Mood Disorders &

Somatic Symptom
and Related
Disorders

Ms. Aysha Nimiya

Assistant Professor of Psychology
SAHS
 CONTENTS
Clinical characteristics, aetiology, diagnosis, and treatment of:

MOOD DISORDERS
1. Unipolar disorders – Persistent depressive disorder (Dysthymia), Major depressive disorder &
Premenstrual dysphoric disorder
2. Bipolar disorders – Cyclothymic disorder, Bipolar I & Bipolar II disorder

SOMATIC SYMPTOM & RELATED DISORDERS

1. Somatic Symptom disorder
2. Pain disorder
3. Factitious disorder
4. Conversion disorder
What are mood disorders?
 Affect Mood
• A short-lived emotional response to an idea or an

event
• A sustained and pervasive emotional response which

• Affect normally results in mood

influences all aspects of mental state

• Can be physiological or psychological

• Mood can cause changes in behaviour

• For e.g., anxious, agitated, irritable, angry, elated,

• Can be positive or negative

euphoric
• For e.g., Happy or Sad

• Objective measure
• Subjective measure
• Mood disorders - fundamental disturbance is a change in mood or affect, usually to depression or to elation

• Most of these disorders tend to be recurrent; onset of individual episodes is often related to stressful events or situations

• The terms “mania” and “depression” are used in this classification to denote the opposite ends of the affective spectrum

• Mood can be labile, fluctuating or alternating rapidly between extremes (e.g., laughing loudly and expansively one moment, tearful
and despairing the next)

• Patients with only major depressive episodes are said to have major depressive disorder or unipolar depression

• Patients with both manic and depressive episodes or patients with manic episodes alone are said to have bipolar disorder
• Other signs and symptoms of mood disorders include changes in activity level, cognitive abilities, speech, and vegetative
functions (e.g., sleep, appetite, sexual activity, and other biological rhythms)

• These disorders virtually always result in impaired interpersonal, social, and occupational functioning
UNIPOLAR DISORDERS
Major depressive disorder (Dysthymia)
Persistent depressive disorder
Premenstrual dysphoric disorder
 Major depressive disorder
Diagnostic criteria (DSM 5 TR)

A. Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from
previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure

1. Depressed mood most of the day, nearly every day

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death or recurrent suicidal ideation

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C. The episode is not attributable to the physiological effects of a substance or another medical condition
D. At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on
schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other
psychotic disorders

E. There has never been a manic episode or a hypomanic episode.

Risk and prognostic factors

Temperamental - Negative affectivity (neuroticism) is a well-established risk factor for the onset of major depressive disorder, and
high levels appear to render individuals more likely to develop depressive episodes in response to stressful life events

Environmental - Adverse childhood experiences, particularly when they are multiple and of diverse types, constitute a set of potent
risk factors for major depressive disorder. Women may be disproportionately at risk for adverse childhood experiences, including
sexual abuse, that may contribute to the increased prevalence of depression in this group. Other social determinants of mental
health, such as low income, limited formal education, racism, and other forms of discrimination, are associated with higher risk of
major depressive disorder. Stressful life events are well recognized as precipitants of major depressive episodes

Genetic and physiological - First-degree family members of individuals with major depressive disorder have a risk for major
depressive disorder two- to fourfold higher than that of the general population

Note: Women may also be at risk for depressive disorders in relation to specific reproductive life stages, including in the
premenstrual period, postpartum, and in perimenopause
 Persistent depressive disorder (Dysthymia)
Diagnostic criteria (DSM 5 TR)

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others,
for at least 2 years

B. Presence, while depressed, of two (or more) of the following:

1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness

C. During the 2-year period of the disturbance, the individual has never been without the symptoms in Criteria A and B for more
than 2 months at a time

D. Criteria for a major depressive disorder may be continuously present for 2 years

E. There has never been a manic episode or a hypomanic episode

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other
specified or unspecified schizophrenia spectrum and other psychotic disorder

G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g., hypothyroidism)

H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Risk and prognostic factors

Temperamental - Negative affectivity (neuroticism) is a well-established risk factor for the onset of major depressive disorder, and
high levels appear to render individuals more likely to develop depressive episodes in response to stressful life events

