SOMATIC SYMPTOM
DISORDER/CONVERSION DISORDER:
PSYCHOPATHOLOGY & DIAGNOSIS FOR
SOCIAL WORK PRACTICE
The Case of Jennifer Brea
By: Cynthia Blevins
Client Description & Problem
Client Proxy: Jennifer Brea
Ø
Ø
Ø
Ø
Role within her family system: Wife
33 years old
Suffers from myalgic encephalomyelitis (chronic fatigue syndrome)
Psychiatrist doesn’t feel anything wrong, but Primary Care diagnosed with Conversion Disorder/
Somatic symptom disorder
Ø Illness has impaired ability to perform normal activities
Jennifer Brea: Meeting with the Client
Engagement skills with client
Ø
Ø
Ø
Ø
Ø
Ø
Empathy
Compassion
Reflective listening
Focus on your feelings and be cognizant of your reactions.
Monitor your own feelings of defensiveness, impatience, frustration, or anger toward the client.
Practice increased self-awareness.
Client symptoms
Ø
Ø
Ø
Ø
Ø
Paralysis
Fevers
Sore throats
Sinus infection
Gastrointestinal
Client Reassurance
Ø Client must be reassured we believe her and understand she is in no way:
Ø Malingering
Ø
Ø
Symptoms are consciously produced or feigned
Have various motivations, including financial gain, relief of work duties, or obtaining illicit drugs
Ø Factitious Disorder
Jennifer Brea: Multidisciplinary
Approach
Multidisciplinary Approach to the Problem:
Ø
Ø
Ø
Ø
Social Worker
Neurologist
Husband
Mental Health Professionals
Ø Psychiatrist
Ø Medical Social Worker
Ø Case Manager
Ø Home Health Care Nurse
Jennifer
Conversion
Disorder
Somatic Symptom
DIsorder
Neurologist
Autoimmune
Disease
Nrurology
Treatment
Social Worker
Social Service
Support
Individual
Counseling
Family Counseling
Husband
Family
Support
Caretaker
Jennifer Brea: Biopsychosocial Approach
Jennifer is cognizant of her condition and the limitations she has encountered based upon the
onset of her illness. As I reviewed the case of Jennifer Brea and looked at her case from a
biopsychosocial perspective, I have to consider biological, psychological, and social factors and
their complex interactions in understanding health, illness, and health care delivery.
Ø
Ø
Ø
Ø
Ø
Ø
Client has some undisclosed issues that stem from her childhood that could be triggers
Ø Counseling is needed to address these issues that could be impacting her recovery
Client has a supportive husband
Client doesn’t have the trust and confidence in her previous psychologist who doesn’t think
she has conversion disorder
Social and cultural factors are conceptualized as a particular set of stressful events (that
can differentially impact mental health depending on the individual and his or her social
context.
Humanistic theorists view the client in context to what is happening at the time
Ø Client was attending Harvard PhD program at the onset of her paralysis
Life stressors like marital or work issues are precipitants for somatic symptoms
Ø Client was attending school and was engaged to be married
Jennifer Brea: Long-term Stabilization
Approach
Ø
Cognitive-behavioral Therapy
Ø
CBT has been mentioned as an efficacious treatment for the range of the
conditions loosely grouped under Somatic Symptom and Related Disorders.
Randomized controlled clinical trials found that conversion disorder can
be successfully treated with CBT which included the modification of
catastrophic cognitions and inappropriate behaviors. A study conducted
in Bangladesh showed CBT to be effective in treating general conversion
disorder
Ø Long-term management involves interrupting perpetuating factors
Ø Maintaining the same doctor
Ø Implementing Strategies for:
Ø
Ø
Ø
Ø
Self-efficacy
distress tolerance
Coping
Modulating the interaction of anxiety, stress, and physical symptoms
Controversy in Diagnosing Mental
Disorders
Issues with DSM-5
Issues with Diagnosing Mental Disorders
Ø The manual's shortcomings include its lack of scientifically
conclusive field testing of some of its recommendations
Ø Everyone seems to have bipolar disorder without ever
having a manic experience
Ø Failure to consider the prior effectiveness or ineffectiveness
of anti-psychotic drugs to determine a patient's present
diagnosis
Ø An increasing number of primary care and other
nonpsychiatric doctors are dispensing anti-psychotic
drugs, despite their lack of training in that area of
medicine.
Ø Lumping of, for example, what had been a spectrum of
depressions -- from the mildly melancholic to the severely
debilitating -- into one group
Ø DSM-5 would mislabel one in four people with chronic pain
and irritable bowel syndrome with the DSM-5's newly created
"somatic symptom disorder," which is diagnosed when a
person has spent at least six months steadily thinking of and
being anxious about their medical illness.
Ø Aggressive sales and marketing by pharmaceutical
companies may also be driving the surge in diagnosing
mental disorders
Questions?
References
American Psychiatric Association. (2013p). Somatic symptom and related disorders. In Diagnostic and statistical
manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09
TED Conferences, LLC (Producer). (2016). What happens when you have a disease doctor’s can’t diagnose [Video
file]. Retrieved from
https://www.ted.com/talks/jen_brea_what_happens_when_you_have_a_disease_doctors_can_t_diagnose
Soares ND, Grossman L: Somatoform disorder: conversion. 2005; Retrieved on 09.03.06 from:
http://www.emedicaine.com/ped/topic2780.htm.
Goldstein LH, Deale AC, Mitchell-O’Malley SJ, Toone BK, Mellers JDC: An evaluation of cognitive-behavioural therapy as
a treatment for dissociative seizures: a pilot study. Cogn Behav Neurol; 2004; 17(1): 41 – 49.
