\u00a0 subgroups but finding accurate data about\u00a0 the prevalence in the general population was not there you know except for what is\u00a0 stated in the dsm so i’m not sure where\u00a0\u00a000:30:23<\/a>those numbers came from but those are the\u00a0 numbers still 17 that’s almost one in five\u00a0\u00a0 so it’s important to recognize\u00a0 that that’s a pretty high number\u00a0\u00a0 it says that somatic symptom disorders are higher\u00a0 in women and you know i tend to take issue with\u00a0\u00a000:30:40<\/a>that because of the stigma associated with it\u00a0 what many women perceive when they hear that is\u00a0\u00a0 just like when they hear that prevalence\u00a0 of anxiety disorders is higher in women\u00a0\u00a0 they hear that the perception is that\u00a0 females may present in ways that are more\u00a0\u00a000:31:06<\/a>to use the old term um hypochondriacal if\u00a0 that’s even a correct conjugation of it\u00a0\u00a0 however there are some interesting things\u00a0 that they don’t point out and there are some\u00a0\u00a0 interesting things to consider in today’s\u00a0 day and age with p a lot of people that are\u00a0\u00a000:31:25<\/a>undergoing gender reassignment procedures\u00a0 testosterone seems to be unrelated to pain\u00a0\u00a0 perception okay so that’s interesting however\u00a0 estrogens and progesterone significantly impact\u00a0\u00a0 not only pain perception but also serotonin levels\u00a0 this is something that is really important for\u00a0\u00a000:31:48<\/a>us to recognize for people who are biologically\u00a0 female as well as for people who are transitioning\u00a0\u00a0 to female because the addition of\u00a0 estrogens and progesterone may impact their\u00a0\u00a0 some of their physiological symptoms estrogens\u00a0 also directly interact with cardiac function\u00a0\u00a000:32:14<\/a>okay well so let’s think about this\u00a0 when estrogen is high people tend to\u00a0\u00a0 have more quote anxiety symptoms heart\u00a0 racing shallow breathing clammy hands\u00a0\u00a0 high levels of estrogens are associated more with\u00a0 activation of that hpa axis and again that cardiac\u00a0\u00a000:32:35<\/a>function heart heart beating a lot of people\u00a0 with somatic symptom disorders have symptoms\u00a0\u00a0 that are related to either pain or heart function\u00a0 so estrogen alterations may impact the symptoms\u00a0\u00a0 therefore i think it’s important that we make sure\u00a0 that the person has had a uh physiological workup\u00a0\u00a000:33:04<\/a>not only for estrogens but also to look for\u00a0 imbalances and things like high thyroid um\u00a0\u00a0 to assess if there are any underlying thyroid\u00a0 uh um any underlying hormone conditions that\u00a0\u00a0 may be contributing to the somatic symptoms that\u00a0 aren’t readily apparent elevated cyclic estrogens\u00a0\u00a000:33:26<\/a>are associated with somatic symptoms that are\u00a0 common to many mental disorders there is evidence\u00a0\u00a0 that changes in estrogen levels may precipitate\u00a0 certain symptoms and people who have\u00a0\u00a0 um irregular hormone cycles which can be\u00a0 influenced by disrupted circadian rhythms\u00a0\u00a000:33:50<\/a>may have seemingly unpredictable symptom onsets\u00a0 but it would be interesting to correlate them with hormone levels both gonadal and testosterone\u00a0 or i’m sorry gonadal and thyroid\u00a0\u00a0 additionally research indicates that our\u00a0 distinct sex hormone actions between the sexes\u00a0\u00a000:34:14<\/a>play a critical role in the cns functioning so\u00a0 the people who are of different biological genders\u00a0\u00a0 um or or who have differential levels of\u00a0 hormones and there wasn’t any research\u00a0\u00a0 that i found on people who are undergoing uh\u00a0 gender reassignment so i’m i’m speculating here\u00a0\u00a000:34:41<\/a>may have altered sensory perceptions may have\u00a0 altered sensations of pain and cardiac rhythm\u00a0\u00a0 and things like that so it would be interesting\u00a0 to explore whether it’s the way the body is\u00a0\u00a0 wired you know so those who are biologically\u00a0 assigned female and biologically assigned male\u00a0\u00a000:35:04<\/a>will always act differently or whether that\u00a0 changes when hormone levels are rebalanced