Chapter 10
This chapter covered somatic symptoms and somatic disorders, which consists of
disorders or conditions that involve distress around personal health, and abnormally excessive
feelings and behaviors in response towards issues that in normality do not trigger distress,
such as mild pains, fatigue, stomach upsets etc. eliciting unnecessary mental and physical
health problems One major disorder in this category is illness anxiety disorder. This paper
describes the updated diagnostic criteria, evidence-based treatments, etiologies, counseling
intervention and multicultural implications of this disorder.
DSM-V-TR diagnosis of the disorder
Preoccupation with having or acquiring a serious illness.
Persistent high-level anxiety about health, with the inclination to being alarmed about
personal health status.
Excessive preoccupation with health-related behaviors, such as frequently checking
the body for signs of illness and maladaptive avoidance, such as avoiding the
hospitals in fear of being identified as sick (care-avoidant).
The anxiety arouses intensive distress that adversely affects social and occupational
functioning.
The preoccupation is consistent for about 6 months and is not altered with
reassurances from a doctor (after assessing/examining/conducting tests), family or
friends. They often do not believe the results of multiple diagnostic tests conducted by
the health provider (care-seeking).
Constantly talking about one’s health and possible illnesses and seeking information
(e.g. from internet) about symptoms of a particular illness.
Symptoms not better explained by a related disorder, such as body dysmorphic
disorder, somatic symptom disorder etc. (Levenson, 2018).
Etiologies
Past experiences- having experienced a serious illness in the past is a potential
predeterminant of illness anxiety, triggered by excessive fear of contracting the
disease once again.
Family factors- having parents who had health anxiety is described as a common
determinant of the disorder. Having a person in the family who ailed a serious illness
, that distressed the family may also increase odds of others being diagnosed with the
disorder at a point in their life.
Traumatic past- History of abuse, such as sexual, physical or emotional abuse may
trigger illness anxiety.
Excessive information- Preoccupation with searching and consuming too much
health-related information.
Poor resilience- difficulties in tolerating uncertainties and managing pain may put
one in the path of the disorder, such that s/he adversely confers unusual body
sensations.
Underlying conditions-such as depression and anxiety
Evidence-based treatments
Psychotherapy- psychotherapy is considered an effective treatment modality for illness
anxiety disorder. Among psychotherapy approaches that boast utility in treating this disorder
include:
Exposure and Response Prevention (ERP)- here, the client is exposed to situations
that trigger your anxiety, e.g. searching information about an illness online, and then
is trained to prevent themselves from engaging in examining the body for signs of the
illness for a period of time.
Mindfulness- mindfulness-based cognitive therapy is cited as effective in health
anxiety disorders. This therapy trains the patient to come into terms with their feelings
and fears, and then nurtures internal stimuli to adapt and improve internal resilience.
A study by Lovas (2016) confirmed effectiveness of this tool in managing this
disorder.
Medication-first line of treatment aimed at controlling symptoms and their severity.
Commonly, medications used to treat mood disorders and anxiety, including SSRIs may be
used.
Counselling intervention
Cognitive behavioral therapy (CBT)-this disorder helps in: identifying causes of fears
and beliefs about being ill, discover responsible body sensations and unhelpful thoughts,
improve awareness of how these worries, sensations and feelings affect one’s behavior, learn
skills to cope, respond to sensations and anxieties and changing behaviors like frequently
, checking one’s body for illness symptoms and seeking reassurances and controlling mental
health triggers, such as depression.
Areas addressed
Resilience
Anxieties
Social and physical functioning
Maladaptive behaviors
Excessive body checking
Multicultural implications
Culture may influence the trajectory of illness anxiety disorder. Culture affects attitudes
towards mental health illnesses, motivation to seek treatment, where healthcare is sought and
coping skills for people citing different cultural affiliations and arising beliefs.
Chapter 11
This chapter covered eating and feeding disorders, which consists of conditions that
involve severe impaired eating/feeding patterns and disturbed attitudes and feelings about
food. A major diagnosis in this category of mental disorders is anorexia nervosa. Below is a
description of the diagnostic criteria (DSM-V-TR), accepted treatment modalities, etiology,
counselling intervention and multicultural implications of the disorder.
DSM-V-TR diagnostic criteria for anorexia nervosa
Active decline to maintain a standard body weight based on sex, age, developmental
stage, and physical health informed by morbid fear of getting fat, even though one is
relatively underweight.
Refusal of taking energy foods leading to low-body weight in contexts of gender, age,
physical health or developmental trajectory.
A disturbed body image (believing themselves to be fat even though they are
emaciated), and dread of loss of control.