SOMATIC SYMPTOM
DISORDER/CONVERSION DISORDER:
PSYCHOPATHOLOGY & DIAGNOSIS FOR
SOCIAL WORK PRACTICE
The Case of Jennifer Brea
By: Cynthia Blevins
Client Description & Problem
Client Proxy: Jennifer Brea
Ø
Ø
Ø
Ø
Role within her family system: Wife
33 years old
Suffers from myalgic encephalomyelitis (chronic fatigue syndrome)
Psychiatrist doesn’t feel anything wrong, but Primary Care diagnosed with Conversion Disorder/
Somatic symptom disorder
Ø Illness has impaired ability to perform normal activities
Jennifer Brea: Meeting with the Client
Engagement skills with client
Ø
Ø
Ø
Ø
Ø
Ø
Empathy
Compassion
Reflective listening
Focus on your feelings and be cognizant of your reactions.
Monitor your own feelings of defensiveness, impatience, frustration, or anger toward the client.
Practice increased self-awareness.
Client symptoms
Ø
Ø
Ø
Ø
Ø
Paralysis
Fevers
Sore throats
Sinus infection
Gastrointestinal
Client Reassurance
Ø Client must be reassured we believe her and understand she is in no way:
Ø Malingering
Ø
Ø
Symptoms are consciously produced or feigned
Have various motivations, including financial gain, relief of work duties, or obtaining illicit drugs
Ø Factitious Disorder
Jennifer Brea: Multidisciplinary
Approach
Multidisciplinary Approach to the Problem:
Ø
Ø
Ø
Ø
Social Worker
Neurologist
Husband
Mental Health Professionals
Ø Psychiatrist
Ø Medical Social Worker
Ø Case Manager
Ø Home Health Care Nurse
Jennifer
Conversion
Disorder
Somatic Symptom
DIsorder
Neurologist
Autoimmune
Disease
Nrurology
Treatment
Social Worker
Social Service
Support
Individual
Counseling
Family Counseling
Husband
Family
Support
Caretaker
Jennifer Brea: Biopsychosocial Approach
Jennifer is cognizant of her condition and the limitations she has encountered based upon the
onset of her illness. As I reviewed the case of Jennifer Brea and looked at her case from a
biopsychosocial perspective, I have to consider biological, psychological, and social factors and
their complex interactions in understanding health, illness, and health care delivery.
Ø
Ø
Ø
Ø
Ø
Ø
Client has some undisclosed issues that stem from her childhood that could be triggers
Ø Counseling is needed to address these issues that could be impacting her recovery
Client has a supportive husband
Client doesn’t have the trust and confidence in her previous psychologist who doesn’t think
she has conversion disorder
Social and cultural factors are conceptualized as a particular set of stressful events (that
can differentially impact mental health depending on the individual and his or her social
context.
Humanistic theorists view the client in context to what is happening at the time
Ø Client was attending Harvard PhD program at the onset of her paralysis
Life stressors like marital or work issues are precipitants for somatic symptoms
Ø Client was attending school and was engaged to be married
Jennifer Brea: Long-term Stabilization
Approach
Ø
Cognitive-behavioral Therapy
Ø
CBT has been mentioned as an efficacious treatment for the range of the
conditions loosely grouped under Somatic Symptom and Related Disorders.
Randomized controlled clinical trials found that conversion disorder can
be successfully treated with CBT which included the modification of
catastrophic cognitions and inappropriate behaviors. A study conducted
in Bangladesh showed CBT to be effective in treating general conversion
disorder
Ø Long-term management involves interrupting perpetuating factors
Ø Maintaining the same doctor
Ø Implementing Strategies for:
Ø
Ø
Ø
Ø
Self-efficacy
distress tolerance
Coping
Modulating the interaction of anxiety, stress, and physical symptoms
Controversy in Diagnosing Mental
Disorders
Issues with DSM-5
Issues with Diagnosing Mental Disorders
Ø The manual's shortcomings include its lack of scientifically
conclusive field testing of some of its recommendations
Ø Everyone seems to have bipolar disorder without ever
having a manic experience
Ø Failure to consider the prior effectiveness or ineffectiveness
of anti-psychotic drugs to determine a patient's present
diagnosis
Ø An increasing number of primary care and other
nonpsychiatric doctors are dispensing anti-psychotic
drugs, despite their lack of training in that area of
medicine.
Ø Lumping of, for example, what had been a spectrum of
depressions -- from the mildly melancholic to the severely
debilitating -- into one group
Ø DSM-5 would mislabel one in four people with chronic pain
and irritable bowel syndrome with the DSM-5's newly created
"somatic symptom disorder," which is diagnosed when a
person has spent at least six months steadily thinking of and
being anxious about their medical illness.
Ø Aggressive sales and marketing by pharmaceutical
companies may also be driving the surge in diagnosing
mental disorders
Questions?
References
American Psychiatric Association. (2013p). Somatic symptom and related disorders. In Diagnostic and statistical
manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09
TED Conferences, LLC (Producer). (2016). What happens when you have a disease doctor’s can’t diagnose [Video
file]. Retrieved from
https://www.ted.com/talks/jen_brea_what_happens_when_you_have_a_disease_doctors_can_t_diagnose
Soares ND, Grossman L: Somatoform disorder: conversion. 2005; Retrieved on 09.03.06 from:
http://www.emedicaine.com/ped/topic2780.htm.
Goldstein LH, Deale AC, Mitchell-O’Malley SJ, Toone BK, Mellers JDC: An evaluation of cognitive-behavioural therapy as
a treatment for dissociative seizures: a pilot study. Cogn Behav Neurol; 2004; 17(1): 41 – 49.
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