Environmental - Adverse childhood experiences, particularly when they are multiple and of diverse types, constitute a set of potent
risk factors for major depressive disorder. Women may be disproportionately at risk for adverse childhood experiences, including
sexual abuse, that may contribute to the increased prevalence of depression in this group. Other social determinants of mental
health, such as low income, limited formal education, racism, and other forms of discrimination, are associated with higher risk of
major depressive disorder. Stressful life events are well recognized as precipitants of major depressive episodes

Genetic and physiological - First-degree family members of individuals with major depressive disorder have a risk for major
depressive disorder two- to fourfold higher than that of the general population

Note: Women may also be at risk for depressive disorders in relation to specific reproductive life stages, including in the
premenstrual period, postpartum, and in perimenopause
 Premenstrual dysphoric disorder
Diagnostic criteria (DSM 5 TR)

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to
improve within a few days after the onset of menses, and become minimal or absent in the week postmenses

B. One (or more) of the following symptoms must be present:

1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection)
2. Marked irritability or anger or increased interpersonal conflicts
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.

C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with
symptoms from Criterion B above
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies)
2. Subjective difficulty in concentration
3. Lethargy, easy fatigability, or marked lack of energy
4. Marked change in appetite; overeating; or specific food cravings
5. Hypersomnia or insomnia
6. A sense of being overwhelmed or out of control
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain

D. The symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with
others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home)

E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic
disorder, persistent depressive disorder, or a personality disorder (although it may co-occur with any of these disorders)

F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.

G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other
treatment) or another medical condition (e.g., hyperthyroidism).
Risk and prognostic factors

Environmental - stress, history of interpersonal trauma, seasonal changes, and sociocultural aspects of female sexual behavior in
general, and female gender roles in particular

Genetic & physiological - No studies have examined heritability in premenstrual dysphoric disorder specifically. Estimates for
heritability of premenstrual dysphoric symptoms range between 30% and 80%
BIPOLAR DISORDERS
Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder
 Bipolar I disorder
Diagnostic criteria (DSM 5 TR)

For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode

Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently
increased activity or energy, lasting at least 1 week and present most of the day, nearly every day

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if
the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless
non-goal-directed activity)
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business investments).
 C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to
necessitate hospitalization to prevent harm to self or others, or there are psychotic features

D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment)
or another medical condition

Hypomanic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently
increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day

B. Same as manic episode

C. The episode is associated with a change in functioning that is uncharacteristic of the individual when not symptomatic

D. The disturbance in mood and the change in functioning are observable by others

E. The episode is not severe enough to cause marked impairment in social or occupational functioning

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment)
or another medical condition.
Depressive episode – same criteria as Major Depressive disorder

Bipolar I Disorder

A. Criteria have been met for at least one manic episode (Criteria A–D under “Manic Episode” above)

B. At least one manic episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia,
schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic
disorder
 Bipolar II disorder
Diagnostic criteria (DSM 5 TR)

• For a diagnosis of bipolar II disorder, it is necessary to meet the criteria for a current or past hypomanic episode and the
criteria for a current or past major depressive episode

Bipolar II Disorder

A. Criteria have been met for at least one hypomanic episode (Criteria A–F under “Hypomanic Episode” above) and at least one
major depressive episode (Criteria A–C under “Major Depressive Episode” above)

B. There has never been a manic episode

C. At least one hypomanic episode and at least one major depressive episode are not better explained by schizoaffective disorder
and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder

D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and
hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
 Cyclothymic disorder
Diagnostic criteria (DSM 5 TR)

A. For at least 2 years there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic
episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode

B. During the above 2-year period, Criterion A symptoms have been present for at least half the time and the individual has not
been without the symptoms for more than 2 months at a time

C. Criteria for a major depressive, manic, or hypomanic episode have never been met

D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder

E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism)

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
Risk and prognostic factors

Genetic & physiological - Major depressive disorder, bipolar I disorder, and bipolar II disorder are more common among
first-degree biological relatives of individuals with cyclothymic disorder than in the general population. There may also be an
increased familial risk of substance-related disorders. Cyclothymic disorder may be more common in the first-degree biological
relatives of individuals with bipolar I disorder than in the general population.
 Theories of Depression
Biochemical Theory

