SOMATIC SYMPTOM DISORDER WHAT YOU NEED TO KNOW

SOMATIC SYMPTOM DISORDER: WHAT YOU NEED TO KNOW Kunal K. Patra, MD Diplomate American Board Of Psychiatry and Neurology 1 Psychiatry P. C. Medical-Legal Services HUB Tower, 699 Walnut Street, Suite 400, Des Moines, IA 50309 211 Sioux Point Road, Suite 300, Dakota Dunes, SD 57049 1 PSYCHIATRY 211@GMAIL. COM

QUESTION: DO YOU HAVE A DIAGNOSIS RELATED TO CLIENT’S COMPLAINTS? Expert Response: Client has Somatic Symptom Disorder, Persistent, Moderate. Our opinion is based on the fact that she was likely to exaggerate minor ailments, enjoy the role of being ill, and has a prolonged recovery time from any particular illness, thus resulting in additional medical costs. Furthermore, we now feel this is her primary problem which in turn drives the depression and anxiety symptoms as they wax and wane.

OH GOD! MY CLIENT HAS BEEN DIAGNOSED WITH SOMATIC SYMPTOM DISORDER. NOW WHAT? • Is she faking it then?

PROMINENCE OF SOMATIC SYMPTOMS ASSOCIATED WITH SIGNIFICANT DISTRESS AND IMPAIRMENT Incorporating a) Cognitive component b) Affective component c) Behavioral component into the criteria for somatic symptom disorder provides a more comprehensive and accurate reflection of the true clinical picture.

DSM-5 DIAGNOSTIC CRITERIA A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about seriousness of symptoms. 2. Persistently high level of anxiety about symptoms or health. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically longer than 6 months).

IMPORTANT DISTINCTION • DSM-IV Criteria overemphasized the centrality of medically unexplained symptoms. • Individuals with somatic symptom disorder actually experience and do not simulate the symptoms they report. • Somatic symptom disorder can accompany diagnosed medical disorders.

DIAGNOSES: THINGS ARE NOT ALWAYS AS THEY SEEM! • Anxiety disorders and depressive disorders may accompany somatic symptoms. • Somatic component adds severity and complexity to depressive and anxiety disorders.

BIOPSYCHOSOCIAL MODEL Genetic and Biological Vulnerability Early Traumatic Experiences Cultural & Social Norms Learning Model

IS SHE FAKING IT THEN? Factitious Disorder Malingering

TAKE HOME MESSAGE Physical symptoms Significant concerns Avoidance behavior Anxiety and depression