Obsession with calorific and nutritional content of food (restrictive type)
This chapter covered somatic symptoms and somatic disorders, which consists of
disorders or conditions that involve distress around personal health, and abnormally excessive
feelings and behaviors in response towards issues that in normality do not trigger distress,
such as mild pains, fatigue, stomach upsets etc. eliciting unnecessary mental and physical
health problems One major disorder in this category is illness anxiety disorder. This paper
describes the updated diagnostic criteria, evidence-based treatments, etiologies, counseling
intervention and multicultural implications of this disorder.
DSM-V-TR diagnosis of the disorder
Preoccupation with having or acquiring a serious illness.
Persistent high-level anxiety about health, with the inclination to being alarmed about
personal health status.
Excessive preoccupation with health-related behaviors, such as frequently checking
the body for signs of illness and maladaptive avoidance, such as avoiding the
hospitals in fear of being identified as sick (care-avoidant).
The anxiety arouses intensive distress that adversely affects social and occupational
functioning.
The preoccupation is consistent for about 6 months and is not altered with
reassurances from a doctor (after assessing/examining/conducting tests), family or
friends. They often do not believe the results of multiple diagnostic tests conducted by
the health provider (care-seeking).
Constantly talking about one’s health and possible illnesses and seeking information
(e.g. from internet) about symptoms of a particular illness.
Symptoms not better explained by a related disorder, such as body dysmorphic
disorder, somatic symptom disorder etc. (Levenson, 2018).
Etiologies
Past experiences- having experienced a serious illness in the past is a potential
predeterminant of illness anxiety, triggered by excessive fear of contracting the
disease once again.
Family factors- having parents who had health anxiety is described as a common
determinant of the disorder. Having a person in the family who ailed a serious illness
, that distressed the family may also increase odds of others being diagnosed with the
disorder at a point in their life.
Traumatic past- History of abuse, such as sexual, physical or emotional abuse may
trigger illness anxiety.
Excessive information- Preoccupation with searching and consuming too much
health-related information.
Poor resilience- difficulties in tolerating uncertainties and managing pain may put
one in the path of the disorder, such that s/he adversely confers unusual body
sensations.
Underlying conditions-such as depression and anxiety
Evidence-based treatments
Psychotherapy- psychotherapy is considered an effective treatment modality for illness
anxiety disorder. Among psychotherapy approaches that boast utility in treating this disorder
include:
Exposure and Response Prevention (ERP)- here, the client is exposed to situations
that trigger your anxiety, e.g. searching information about an illness online, and then
is trained to prevent themselves from engaging in examining the body for signs of the
illness for a period of time.
Mindfulness- mindfulness-based cognitive therapy is cited as effective in health
anxiety disorders. This therapy trains the patient to come into terms with their feelings
and fears, and then nurtures internal stimuli to adapt and improve internal resilience.
A study by Lovas (2016) confirmed effectiveness of this tool in managing this
disorder.
Medication-first line of treatment aimed at controlling symptoms and their severity.
Commonly, medications used to treat mood disorders and anxiety, including SSRIs may be
used.
Counselling intervention
Cognitive behavioral therapy (CBT)-this disorder helps in: identifying causes of fears
and beliefs about being ill, discover responsible body sensations and unhelpful thoughts,
improve awareness of how these worries, sensations and feelings affect one’s behavior, learn
skills to cope, respond to sensations and anxieties and changing behaviors like frequently
, checking one’s body for illness symptoms and seeking reassurances and controlling mental
health triggers, such as depression.
Areas addressed
Resilience
Anxieties
Social and physical functioning
Maladaptive behaviors
Excessive body checking
Multicultural implications
Culture may influence the trajectory of illness anxiety disorder. Culture affects attitudes
towards mental health illnesses, motivation to seek treatment, where healthcare is sought and
coping skills for people citing different cultural affiliations and arising beliefs.
Chapter 11
This chapter covered eating and feeding disorders, which consists of conditions that
involve severe impaired eating/feeding patterns and disturbed attitudes and feelings about
food. A major diagnosis in this category of mental disorders is anorexia nervosa. Below is a
description of the diagnostic criteria (DSM-V-TR), accepted treatment modalities, etiology,
counselling intervention and multicultural implications of the disorder.
DSM-V-TR diagnostic criteria for anorexia nervosa
Active decline to maintain a standard body weight based on sex, age, developmental
stage, and physical health informed by morbid fear of getting fat, even though one is
relatively underweight.
Refusal of taking energy foods leading to low-body weight in contexts of gender, age,
physical health or developmental trajectory.
A disturbed body image (believing themselves to be fat even though they are
emaciated), and dread of loss of control.
Obsession with calorific and nutritional content of food (restrictive type)