• The mono amine hypothesis - abnormality in the monoamine [catecholamine (norepinephrine and dopamine) and
serotonin] system in the central nervous system at one or more sites

• Functional increase in amines in mania and decrease in depression

• Reduction in hippocampal and caudate nucleus size and an increase in pituitary volume

Psychodynamic Theory

• View depression in terms of inwardly directed anger, loss of self-esteem or self-worth, egotistic or excessive narcissistic or
personality demand, or deprivation in mother-child relationship (loss or rejection by a parent) – introjection of loss of a
libidinal object

• Argues that people prone to depression have an excessively high interpersonal dependency

• Mania – liberation from suffering imposed by the ego

 Theories of Depression
Behavioral Theory

• Considers the cause of depression to be the removal of positive reinforcement from the environment

• Fail to consider the influence of thought (cognition) on mood

Theory of Learned Helplessness

• Developed by Martin Seligman

• Phenomenon observed in both humans and other animals when they have been conditioned to expect pain, suffering, or
discomfort without a way to escape it (Cherry, 2017)

• Eventually, after enough conditioning, the animal will stop trying to avoid the pain at all—even if there is an opportunity to
truly escape it

• Universal helplessness vs Personal helplessness

 Theories of Depression
Cognitive Theory

• Consider the way people think about and process personal information, by focusing on core beliefs, underlying
assumptions and systematic negative bias in thinking

• Aaron Beck (1967) proposed three mechanisms underlying the ‘negative appraisal’ of events in depression: the cognitive
triad (negative automatic thinking), negative self schemas and errors in logic (altered processing of information)
TREATMENT FOR DEPRESSIVE
AND BIPOLAR DISORDERS
• Cognitive behavioral therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of
depressive disorders

• Aims to reduce negative or unhelpful thoughts and behaviors common in those with depression through practical
problem-solving and homework assignments

• Cognitive methods – to change depressive thinking patterns

• Behavioural methods – to improve energy and motivation

Beck’s Cognitive Triad Model

 • Depression typically involves a negative view of oneself, the world and the future

• Cognitive distortions are characteristic of depression. These include:

1. Dichotomous/All-or-Nothing thinking - Looking at things in absolute (‘black or white’) categories with no middle ground

2. Overgeneralization - Generalizing from a single negative experience and viewing this as a never-ending pattern of defeat

3. Mental filtering - Dwelling on the negatives, filtering out the positives

4. Disqualifying/discounting positives - Rejecting positive experiences, qualities or accomplishments, insisting that they
‘don’t count’

5. Jumping to conclusions - Drawing negative conclusions even though there is insufficient evidence or not warranted by
facts

6. Magnifying or minimizing - Blowing things out of proportion or shrinking their importance

7. Emotional reasoning - Reasoning from one’s subjective feelings

8. Catastrophizing - Assuming extreme and horrible consequences of events

9. ‘Should’ statements - Holding oneself and others to strict rules of what should and shouldn’t (‘ought’, ‘must’ or ‘have to’)
be done

10. Labelling - Labelling yourself based on mistakes and perceived shortcomings

11. Personalization - Assuming responsibility for things that are beyond one’s control
7 Common CBT techniques for depression

1. Cognitive restructuring - helps form healthier patterns, reduce cognitive errors, and practice ways to rationalize distortions
and untrue beliefs

2. Activity scheduling - rewarding oneself for scheduling activities that encourage positive regard and self-care

3. Thought Journaling - exploring things like emotions, thoughts, and behaviors, you create a space to process and identify
any potential triggers

4. ABC analysis - focused on breaking down the behaviors that are related to depression

5. Fact checking - encourages patients to review your thoughts and understand that, while you may be stuck in a depressive
or harmful thought pattern

6. Successive Approximation or “Breaking It Down” - Breaking down large tasks into smaller goals will help feel less
overwhelmed

7. Mindful Meditation - learn to reduce focus on negative thoughts and increase ability to remain in the present
Treatment for Mania