to the\u00a0\u00a0 identified gender so just\u00a0 things things that i think about\u00a0\u00a0 children as young as five have evidence limiting\u00a0 somatic complaints especially stomach ache\u00a0\u00a000:35:26<\/a>headache fatigue and nausea now what do we what do\u00a0 we know about this uh the research has indicated\u00a0\u00a0 that it’s highly comorbid with depression and\u00a0 anxiety in adolescents okay so adolescents who\u00a0\u00a0 have high levels of anxiety or depression often\u00a0 have stomach aches headaches fatigue and nausea\u00a0\u00a000:35:48<\/a>well aren’t those kind of part and parcel\u00a0 of depression and anxiety just a question\u00a0\u00a0 and in young children somatic symptoms were\u00a0 highly correlated with parental accommodation\u00a0\u00a0 so the more the parents accommodated the\u00a0 symptoms the more prevalent the symptoms became\u00a0\u00a000:36:09<\/a>the more the parents focused on the symptoms\u00a0 the more the child focused on the symptoms\u00a0\u00a0 the course of the illness is impacted by\u00a0 age at onset level of impairment comorbidity\u00a0\u00a0 whether comorbidity with physical or mental\u00a0 health issues harm avoidance if the person is um\u00a0\u00a000:36:30<\/a>afraid that they’ve got a problem then that\u00a0 harm avoidance that fear of having to face\u00a0\u00a0 uh a problem maybe make it more difficult to\u00a0 treat and increase the severity rumination and\u00a0\u00a0 negative affect which are both associated with the\u00a0 personality characteristic of quote neuroticism\u00a0\u00a000:36:52<\/a>can also negatively impact the outcome the more\u00a0 the person ruminates on it and stresses about\u00a0\u00a0 it the worse it can get the more that hpa axis\u00a0 stays activated the more inflammation the more cis\u00a0\u00a0 systemic dysregulation the person’s going to\u00a0 experience cooperativeness also obviously if\u00a0\u00a000:37:15<\/a>they’re treatment compliant then um the course\u00a0 is probably going to be different than if they’re\u00a0\u00a0 treatment non-compliant health literacy\u00a0 also impacts the development if people are able to understand the multiplicity of causes\u00a0 of different symptoms and not just focus on the\u00a0\u00a000:37:37<\/a>one catastrophic thing that can actually help so\u00a0 if they had a loved one for example who died of\u00a0\u00a0 a heart attack or of can’t cancer yes that could\u00a0 be something that could happen but what else could\u00a0\u00a0 cause that symptom in you a healthy individual a\u00a0 person who’s health literate is able to evaluate\u00a0\u00a000:38:01<\/a>the options more effectively than somebody who\u00a0 just says oh this symptom means this diagnosis\u00a0\u00a0 access to medical services also contributes to the\u00a0 development in course if the person does not have\u00a0\u00a0 access to adequate helpful medical services\u00a0 then they may have symptoms that are perpetual\u00a0\u00a000:38:25<\/a>and they don’t know what’s causing them or how\u00a0 to fix it and prior health care experiences if\u00a0\u00a0 they’ve been poor then the person is more likely\u00a0 going to be distrustful of future providers somatic symptom disorder is under diagnosed in\u00a0 older adults because the worry is often considered\u00a0\u00a000:38:45<\/a>understandable well so maybe the worry is\u00a0 understandable does it mean we need to be\u00a0\u00a0 diagnosing everybody who worries about\u00a0 symptoms in a level that we perceive\u00a0\u00a0 as excessive is there an opportunity for\u00a0 quality of life improvement even if their\u00a0\u00a000:39:06<\/a>symptoms are perceived as understandable that’s\u00a0 something that we really need to look at do we\u00a0\u00a0 need to wait until they meet dsm criteria\u00a0 for something before we try to help people\u00a0\u00a0 improve their quality of life or manage\u00a0 their symptoms cultural stigma related to\u00a0\u00a000:39:25<\/a>mental health diagnosis partially explains\u00a0 differences in somatic symptom reporting\u00a0\u00a0 some cultures have what they call idioms of\u00a0 distress that are misunderstood by many providers\u00a0\u00a0 so they may be um downplayed and or ignored and\u00a0 other times there are cultural explanations that00:39:53<\/a>mean