Somatoform Disorders
Somatoform Disorders
Somatoform Disorders
IV-BSOT
Psychiatry
SOMATOFORM DISORDERS
1. Somatization Disorder: characterized by many physical complaints
affecting many organ systems.
2. Conversion Disorder: characterized by one or two neurological complaints.
3. Hypochondriasis: characterized less by a focus on symptoms than by
patients beliefs that they have a specific disease.
4. Body dysmorphic Disorder: characterized by a false belief or exaggerated
perception that a body part is defective.
5. Pain Disorder: characterized by symptoms of pain that are either solely
related to, or significantly exacerbated by, psycho-logical factors.
6. Undifferentiated somatoform disorder: includes somatoform disorders
not otherwise described that have been present for 6 months of longer.
7. Somatoform disorder not otherwise specified: the category for
somatoform symptoms that do not meet any of the somatoform disorder
diagnoses mentioned above.
SOMATIZATION
Clinical Features:
Patients with somatization disorder have many somatic com-plaints and long,
complicated medical histories.
Nausea and vomiting (other than during pregnancy), difficulty swallowing,
pain in the arms and legs, shortness of breath unrelated to exertion, amnesia,
and complications of pregnancy and menstruation are among the most
common symptoms.
Patients frequently believe that they have been sickly most of their lives.
Psychological distress and interpersonal problems are prominent; anxiety and
depression are the most prevalent psychiatric conditions.
Suicide threats are common, but actual suicide is rare. If suicide does occur,
it is often associated with substance abuse.
Somatization disorder is commonly associated with other mental disorders,
including major depressive disorder, personality disorders, substance-related
disorders, generalized anxiety disorder, and phobias.
Epidemiology/Etiology
Karen Abinsay
IV-BSOT
Common d/o
W>M
5:1 female-male ratio
Beginning before age 30,
usually during teenage years.
Psychiatry
DX
Differential DX
TX
Best treated when the patient has a single identified physician as primary
caretaker.
The visits should be relatively brief, although a partial physical examination
should be conducted to respond to each new somatic complaint.
Additional laboratory and diagnostic procedures should generally be avoided.
Once somatization disorder has been diagnosed, the treating physician
should listen to the somatic complaints as emotional expressions rather than
as medical complaints.
Psychotherapy & Psychopharmacological tx
CONVERSION DISORDER
Clinical Features:
Paralysis, blindness, and mutism are the most common conversion disorder
symptoms.
Depressive and anxiety dis-order symptoms often accompany the symptoms
of conversion disorder, and affected patients are at risk for suicide.
Epidemiology/Etiology
W>M
Among children, an even higher predominance is seen in girls.
Symptoms are more common on the left than on the right side of the body in
women.
The onset is general from late childhood to early adulthood and is rare before
10 years of age or after 35 years of age.
Possible factors: Psychoanalytic, Learning theory, biological
DX
Differential DX
TX
HYPOCHONDRIASIS
Clinical Features:
Believe that they have a serious disease that has not yet been detected, and
they cannot be persuaded to the contrary.
Convictions persist despite negative laboratory results, the benign course of
the alleged disease over time, and appropriate reassurances from physicians.
Often accompanied by symptoms of depression and anxiety and commonly
coexists with a depressive or anxiety disorder.
Although DSM-IV-TR specifies that the symptoms must be present for at least
6 months, transient hypochondrical states can occur after major stresses.
Such states that last fewer than 6 months should be diagnosed as
somatoform disorder not otherwise specified.
Epidemiology
M=F
Onset 20-30 y/o
More common in blacks than whites plus medical students
DX
Differential DX
Episodic
Lasts from months to years
Good prognosis= associated with high socioeconomic status, treatmentresponsive anxiety or depression, sudden onset of symptoms, the absence of
a personality disorder, and the absence of a related nonpsychiatric medical
cx.
TX
Group psychotherapy
Frequent, regular physical exams
Pharmacotherapy
BODY DYSMORPHIC DISORDER
Clinical Features:
Most common concern involves facials flaws. Other body parts of concerns
are hair, breasts, and genitalia.
FEFER TO TABLE 17-9
Epidemiology/Etiology
Cause unknown.
W>M
Common age of onset between 15-30 y/o.
High comorbidity with depressive d/o, a higher-than-expected family history
of mood d/os and OCD, plus serotonin pathophysiology.
DX
Differential DX
Although individuals with body dysmorphic disorder have obsessional preoccupations about their appearance and may have associated compulsive
behaviors (e.g., mirror checking), a separate or additional diagnosis of OCD is
made only when the obsessions or compulsions are not restricted to concerns
about appearance and are ego dystonic.
An additional diagnosis of delusional disorder, somatic type, can be made in
people with body dysmorphic dis-order only if their preoccupation with the
imagined defect in appearance is held with a delusional intensity.
Restricted to concerns in anorexia nervosa and major depressive episode.
TX
PAIN DISORDER
Characterized by the presence of, and focus on, pain in one or more body
sites and is sufficiently severe to come to clinical attention.
Psychological factors are necessary in the genesis, severity, or maintenance
of the pain, which causes significant distress or impairment, or both.
Clinical Features:
Patients with pain disorder are not a uniform group, but a heterogeneous
collection of persons with low back pain, headache, atypical facial pain,
chronic pelvic pain, and other kinds of pain.
A patients pain may be posttraumatic, neuropathic, neurological, iatrogenic,
or musculoskeletal.
To meet a diagnosis of pain disorder, however, the disorder must have a
psychological factor judged to be significantly involved in the pain symptoms
and their complications.
Epidemiology/Etiology
DX
Differential DX
TX