• The goals of treatment of an acute manic or mixed episode are to alleviate symptoms and allow a return to usual levels of
psychosocial functioning

• Pharmacological treatment of acute mania - The most widely used medications in the acute setting are
1. lithium,
2. some anticonvulsants (valproate, carbamazepine),
3. standard antipsychotics (eg, haloperidol, chlorpromazine),
4. atypical antipsychotics (eg, quetiapine, olanzapine, risperidone, ziprasidone, aripiprazole, clozapine), and
5. benzodiazepines (eg, lorazepam, clonazepam)

• In severe cases, ECT is used

SOMATIC SYMPTOM AND RELATED
DISORDERS
Somatic Symptom Disorder
Illness Anxiety Disorder
Functional Neurological Symptom Disorder (Conversion Disorder)
Factitious Disorder
WHAT ARE SOMATIC DISORDERS?
• The prominence of somatic symptoms and/or illness anxiety associated with significant distress and impairment

• Diagnosis is made based on the presence of symptoms and rather than the absence of a medical explanation for somatic symptoms

• A distinctive characteristic of many individuals with somatic symptom disorder is not the somatic symptoms per se, but instead the
way they present and interpret them

• Individuals with disorders with prominent somatic symptoms are commonly encountered in primary care and other medical settings
but are less commonly encountered in psychiatric and other mental health settings

• Incorporating affective, cognitive, and behavioral components into the criteria provides a more comprehensive and accurate
reflection of the true clinical picture than can be achieved by assessing the somatic complaints alone
 Somatic Symptom Disorder
Diagnostic criteria (DSM 5 TR)

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 or associated health concerns as manifested by at
least one of the following:

1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

2. Persistently high level of anxiety about health or symptoms.
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 more
than 6 months).

Specify if: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms
predominantly involve pain

Specify if: Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6
months).
Specify current severity:

Mild: Only one of the symptoms specified in Criterion B is fulfilled.

Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.

Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very

severe somatic symptom).

Risk and prognostic factors

Temperamental - The personality trait of negative affectivity (neuroticism) has been identified as an independent correlate/risk
factor of a high number of somatic symptoms.

Environmental - Somatic symptom disorder is more frequent in individuals with few years of education and low socioeconomic
status, and in those who have recently experienced stressful or health-related life events. Early lifetime adversity such as childhood
sexual abuse is also likely a risk factor for somatic symptom disorder in adults.

Course modifiers - Persistent somatic symptoms are associated with demographic features (women, older age, fewer years of
education, lower socioeconomic status, unemployment), a reported history of sexual abuse or other childhood adversity, concurrent
chronic physical illness or mental disorder (depression, anxiety, persistent depressive disorder, panic), social stress, and reinforcing
social factors such as illness benefits

Cognitive factors that affect clinical course include sensitization to pain, heightened attention to bodily sensations, and attribution
of bodily symptoms to a possible medical illness rather than recognizing them as a normal phenomenon or psychological stress.
 Illness Anxiety Disorder

Diagnostic criteria (DSM 5 TR)

A. Preoccupation with having or acquiring a serious illness

B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a
high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or
disproportionate

C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status

D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or
exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals)

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of
time

F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic
disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder,
somatic type.
Specify whether:

Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.

Care-avoidant type: Medical care is rarely used.

Risk and prognostic factors

Environmental - Illness anxiety disorder may sometimes be precipitated by a major life stress or a serious but ultimately benign
threat to the individual’s health. A history of childhood abuse or of a serious childhood illness, serious illness in a parent, or death
of an ill parent during childhood may predispose to development of the disorder in adulthood

Course modifiers - Approximately one-third to one-half of individuals with illness anxiety disorder have a transient form, which is
associated with less psychiatric comorbidity, more medical comorbidity, and less severe illness anxiety disorder.
 Functional Neurological Symptom Disorder (Conversion Disorder)

Diagnostic criteria (DSM 5 TR)

A. One or more symptoms of altered voluntary motor or sensory function

B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
C. The symptom or deficit is not better explained by another medical or mental disorder
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of
functioning or warrants medical evaluation.

