Second lecture of the CBI course. The document contains a detailed summary, discussing the topic of Cognitive and Behavioural Interventions in Medically Unexplained Symptoms and syndromes. The lecture is based on the article by Deary, Chalder, & Sharpe (2007).
College 2 – Cognitive and Behavioural Interventions in Medically
Unexplained Symptoms and syndromes
Medically Unexplained Physical Symptoms (MUPS)
A physical symptom – A bodily sensation that is perceived as unpleasant, painful or
worrisome.
Facts and figures
In the general population, about 80%-90% experiences 1 or 2 physical complaints per
week. But these complaints are mostly stress-related and transient. So usually, people
don’t seek medical help because of these complaints.
In 25% of the cases, symptoms become chronic, with a duration of at least 6 months.
One third (31%-37%) of physical symptoms remain medically unexplained, also
known as medically unexplained physical symptoms (MUPS)→ Symptoms cannot be
adequately explained on the basis of organic dysfunction or disease.
DSM-4: Somatoform Disorders
Somatoform disorders are a heterogeneous group of psychiatric disorders that are
characterized by enduring bodily complaints and symptoms that are not due to organic
dysfunction or disease.
These patients perceive a wide range of severe symptoms, which cause permanent worry and
distress. They excessively seek medical help and reassurance, but have difficulty accepting
the non-pathological results in medical examinations.
The primary focus is on the fact that the symptoms have to be medically unexplained,
in order to be diagnosed with the somatoform disorder.
DISM-5: Somatic Symptom and Related Disorders
Somatic Symptom & related disorders share a common feature; the somatic
symptoms associated with significant distress and impairment, or fear of a serious
illness in the absence of somatic symptoms.
This also lead to change in the primary focus for diagnostics.
The primary focus now lays on the experience of distress and impairment.
CBT model of MUPS
The classical CBT model of emotional distress (proposed by Beck) distinguishes several
factors;
Predisposing factors
Precipitating factors
Perpetuating factors – Also known as maintaining factors;
o Cognitive o Affective
o Behavioral o Physiological
Which factors contribute to the development, maintenance and aggravation of MUPS?
CBT model for MUPS (Deary et al., 2017)
Predisposing factors – Such as early experiences of adversity or high threat
sensitivity.
Precipitating factors (triggers) – Life events, stressors or viruses.
The interaction between these two factors that leads to the development of MUPS. The lower
part of the model contains the perpetuating (maintaining) factors. These are responsible for
the maintenance, and in some cases the aggravation of medically unexplained physical
symptoms.
Cognitive processes – Attentional and attributional processes; rumination.
Physiological factors – Physiological arousal; hypercortisolism.
Behaviors – Avoidance of symptoms; recuperative illness response.
Social factors – Medical uncertainty; lack of explanation or guidance.
Development of MUPS
Predisposing factors
Personality – Personality is a predisposing factor for developing MUPS, containing
two different dimensions; neuroticism and alexithymia.
o One personality factor that is quite important as a predisposing factor is
neuroticism, also known as negative affectivity. This pertains to a stable,
lifelong tendency to experience negative affect, making people more
vulnerable to experience both emotional and physical complaints→
predisposition to somatopsychic distress.
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