SSRD

• Somatic Symptom and Related Disorders (SSRD)


  Based on DSM-5, examples include Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder/Functional Neurological Disorder, Factitious Disorder, and Psychological Factors Affecting Other Medical Conditions
• Illness


  A cluster of symptoms with a specific (organic) cause, defined course, and specific outcome
• Symptom


  Can be part of a disease, disorder, illness, or sickness
• Psychological Disorder


  A syndrome characterized by a cluster of symptoms that occur together more often than expected by chance, representing non-normal behavior or experiences, and clearly defined and distinguishable from other clusters
• Biopsychosocial Model


  • Integrates biological, psychological, and social aspects of illness, suggesting illness is a result of interactions between these factors
  • Includes predisposing, precipitating, perpetuating, and protective factors
• Somatic Symptom Disorder (SSD)


  One or more somatic symptoms that are distressing or disruptive, with excessive thoughts, feelings, or behaviors related to symptoms, present for more than 6 months
• Illness Anxiety Disorder (IAD)


  Preoccupation with having or acquiring a serious illness, with somatic symptoms being mild or absent, high level of anxiety about health, and excessive health-related behaviors or avoidance of medical care, present for at least 6 months
• Conversion Disorder/Functional Neurological Disorder (FND)


  Symptoms of altered voluntary motor or sensory function (can also include cognitive symptoms), with incompatibility between symptoms and recognized neurological or medical conditions, and symptoms not better explained by another medical or mental disorder
• Factitious Disorder


  Falsification of symptoms or induction of injury or disease with intentional deception, with motivation being to become a patient, not for external rewards, including Munchausen syndrome (imposed on self) and Munchausen syndrome by proxy (imposed on another)
• Psychological Factors Affecting Other Medical Conditions

  Medical symptom or condition present, with psychological or behavioral factors negatively impacting the medical condition
• Prevalence of SSRD


  • SSD: Estimated 5-7%
  • IAD: Prevalence still unknown
  • Conversion Disorder/FND: Prevalence still under investigation
  • MUSS/FSD/PPS ("Medically Unexplained Somatic Symptoms"): 20-26% in the general population, most common symptoms being headache, backache, joint pain, stomach ache, fatigue, nausea
• High comorbidity with psychological disorders (anxiety, depression)
• The "R" in SSRD

  Focus on the role of psychological factors in somatic symptom development and maintenance
• The "SSRD" Patient


  • Often have a long history of seeking answers, may distrust health care and clinicians, high self-criticism, perfectionism, and competitiveness, more common in women, may have traumatic experiences, difficulty with mentalization (understanding the mental states underlying behavior)
• Psychodynamic Theory


  • Emphasizes unconscious psychological factors affecting somatic symptoms, limited direct evidence supporting this theory
• Cognitive Behavioral Theory


  • Focuses on the rewarding nature of somatic symptoms, limited support for the "reward" aspect, alternative view: symptoms may serve a communication function
• Cultural-Oriented Theory


  • Cultures influence how individuals express emotions somatically, industrialized countries tend to pathologize somatic expression of emotion, some cultures are more likely to express emotions through physical symptoms
• Behavioral Inhibition System (BIS)


  Responsible for anxiety and fear
• Behavioral Activation System (BAS)


  Responsible for approach behavior and reward seeking
• Fight-Flight-Freeze System (FFFS)


  Responsible for responding to immediate threats
• Center for Body, Mind and Health (CLGG)

  • Excellence center for tertiary care specializing in SSRD, using a multidisciplinary team approach and personalized treatment based on individual needs
• Treatment Interventions


  • Cognitive Behavioral Therapy (CBT)
  • Psychopharmacology
  • Graded Physical Activity
  • Relaxation Training
  • Concentration Training
  • PMT (Psychotherapeutic Mentalization Treatment)