the person is is not going\u00a0 to be reporting the same symptoms burnout for example is one of\u00a0 those cultural explanations\u00a0\u00a0 punishment for doing something bad some cultures\u00a0 believe that illnesses are are a result or a\u00a0\u00a000:40:13<\/a>punishment for doing something bad other cultures\u00a0 may believe that people’s presenting symptoms\u00a0\u00a0 are a result of imbalance between the hot and the\u00a0 cold or the damp and the dry the yin and the yang so it’s important to recognize how people\u00a0 explain things and understand what they’re\u00a0\u00a000:40:36<\/a>trying to communicate somatic symptom disorder has\u00a0 a higher level of suicidal ideation and attempts\u00a0\u00a0 due to comorbidity with mood disorders well\u00a0 i don’t know about you but if i’ve had this\u00a0\u00a0 symptom that is disruptive to my life to my\u00a0 sleep to my ability to do things and the medical\u00a0\u00a000:41:00<\/a>providers keep telling me there’s nothing they\u00a0 can do there’s no underlying cause for it it’s all\u00a0\u00a0 in my head or i’m exaggerating how bad it is then\u00a0 yeah i’m gonna start to feel hopeless and helpless\u00a0\u00a0 and the impact of that symptom may be such and\u00a0 the worry about that symptom may be such that it\u00a0\u00a000:41:19<\/a>starts disrupting sleep which contributes\u00a0 to fatigue and difficulty concentrating\u00a0\u00a0 and you can see how very easily someone\u00a0 could also develop comorbid depression and\u00a0\u00a0 perception of the cause of the symptoms is\u00a0 also linked to increased suicidal ideation\u00a0\u00a000:41:43<\/a>if people think that oh my gosh this symptom\u00a0 means that i’ve got this terminal illness\u00a0\u00a0 or i’ve got this illness that i refuse\u00a0 to live with then they may be more likely\u00a0\u00a0 to take matters into their own hands so we do need\u00a0 to understand people’s perception of what’s going\u00a0\u00a000:42:03<\/a>on and how it’s going to impact their quality\u00a0 of life and their sense of personal control now illness anxiety disorder we’re moving on\u00a0 from somatic symptom disorder there are a couple\u00a0\u00a0 others in this chapter that are have very minimal\u00a0 information on them illness anxiety disorder\u00a0\u00a000:42:24<\/a>is diagnosed when the individual performs\u00a0 excessive health-related behaviors\u00a0\u00a0 like frequent checking of you know moles\u00a0 or heart rate or blood pressure or whatever\u00a0\u00a0 extreme lifestyle alterations or intensive ongoing\u00a0 research about a particular symptom or disorder\u00a0\u00a000:42:47<\/a>or exhibit maladaptive avoidance of\u00a0 medical care so they may be either all\u00a0\u00a0 in and trying to figure out what it is or\u00a0 they may be all out going yeah this might\u00a0\u00a0 be really bad so i don’t want to know and i\u00a0 refuse to go seek medical a medical opinion\u00a0\u00a000:43:06<\/a>illness anxiety is present for at least six\u00a0 months but the specific illness may change\u00a0\u00a0 and it’s not better explained by another\u00a0 mental disorder according to the dsm-5 tr preoccupation with having or acquiring\u00a0 a serious illness is a mainstay\u00a0\u00a000:43:27<\/a>of illness anxiety disorder and the\u00a0 somatic symptoms are not present\u00a0\u00a0 or and this is where it starts to get dicey\u00a0 if present they are only mild in intensity\u00a0\u00a0 if a medical condition is present or there’s a\u00a0 high risk for developing a medical condition like\u00a0\u00a000:43:46<\/a>a strong family history the preoccupation\u00a0 is clearly excessive or disproportionate\u00a0\u00a0 thinking about somebody who’s had a family\u00a0 member that died of cancer or heart disease\u00a0\u00a0 and they have a strong family history you know\u00a0 it’s not just one person it’s like the whole\u00a0\u00a000:44:04<\/a>family is there preoccupation or concern about the\u00a0 issue excessive or disproportionate who’s to make\u00a0\u00a0 that decision and that’s really where we need to\u00a0 work with the the patient if the patient considers\u00a0\u00a0 it disproportionate okay you know let’s work with\u00a0 that however i think we get into very gray area\u00a0\u00a000:44:31<\/a>ethically when we start telling