Specify symptom type:

F44.4 With weakness or paralysis
F44.4 With abnormal movement (e.g., tremor, dystonia, myoclonus, gait disorder)
F44.4 With swallowing symptoms
F44.4 With speech symptom (e.g., dysphonia, slurred speech)
F44.5 With attacks or seizures
F44.6 With anesthesia or sensory loss
F44.6 With special sensory symptom (e.g., visual, olfactory, or hearing disturbance)
F44.7 With mixed symptoms

Specify if:
Acute episode: Symptoms present for less than 6 months
Persistent: Symptoms occurring for 6 months or more
Risk and prognostic factors

Temperamental – Maladaptive personality traits, especially emotional instability, are commonly associated with functional
neurological symptom disorder

Environmental – There may be a history of childhood abuse and neglect. Stressful life events including physical injury are common
but not universal triggering factors.

Genetic and Physiological - The presence of neurological disease that causes similar symptoms is a risk factor (e.g., around one in
five individuals with functional [nonepileptic] seizures also have epilepsy).

Course modifiers - Short duration of symptoms and agreement with the diagnosis are positive prognostic factors. Maladaptive
personality traits, the presence of comorbid physical disease, and the receipt of disability benefits appear to be negative prognostic
factors
 Factitious Disorder

Diagnostic criteria (DSM 5 TR)

Factitious Disorder Imposed on Self

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified
deception
B. The individual presents himself or herself to others as ill, impaired, or injured
C. The deceptive behavior is evident even in the absence of obvious external rewards
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder

Specify:
Single episode
Recurrent episodes (two or more events of falsification of illness and/or induction of injury)

Factitious Disorder Imposed on Another

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with
identified deception.
B. The individual presents another individual (victim) to others as ill, impaired, or injured
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder
 Theories of Somatic & Related Disorders

Psychodynamic Theory

• Suggests that somatic symptoms present as a response against unconscious emotional issues. Two factors initiate and
maintain somatic symptoms: primary gain and secondary gain

• Primary gains produce internal motivators, whereas secondary gains produce external motivators

Cognitive theory

• Believe that somatic disorders are a result of negative beliefs or exaggerated fears of physiological sensations

• Individuals with somatic related disorders may have a heightened sensitivity to bodily sensations

• This sensitivity, combined with their maladaptive thought patterns, may lead individuals to overanalyze and interpret their
physiological symptoms in a negative light
Behavioural Theory

• Propose that somatic disorders are developed and maintained by reinforcers

• More specifically, individuals experiencing significant somatic symptoms are often rewarded by gaining attention from
other people

Sociocultural theory

• Familial influence that likely plays a significant role in the attention to somatic symptoms

• Culturally, Western countries express less of a focus on somatic complaints compared to those in the Eastern part of the
world
TREATMENT FOR SOMATIC
AND RELATED DISORDERS
THE RELATIONSHIP BETWEEN
PSYCHE AND BODY
SIMPLE CBT MODEL
CBT MODEL – SOMATIC AND RELATED DISORDERS
 Cognitive strategies

• Thoughts about symptoms that, if true, are very scary

• The problem is that very often the thoughts are not accurate

• Patients need to learn to take a step back and evaluate thoughts for accuracy

Common thinking errors include:

Probability Overestimation-overestimating the danger

Catastrophizing- assuming the worst possible outcome is the one that is going to happen

Fortune Telling- thinking that one can predict the future

Situation: Notice abdominal pain

Automatic Thought: This must be a sign of a serious problem

Interpretation: I’m probably going to die from cancer or another serious illness

Emotion: Anxiety

Safety behaviors: Look on internet, ask others for reassurance, go to doctor often, insist on multiple diagnostic tests

Rational Response: This is just a thought. There are many reasons why I could be having abdominal pain. I just ate a big, spicy
meal—it could be mild indigestion
 Behavioural strategies

• The primary intervention is essentially exposure and response prevention (ERP), but it looks a little different than the ERP done
with OCD patients

• Identification of safety behaviours - Seeking reassurance from family members, friends or doctors searching for information on
the internet, monitoring physical symptoms, requesting unnecessary tests, following rigid rules about diet, exercise or other
health behaviors

• Anxiety hierarchy - Need to understand what patient is avoiding and why in order to create effective hierarchy
THANK YOU