Transcript Somatoform Disorders

Somatoform Disorders
•Also know as Hysteria (Freud)
•Conditions involving physical
complaints or disabilities that occur
without physical pathology
•NOT psychosomatic disorders…
– Somatization Disorder
– Conversion Disorder
– Pain Disorder
– Hypochondriasis
– Body Dysmorphic Disorder
Somatization disorder
1. Previously known as “hysteria”
2. Usually strikes before the age of 30
3. Commonly develop more symptoms during times of
emotional distress
4. Generally history of vague symptoms related to specific
body systems--cause him/her to see variety of physicians
5. Often self-rate their health as very poor even lower than
people with chronic medical conditions
6. Significant social, occupational, and/or other
impairment
7. Most common symptoms related to gastrointestinal,
sexual/reproductive and neurologic body systems
8. Symptoms not intentionally produced
In the not too distant past, conditions like
asthma were thought to be somatoform
disorders.
QUESTION:
Are the somatoform disorders, as defined by
DSM IV (THX), purely psychological, or do
you believe that they are biological and it is a
matter of time until doctors identify the
etiology?
Conversion Disorder
•Conversion of emotional difficulties
into the persistent loss of a
physiological function
•Paralysis, loss of feeling, exceptional
sensitivity, mutism, blindness,
deafness
•Not faking a physical problem
•Cannot be explained physically
Conversion disorder
1. Only one symptom (whereas a person with
somatization disorder has several) which can appear
at any age
2. Sensorimotor disturbance of bodily functions
a. range of sensory symptoms: paresthesia (abnormal
sensations, such as tingling, numbness, or
heightened sensation), and anesthesia (loss of
feeling) to blindness and deafness
b. range of motor symptoms: tics to seizures to
paralysis
3. Sometimes precipitated by a severe trauma such as
rape, deep anger and frustration, disaster, war, etc.
4. Typically begins/ends abruptly relapsing within 5
yrs
Conversion disorder…cont.
5. Affected body part sometimes related to inner
psychological conflict person is experiencing
a. Example: A husband, who is denying his anger and growing
dislike towards his spouse, may be experiencing a deep
unconscious hatred and desire to hurt his wife.
b. He could experience paralysis of his dominant arm and not
know why.
6. Contracture may occur after disorder ends if there
is long-term paralysis.
7. Tends to be strong denial against possible
psychological explanations
8. Prognosis generally good with only 20% of patients
relapsing within 5 years
Pain disorder
1. Patient consistently preoccupied with
unexplained pain for period of over 6 months
2. Frequently prevents individual from attending
work or school
3. Frequent medication use and relationship
problems
4. Contributes to work disability in about 10 to 15
% of the population
5. Pain often leads to depression, suicide, social
isolation and results in expenditure of many
resources trying to find a cure
6. Treatment might include use of nerve blocks,
Hypochondriasis
1. Preoccupation with fears of heaving serious
disease or chronic belief that one has a
serious illness
2. Hyperawareness of normal bodily
sensations such as heartbeat or breathing
3. Do not want to be referred to psychiatrists
4. Most treated by family physicians with
physicals and reassurance that they do not
have serious ailment
5. 6+ mos.
Hippocrates used the term hypochondrium in
the 4th century BC to refer to the anatomic
area below the ribs.
Later, the term hypochondriasis emerged to
refer to the ill effects upon the psyche and
soma of humors or fluids that emanate from
the hypochondrium and cause disease.
The term hypochondria is from the Greek literally 'below the cartilage', referring to the
lower ribs and the underlying spleen and
liver.
Its application to mental states comes from the
theory of humours, relating moods to the liver
and spleen.
Similarly depression was called melancholia,
literally black bile.
The Four Humors - Ancient Greeks (~2000 BC - 0 AD)
Ancient Greek philosophers such as Hippocrates 400 BC
and Galen, 140/150 AD classified 4 "humors" in people.
Each type was believed to be due to an excess of one of
four bodily fluids, corresponding to their character.
The personalities were termed "humors"
Corresponding Type
Character Humor
Fluid
Irritable
Choleric
yellow bile
Depressed
Melancholic black bile
Optimistic
Sanguine
blood
Socially useful type
Openness to experience
Calm
Phlegmatic
phlegm
Leaning type/Neuroticism
Ruling type
Avoiding type
Body Dysmorphic Disorder
1. Normal-appearing person is preoccupied with
imagined or minor physical defect
2. Pervasive feeling of ugliness despite a normal
appearance
3. Body parts that are often thought to be
inferior – face, hair, breasts and genitalia
4. Average age of patient is 30 years—some as
early as five.
5. Patients may appear shy, narcissistic and/or
obsessive, and will seek plastic surgery as a
definitive cure
Body Dysmorphic disorder
Body Dysmorphic Disorder (BDD) was
recognized formally in 1997 in the Diagnostic
and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) under the
somatoform disorders.
BDD is defined as
“…a
preoccupation with an imagined or
slight
defect in appearance. This preoccupation
causes significant distress or impairment in
social, occupational, or
other areas of
functioning in the
person's life.”
Body Dysmorphic Disorder
Background:
Europe: more than 100 years ago, Enrico Morselli, a
psychiatrist in Italy described persons with a
subjective feeling of ugliness or with a slight
physical defect considered abnormal by the patient
but undetectable by others.
He stated that these people felt miserable, were
tormented by their imagined defect, and were
consumed by thoughts of this defect in any
situation.
The term dysmorphobia was coined by him.
Body Dysmorphic Disorder
Many are dissatisfied with their appearance in some
way, so does everyone have BDD?
No. Individuals with BDD usually dislike every aspect of
themselves to the point of total self hatred.
Will spend hours a day thinking about everything from
appearance, to communication, to mistakes they've
made.
Often perform rituals, looking at themselves in reflective
surfaces repeatedly, or ask for constant reassurance.
Additionally, co-morbid with depression
For an diagnosis, appearance concerns must meet the
3 Ds.
Body Dysmorphic Disorder
True incidence of BDD is unknown, due to the
secrecy of the disorder
~many
people with BDD have Social Phobia and are afraid
of visiting the doctor
BDD affects ~1-2% of the general population;
However, this is thought to be an
underestimate because BDD frequently is
underdiagnosed.
Patients are ashamed of their problem and do not
report it to their physicians.
Body Dysmorphic Disorder
Background:
> The facial area, including the skin, hair, or nose, are
the most common areas of concern
for many
patients.
> Many patients affected with BDD have
comorbid conditions, such as obsessivecompulsive
disorder (OCD), major depression, delusions, or social
phobia.
> Of those with a primary diagnosis of BDD, 30% meet
criteria for OCD.
> Approximately 2-7% of patients who undergo
plastic surgery have BDD.
Patients who undergo plastic surgery generally are
unhappy with the results and find another part of the
body with which to be concerned or continue to be
consumed with thoughts about the postoperative site.