Transcript Somatoform Disorders - Roger Peele: Introduction

Somatoform Disorders
Sources, DSM-IV-TR, Tasman and
First, and Kaplan and Sadock.
As 8July2008
General Definition
Q. What is the general definition of
somatoform disorder?
General Definition
Ans. The presence of physical symptoms
that suggest a general medical condition
and are not fully explained by a general
medial condition, by a substance, or by
another mental illness.
Somatoform Disorders
List
Q. List the six somatoform disorders, in
addition to the NOS category.
Somatoform Disorders
List
Ans.
Somatization disorder
Undifferentiated somatization disorder
Conversion disorder
Pain disorder
Hypochondriasis
Body dysmorphic disorder
Somatization Disorder
Q. Primary criteria for somatization
disorder?
Somatization Disorder
Ans.
1. Begins before age 30.
2. Four pain symptoms, two GI, one
sexual, and one pseudoneurological.
3. Is not explained by another disorder or,
if explained, complaints are in excess of
what would be expected.
Prevalence
Q. What is the prevalence?
Prevalence
Ans. Women: 0.2 to 2%
Men: <0.2%
[While much more common in women in
most areas of the US, is reported to be
high in Puerto Rico men – suggesting
culture plays a role.]
Course
Q. What is the course?
Course
Ans. Rarely remits completely. Usually sees
a physician at least once/year.
Criteria of Undifferentiated
Somatoform Disorder
Q. What is the criteria of this disorder?
Undifferentiated Somatoform
Disorder
Ans.
On or more physical complaints that cannot
be explained or the complaints are
excessive.
Last at least 6 months.
USD Gender
Q. Gender breakdown?
USD - Gender
Ans. Women
USD - course
Q. Course?
USD - course
Ans. Unpredictable. Frequently evolves into
another psychiatric or somatic disorder
Conversion Disorder
Q. Essential feature?
Essential feature of CD
Ans.
The presence of symptoms or deficits
affecting voluntary motor or sensory
function that suggests neurological or
other general medical condition, but in
actuality seems based on psychological
factors.
CD subtypes
Q. What are the subtypes of conversion
disorder?
CD Subtypes
Ans.
1. With motor symptom or deficit
2. With sensory symptom or deficit
3. With seizures or convulsions
4. With mixed presentations
CD prevalence
Q. Prevalence of conversion disorder. More
common in urban or rural? More in men or
women? Associated dx in women?
Associated dx in men?
CD prevalence
Ans. Prevalence is rare to common, the
latter being in rural, poor, uneducated
parts of the world. More common in
women, and women often have other
somatoform disorders, whereas men are
more likely to also have an antisocial
personality disorder.
Treatment of Conversion
Disorder
Q. What is the usual treatment of conversion
disorder?
Treatment of Conversion Disorder
Ans. Resolution is usually spontaneous, but
if not, a positive relationship with a caring
and confident therapist. Focus on issues
of stress and coping. Sometimes effective:
Hypnosis, anxiolytics, and relaxation
exercises.