people how how\u00a0 valid it is their the intensity of their worry\u00a0\u00a0 there’s a high level of anxiety and\u00a0 hyper vigilance about their health\u00a0\u00a0 so all of these things have\u00a0 to be there they have to\u00a0\u00a000:44:51<\/a>do the frequent checking they have to have\u00a0 a preoccupation with having or acquiring an\u00a0\u00a0 illness they have to have it for at least six\u00a0 months and it’s not explained by a another medical\u00a0\u00a0 condition and there has to be a high level\u00a0 of anxiety and hyper vigilance about health00:45:11<\/a>now not in the dsm so this isn’t part of the\u00a0 diagnostic criteria but it’s also interesting to\u00a0\u00a0 consider health anxiety by proxy and this is when\u00a0 a parent caregiver loved one becomes so focused\u00a0\u00a0 on the symptoms of their child or loved one\u00a0 that they start having all of these other\u00a0\u00a000:45:39<\/a>meeting all of these other criteria and\u00a0 they want a doctor to diagnose their child\u00a0\u00a0 so there is the health anxiety by proxy this\u00a0 is very different than munch houses by proxy\u00a0\u00a0 in which there is a clear issue that’s going\u00a0 on a clear physiological problem but health\u00a0\u00a000:45:57<\/a>anxiety by proxy is not in the dsm however it is\u00a0 a something that does present more often than not um illness uh anxiety disorder the prevalence in\u00a0 the dsm-5tr is between one and ten percent not\u00a0\u00a0 finding a lot of information in pubmed that gives\u00a0 us any other reference for how prevalent it is\u00a0\u00a000:46:30<\/a>the development in course there was\u00a0 virtually no information although they\u00a0\u00a0 did mention it was rare in children the\u00a0 risk factors include a history of abuse\u00a0\u00a0 serious illness in self or parent during childhood\u00a0 if the child remember children think dichotomously\u00a0\u00a000:46:49<\/a>all good all bad all healthy all sick and if\u00a0 the loved one experienced a serious illness in\u00a0\u00a0 childhood then that child probably associated\u00a0 that symptom with catastrophic consequences\u00a0\u00a0 so we can see that that schema that was\u00a0 developed may be outdated but we can see\u00a0\u00a000:47:13<\/a>how it develops and again the history of abuse may\u00a0 be somaticized they may be having that traumatic\u00a0\u00a0 memory come out as a physiological reaction as\u00a0 opposed to an overt visual or or verbal memory\u00a0\u00a0 culture related issues to um illness anxiety\u00a0 disorder are unknown the functional consequences\u00a0\u00a000:47:40<\/a>the only thing the dsm identifies is that it\u00a0 interferes with relationships and work performance\u00a0\u00a0 i would argue that it interferes with a whole\u00a0 lot more than that if people have a high level\u00a0\u00a0 of illness and anxiety and they’re seeing a lot\u00a0 of doctors it’s going to impact them financially\u00a0\u00a000:47:58<\/a>physically that anxiety is likely going to impact\u00a0 their ability to get good quality sleep it’s going\u00a0\u00a0 to impact their energy levels it’s going to\u00a0 impact their immunity as that hpa axis stays\u00a0\u00a0 activated as that anxiety level stays high\u00a0 cortisol loses its ability as an anti-inflammatory\u00a0\u00a000:48:22<\/a>and we start seeing pro-inflammatory cytokines\u00a0 being secreted a lot more frequently so we’re\u00a0\u00a0 going to start seeing um increased problems\u00a0 in various health functions if you will\u00a0\u00a0 affectively people with illness anxiety disorder\u00a0 may have anger they may have guilt they may have\u00a0\u00a000:48:47<\/a>grief they may have depression cognitively when\u00a0 you’re not getting good sleep when you’re stressed\u00a0\u00a0 out all the time when your brain cells are bathed\u00a0 in stress hormones it is really hard to think\u00a0\u00a0 clearly make decisions problem solve do all those\u00a0 things that help us function throughout the day\u00a0\u00a000:49:07<\/a>and interpersonally you know the dsm did note that\u00a0 so i really emphasize and encourage you to think\u00a0\u00a0 about the person as a biopsychosocial being\u00a0 and the impact that these conditions either\u00a0\u00a0 directly or indirectly may have on a person’s\u00a0 