Day # 117: Intro to Psychosomatic and Functional Disorders

If you are following along in the suggested curriculum you have now finished the first eight themes (psychotic disorders, depressive disorders, bipolar disorder, anxiety disorders, emergency psychiatry, OCD and related disorders, trauma/stressor related disorders, and dissociative disorder). Nice work!

We will now begin the ninth theme in the Bullet Psych curriculum which is psychosomatic disorders. Today we will provide a brief overview of these disorders and in the coming posts we will cover each disorder in detail.

Today's Content Level: Beginner; Intermediate (Review)

WHAT DOES PSYCHOSOMATIC MEAN? 1

•Psycoysomatic = greek for psyche (soul) and soma (body). The term literally refers to how the mind affects the body.

•Other related terms include functional disorders and somatoform disorders.

•Generally, these terms refer to a group of disorders which have manifestations of physical or neurological symptoms which cannot be fully explained by a general medical or neurological condition and are not attributable to another psychiatric disorder.

•Unfortunately, these words are sometimes used by the lay public and even ill-informed medical professions to label certain medical complaints as “all in your head”

•Relevant journals and academic societies in this field include Psychosomatic Medicine, Psychsomatics, Journal of Psychosomatic Research, The Academy of Psychosomatic Medicine, and The American Psychosomatic Society.

MEDICAL ILLNESS AND PSYCHIATRIC COMORBIDITY 2

•In the next section we will discuss specific psychosomatic disorders, however it is important to generally discuss the impacts of psychiatric comorbidity and its impact on other medical conditions.

•Psychiatric comorbidity has serious effects on medically ill patients and is often a risk factor for other medical conditions.

•Influential psychological or behavioral factors may include depression, low motivation, anxiety, distress, poor coping styles, impulsivity, disorganized behaviors or thought process, maladaptive health behaviors, substance use, and more.

•Psychiatric illness and behavioral factors may adversely affect the medical condition in a number of ways such as influencing denying or delaying treatment, forgetting to take medications, skew symptom reporting, and more.

•Well-researched examples include worse outcomes in cardiac morbidity, mortality in patients with a history of myocardial infarction, diminished glycemic control in patients with diabetes, worse disability outcomes and institutionalization in patients with stroke and major neurocognitive disease.

OVERVIEW OF PSYCHOSOMATIC DISORDERS 3

We will now provide a brief overview of the functional and somatoform disorders in the DSM-5. During subsequent posts we will cover each of these disorders in depth to include their diagnostic criteria, epidemiology, work-up, differential diagnosis, and treatment.

• Illness Anxiety Disorder: patients have high levels of anxiety and preoccupation with having or acquiring a serious illness, however somatic symptoms are not present or mild in intensity.

• Somatic Symptom Disorder: patients have one or more somatic symptoms that are distressing or result in significant disruption. Patients believe they are ill and do not intentionally produce or feign symptoms.

• Functional Neurologic Disorder: Patient experiences at least one symptom of altered voluntary motor or sensory function and clinical findings are incompatible with recognized neurologic or medical conditions. This is also known as conversion disorder.

• Factitious Disorder: Patients intentionally produce symptoms of a psychological or physical illness because of a desire to assume the sick role, not for external rewards.

• Malingering: Patients intentionally produce or feign symptoms for external rewards (food, shelter, medications, avoid legal consequences, etc...). This is not technically a psychosomatic disorder, however it is included in this section for easy comparison to factitious disorder.

• Psychological factors affecting other medical conditions

• Unspecified / Other specified somatic symptom and related disorder

• Bonus: Later in this theme we will also discuss related disorders including chronic pain syndrome, fibromyalgia, and chronic fatigue syndrome.

CONCLUSION

This post should be a review for intermediate learners, but hopefully this provided a helpful overview of psychosomatic disorders for beginners. Next post we will discuss illness anxiety disorder in more detail.

Resources used today include Kaplan & Saddock’s Synopsis of Psychiatry, Pocket DSM-V, and First Aid for the Psychiatry Clerkship.

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