Psychosomatic Disorders

Psychosomatic Basics - Mind-Body Tango

• Psychosomatic Disorders: Genuine physical illnesses where psychological factors (stress, emotions) significantly influence onset, severity, or course. Not feigned.
• Mind-Body Interaction: Bidirectional; psychological distress impacts physiological processes via neuroendocrine, autonomic, and immune pathways.
• Key Concepts:
  • Stress: Central trigger/exacerbator.
  • Coping Styles: Adaptive (e.g., problem-solving) vs. maladaptive (e.g., denial) impact.
  • Alexithymia: Difficulty identifying/expressing emotions, often present.
  • Personality Traits: e.g., Type A, neuroticism can ↑ vulnerability.

⭐ The Biopsychosocial Model (Engel) is fundamental to understanding psychosomatic disorders, emphasizing interplay of biological, psychological, and social factors.

Somatic Symptom & Related - The Body's Voice

• Core: Distressing somatic symptoms + excessive thoughts, feelings, behaviors. Focus: patient's reaction.

Somatic Symptom Disorder (SSD)

• One+ distressing somatic symptoms.
• Excessive thoughts/feelings/behaviors re: symptoms (e.g., high anxiety, much time/energy).
• Persistent (typically >6 months).
• Specify: predominant pain, persistent, severity.

Illness Anxiety Disorder (IAD)

• Preoccupation with having/acquiring serious illness.
• Somatic symptoms: absent or mild.
• High health anxiety; excessive health behaviors (checking) or maladaptive avoidance (avoids MDs).
• Preoccupation ≥6 months (illness feared may change).
• Specify: care-seeking or care-avoidant type.

Conversion & Factitious - Unconscious & Deceptive

• Conversion Disorder (Functional Neurological Symptom Disorder)
  • Unconscious production of neurological symptoms (e.g., weakness, paralysis, sensory loss, non-epileptic seizures).
  • Incompatibility between symptom and recognized neurological/medical conditions.
  • Motivation: Unconscious (primary gain - internal conflict resolution).
  • La belle indifférence may be present.
  • 📌 Mnemonic: 'Can't walk, Can't talk, Can't see, but no organic cause to decree.'
• Factitious Disorder
  • Intentional feigning of physical/psychological signs/symptoms.
  • Motivation: Unconscious desire to assume the "sick role".
  • No obvious external incentives.
  • Can be imposed on self or another (by proxy).
• Differentiating from Malingering:
  • Malingering: Conscious feigning for clear external gain (e.g., financial, avoiding duty). Not a mental disorder.

⭐ Factitious Disorder Imposed on Another (FDIA), previously Munchausen by proxy, is a form of abuse where a caregiver feigns or induces illness in a dependent.

Assessment & Management - Healing the Whole

• Comprehensive Assessment:
  • Thorough medical & psychiatric history; rule out organic pathology. Emphasize patient validation.
  • Psychological evaluation: stressors, coping mechanisms, personality traits.
  • Standardized tools: e.g., PHQ-15, GAD-7.
• Multimodal Management (MDT Approach):
  • Build strong therapeutic alliance.
  • Psychoeducation: Explain mind-body connection.
  • Psychotherapy:
    • CBT (Cognitive Behavioral Therapy) - core strategy.
    • Supportive, IPT, Mindfulness-Based Stress Reduction (MBSR).
  • Pharmacotherapy: For comorbid anxiety/depression (e.g., SSRIs).
  • Lifestyle modifications & stress reduction techniques.
  • Regular follow-up and collaborative care.

⭐ CBT is highly effective for psychosomatic disorders, targeting maladaptive thoughts and behaviors concerning physical symptoms.

High‑Yield Points - ⚡ Biggest Takeaways

• Psychosomatic disorders: genuine physical symptoms significantly influenced by psychological factors.
• Key distinction: Conversion disorder shows neurological symptoms without a neurological basis.
• Factitious disorder: intentional feigning of symptoms for the sick role; no external incentives.
• Malingering: intentional feigning for external gain; not a mental disorder.
• Somatic Symptom Disorder: distressing somatic symptoms plus excessive thoughts/feelings/behaviors.
• Management: biopsychosocial approach; address stress and underlying psychological issues.