quality of life functional neurological symptom\u00a0\u00a000:49:33<\/a>disorder also known as conversion disorder one\u00a0 or more symptoms of altered sensory function or\u00a0\u00a0 voluntary motor function there are no supporting\u00a0 medical findings so the person may be mute\u00a0\u00a0 or may not be able to lift an arm or may\u00a0 not be able to hear or see but there’s\u00a0\u00a000:49:51<\/a>no neurological explanation for it the mri\u00a0 comes back clear it’s not better explained\u00a0\u00a0 by another medical or mental disorder causes\u00a0 clinically significant distress or impairment\u00a0\u00a0 it is important for clinicians mental health\u00a0 clinicians to note that doctors will all often\u00a0\u00a000:50:09<\/a>perform multiple exams to test the dysfunction\u00a0 and look for what they call internal consistency\u00a0\u00a0 so one test for it shows that there is\u00a0 a neurological problem but another test\u00a0\u00a0 of the same issue may show that there’s\u00a0 not a neurological problem and the dsm\u00a0\u00a000:50:32<\/a>goes through different examples of that that’s not\u00a0 something we’re going to get into however again it\u00a0\u00a0 can feel very invalidating for the individual\u00a0 that’s experiencing this neurological symptom subtypes need to be noted it’s\u00a0 either with weakness or paralysis\u00a0\u00a000:50:51<\/a>abnormal movement swallowing issues speech\u00a0 issues and that it can even be mutism\u00a0\u00a0 seizures numbness or sensory loss sensory symptoms\u00a0 or a mixed presentation it is acute if it lasts\u00a0\u00a0 less than six months and persistent if it lasts\u00a0 more than six months and it’s important to specify\u00a0\u00a000:51:13<\/a>with or without psychological stressors this one\u00a0 is pretty straightforward it is often associated\u00a0\u00a0 with dissociative symptoms such as\u00a0 depersonalization derealization and dissociative\u00a0\u00a0 amnesia however the prevalence is thought\u00a0 to be less than one percent risk factors for00:51:38<\/a>functional neurological symptom disorder\u00a0 emotional dysregulation well we see emotional\u00a0\u00a0 dysregulation a lot in people with a history of\u00a0 trauma therefore is it emotional dysregulation\u00a0\u00a0 or the trauma history a history of abuse\u00a0 or neglect well there’s trauma right there\u00a0\u00a000:51:59<\/a>or a presence of a neurological disease that\u00a0 causes similar symptoms so they may have\u00a0\u00a0 for example epilepsy and they may also have\u00a0 non-epileptic seizures instances resembling\u00a0\u00a0 functional neurological and dissociative symptoms\u00a0 are common in certain culturally sanctioned\u00a0\u00a000:52:18<\/a>rituals and would therefore not qualify for fnsd\u00a0 speaking in tongues is one of those examples where\u00a0\u00a0 somebody’s speech gets becomes dysregulated a\u00a0 lot of times they also may faint but that is\u00a0\u00a0 only within the context of the religious\u00a0 ritual it is more common in women and\u00a0\u00a000:52:41<\/a>people with functional neurological symptom\u00a0 disorder have a higher rate of suicidality\u00a0\u00a0 than those with a recognized neurological disease\u00a0 may be due to the perception of hopelessness and\u00a0\u00a0 helplessness if the doctors can’t seem to tell\u00a0 you what’s wrong i don’t know just hypothesizing\u00a0\u00a000:52:59<\/a>functional consequences according to the dsm are\u00a0 simply physical disability however again and we\u00a0\u00a0 don’t have time to really go through it again in\u00a0 this presentation but think about the physical\u00a0\u00a0 affective cognitive and relational impact that\u00a0 having a functional neurological symptom disorder\u00a0\u00a000:53:23<\/a>may have on people remember the fnsd does not have\u00a0 an underlying neurological basis to it so how does\u00a0\u00a0 that impact how do people perceive that how does\u00a0 that impact people’s perception of themselves\u00a0\u00a0 and psychological factors affecting medical\u00a0 conditions a medical condition is present\u00a0\u00a000:53:45<\/a>psychological factors or behaviors that\u00a0 are well established as health risks\u00a0\u00a0 which adversely impact the medical condition\u00a0 by causing exacerbation delayed recovery\u00a0\u00a0 treatment non-compliance or failure to\u00a0 seek treatment so for example people with\u00a0\u00a000:54:04<\/a>high levels of anxiety it may exacerbate their\u00a0 asthma other times people may ignore a heart\u00a0\u00a0 attack because you know they’re they’re avoiding\u00a0 the health system and that could cause them to die\u00a0\u00a0 if not go to the emergency room people who have\u00a0 been diagnosed with diabetes may have a resistance\u00a0\u00a000:54:28<\/a>to that diagnosis either anger about it or what\u00a0 have you and they may engage in behaviors that are\u00a0\u00a0 contrary like eating a lot of sugar additionally\u00a0 anxiety is and and high levels of stress are\u00a0\u00a0 associated with difficulty managing a1c levels\u00a0 so there’s a lot of things that could go here\u00a0\u00a000:54:49<\/a>it’s not better explained by another medical or\u00a0 mental health disorder for example people who are\u00a0\u00a0 um qualify for alcohol use disorder may drink even\u00a0 though they have hepatitis and that is actually\u00a0\u00a0 covered in the diagnostic criteria for addiction\u00a0 continued engagement in behaviors that are00:55:18<\/a>known to cause known to be exacer known to\u00a0 exacerbate medical conditions prevalence\u00a0\u00a0 of is unknown the development of course is unclear\u00a0 quote psychological factors affecting other\u00a0\u00a0 medical conditions must be differentiated\u00a0 from culturally specific coping behaviors\u00a0\u00a000:55:40<\/a>such as accessing faith spiritual or traditional\u00a0 healers or other variations in illness management\u00a0\u00a0 that are acceptable within the cultural context\u00a0 end quote so what they’re saying is if people\u00a0\u00a0 don’t choose to go through traditional western\u00a0 medicine that doesn’t mean that they are having\u00a0\u00a000:55:59<\/a>a psychological issue that’s complicating\u00a0 their medical condition they are following a\u00a0\u00a0 culturally sanctioned treatment path differential\u00a0 diagnosis factors that distinguish somatic symptom\u00a0\u00a0 and related disorders from medical conditions\u00a0 alone include the ineffectiveness of medications\u00a0\u00a000:56:18<\/a>a history of mental disorders thought that\u00a0 was interesting unclear triggers or mitigators\u00a0\u00a0 so there’s no it’s difficult to identify what\u00a0 causes um symptoms and or what makes them better\u00a0\u00a0 persistence over a period of several months\u00a0 or more and excessive anxiety psychological\u00a0\u00a000:56:38<\/a>factors affecting other medical conditions that\u00a0 diagnosis it’s important to recognize that in this\u00a0\u00a0 disorder the psychological presentation\u00a0 is not considered excessive necessarily\u00a0\u00a0 however it negatively impacts treatment or\u00a0 worsens a presenting physical issue okay so00:57:02<\/a>fictitious disorder or malingering we didn’t go\u00a0 over but in in this one the individual presents\u00a0\u00a0 as sick with the intent to deceive they’re\u00a0 faking it functional neurologic symptom disorder\u00a0\u00a0 what used to be called conversion disorder\u00a0 we talked about in this one the presenting\u00a0\u00a000:57:20<\/a>symptom is a loss of function not distress about\u00a0 particular symptoms so there is no neurological\u00a0\u00a0 basis but they have a loss of function in illness\u00a0 anxiety there are few or minimal somatic symptoms\u00a0\u00a0 and the anxiety is only about the illness\u00a0 as opposed to other anxiety disorders\u00a0\u00a000:57:45<\/a>in adjustment disorder a person’s anxiety is\u00a0 clearly related to identified medical conditions\u00a0\u00a0 and does not cause clinically significant\u00a0 impairment and lasts for less than six months panic disorder the physical symptoms or health\u00a0 anxiety occur intermittently and surround the\u00a0\u00a000:58:06<\/a>panic attack um and the episodic and neurological\u00a0 symptoms are not the only symptoms during a\u00a0\u00a0 panic attack so you know you look through the\u00a0 criteria for panic attacks you’ll see there’s\u00a0\u00a0 a host of symptoms um emotional cognitive and\u00a0 physical that need to be present if the person has\u00a0\u00a000:58:28<\/a>generalized anxiety generalized anxiety the worry\u00a0 is about a variety of issues not just their health if the person has depression the focus\u00a0 is on depressed mood and anhedonia not\u00a0\u00a0 the physical symptoms per se or if it\u00a0 is focused on the physical symptoms\u00a0\u00a000:58:50<\/a>this health and health health related stress\u00a0 only occurs during a depressive episode\u00a0\u00a0 they did not specify anything about\u00a0 um persistent depressive disorder\u00a0\u00a0 delusional disorder somatic type the intensity\u00a0 of the conviction about the somatic symptoms\u00a0\u00a000:59:12<\/a>is far greater than in people with somatic symptom\u00a0 disorder so it’s just an intensity type diagnosis\u00a0\u00a0 however sometimes in delusional disorder\u00a0 the delusions may be about something that is objectively not real like an organ is decaying\u00a0 inside them body dysmorphic disorder the focus is\u00a0\u00a000:59:40<\/a>of the distress is on a perceived flaw not getting\u00a0 an illness but on a perceived flaw that they have\u00a0\u00a0 and it usually involves something\u00a0 in the face or upper torso area\u00a0\u00a0 in ocd recurrent thoughts are more\u00a0 intrusive and focused on preventing\u00a0\u00a000:59:56<\/a>getting a disease in the future and\u00a0 there’s a presence of compulsive behaviors\u00a0\u00a0 most of the time with somatic symptom\u00a0 disorder there aren’t the compulsive behaviors\u00a0\u00a0 and the focus is on current symptoms\u00a0 not preventing getting a disease\u00a0\u00a001:00:13<\/a>in psychotic disorders the individual\u00a0 is unable to acknowledge the possibility\u00a0\u00a0 that the feared disease may not be present or the\u00a0 somatic delusions may be more desir more bizarre somatic symptom disorders are frequently\u00a0 comorbid with mood disorders ptsd ocd\u00a0\u00a001:00:35<\/a>sexual dysfunction in men\u00a0 interestingly they were very specific\u00a0\u00a0 um our understanding of many physical disorders\u00a0 is still evolving although known to exist since\u00a0\u00a0 1904 the american college of rheumatology didn’t\u00a0 officially recognize fibromyalgia until 1990.\u00a0\u00a001:00:53<\/a>likewise potts was first described in 1940\u00a0 so i was wrong in my earlier guests it was\u00a0\u00a0 first described in 1940 yet even today many\u00a0 doctors doubt the existence of the disorder\u00a0\u00a0 it is important for us as clinicians to recognize\u00a0 the negative impact of psychological distress on\u00a0\u00a001:01:13<\/a>medical disorders as well as the negative impact\u00a0 of medical disorders on psychological health\u00a0\u00a0 we need to be very careful not to invalidate\u00a0 patient perceptions of their distress\u00a0\u00a0 and instead help them identify strategies\u00a0 to improve their quality of life
Source : Youtube<\/a><\/div><\/div>","protected":false},"excerpt":{"rendered":"

https:\/\/www.youtube.com\/watch?v=hy46OtDsjpIHello everybody and welcome to this week’s ceu\u00a0 class on health anxiety and illness related\u00a0\u00a0 psychological distress in the dsm this is\u00a0 the category of somatic symptom disorders\u00a0\u00a0 i’m your host dr donnelly snipes in this\u00a0 presentation you’re going to learn about\u00a0\u00a000:00:18the category of somatic symptom disorders in the\u00a0 dsm-5tr we’ll explore the diagnostic criteria\u00a0\u00a0 … Continue reading Health Anxiety, and Illness Related Psychological Distress | Somatic Symptom Disorders | DSM 5 TR<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":152200,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[96],"tags":[],"class_list":["post-152199","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tech"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2024\/03\/1709495324-maxresdefault.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/152199","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=152199"}],"version-history":[{"count":0,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/152199\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/152200"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=152199"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=152199"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=152199"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}