Transcript Somatoform Disorders

Somatoform Disorders
Prof. Dr. Elham Al-Jammas
6\10\2013
Objectives
1. To define the term Somatoform disorder,& its
different types
2. To determine the criteria of diagnosing
somatoform disorders
3. To be able to diagnose the different types of
somatoform disorders.
4. To have the ability to treat such disorder
Definition
Soma=BODY
Somatoform disorders:
are mental illnesses that cause physical pain and other symptoms
without any physical explanation.
Or:pathological concern of individuals with the appearance or
functioning of their bodies when there is no identifiable medical
condition causing the physical complaints
Dissociative disorders
individuals feel detached from themselves or their surroundings, and
reality, experience, and identity may
disintegrate.
Historically, both somatoform and dissociative disorders used to be categorized
as hysterical neurosis
in psychoanalytic theory neurotic disorders result from underlying unconscious
conflicts, anxiety that resulted from those conflicts and ego defense mechanisms
Somatoform disorder refers to what many people used to call a psychosomatic
disorder
Epidemiology
Prevalence ::
Women 0.2 – 2 %
Men 0.2 %
Female: Male ratio :: 5-1
Types(DSM1V) :
1.Hypochondriasis
2.Convertion
3.Pain disorders
4.Somatization disorder
4.Body dysmorphic syndrome
Predisposing
factorstors
-Begins before age of 30
-Low income and poor
education
-Commonly Coexist with
other mental disorders
-Personality: Avoidant
Paranoid self defending and
obsessional features
Etiology
No one knows exactly why
symptoms of somatoform disorders
appear.
1.MA theory of pain
2.Childhood illness and history of
parental anxiety toward illness
3.increased frequency of somatization
disorders in first degree relatives
4.Childhood sexual abuse
5psychoanalytic theory : It could be
substitution psychological conflict.
Stress can cause physical symptoms even when no physical
disorder is present. Sometimes physical symptoms result
from the body's automatic response to emotional stress, as
when heart rate and blood pressure increase in response
to fear.
Sometimes a physical symptom appears to be a metaphor
for an emotional experience, as when people with a
“broken heart” have chest pain. Or a physical symptom may
reflect identification with another person's pain. For
example, people may have chest pain after a family member
or friend has had a heart attack
Diagnosis of Somatoform Disorders:
Diagnosis combines the medical and the psychological
A patient who visits a healthcare provider with unexplained
symptoms must be thoroughly examined to rule out any
possibilities of physical illness or trauma.
A medical doctor confronted with a patient who is preoccupied
with inexplicable symptoms may recommend a mental health
evaluation if he suspects a somatoform disorder.
A mental health evaluation must be conducted carefully to rule
out other diagnoses. The perceived symptoms, the preoccupation
with the symptoms, and the repeated search for help may be part
of a larger mental health problem. Additionally, two related
disorders must be ruled out
Criteria for Somatoform Disorders
It is important to remember that someone who plays sick
for a day does not have a somatoform disorder. Three
criteria are required for diagnosis:
1.The physical symptoms cannot be fully explained by a
medical condition, another mental illness, or by the effects
of a substance
2.The diagnosis is not factitious disorder or malingering
3.The symptoms significantly impair in social, occupational,
or other daily life functioning..
Types of Somatoform Disorders
Somatization Disorder (a.k.a. Briquet's syndrome)
Somatization disorder patients usually have a pretty long
history of doctor visits for a variety of symptoms.
There are specific criteria in the DSM for somatization
disorder:
a history of somatic symptoms prior to the age of 30;
pain in at least four different sites on the body;
two gastrointestinal problems other than pain such as vomiting
or diarrhea;
one sexual symptom such as lack of interest or erectile
dysfunction;
one pseudo neurological symptom similar to those seen in
conversion disorder such as fainting or blindness
Undifferentiated somatoform disorder
This is a somewhat vague version of somatization disorder,
requiring only one symptom for 6 months
Conversion disorder
The DSM describes conversion disorder with the following criteria:
one or more symptoms or deficits are present that affect voluntary
motor or sensory function suggestive of a neurologic or other
general medical condition; psychological factors are judged to be
associated with the symptom or deficit because conflicts or other
stressors precede the initiation or exacerbation of the symptom or
deficit; a diagnosis where the stressor precedes
conversion
insistence on the presence of a particular illness.
 large variety of unsubstantiated physical complaints.
 persistent complaints of pain with disproportionate
disability.
 personality style featuring physical manifestations of
psychological problems.
 sensory or motor symptoms suggesting neurologic
origin.

Pain disorder
As its name suggests, patients with pain disorder report
pain that has no apparent physical cause; in pain disorder
the patient is not "faking" the pain as in malingering. They
have chronic pain for several months that causes stress and
disrupts daily life. The pain may or may not be associated
with a medical condition
hypochondriasis
Hypochondriasis
. The DSM lists the following criteria for hypochondriais :
1.a preoccupation with fears of having a serious disease based on the
misinterpretation of bodily symptoms;
2. the preoccupation persists despite medical evaluation and reassurance;
3.the belief in the presence of disease and symptoms is not of delusional
intensit
4. and is not restricted to a circumscribed concern about appearance (as in
Body Dysmorphic Disorder)
5.; the preoccupation causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning;
6. the duration of the disturbance is at least 6 months
7.; the preoccupation is not better accounted for by Generalized Anxiety
Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major
Depressive Episode, Separation Anxiety, or another Somatoform Disorder
Body dysmorphic disorder
A person with body dysmorphic disorder:obsessesion over a physical imperfection or deformity that
may or may not exist.
For example, a small scar on a hand might cause someone to
constantly wear gloves and take extreme measures to prevent
anyone from seeing their hands. The DSM defines body
dysmorphic disorder as a somatoform disorder marked by a
preoccupation with an imagined or trivial defect in appearance
that causes clinically significant distress or impairment in social,
occupational or other important areas of functioning.
Somatoform Disorder not Otherwise
Specified ( NOS )
This diagnosis is reserved for those conditions that are characteristic
of somatoform disorders but fail to meet the criteria for more
specific diagnosis
Factitious Disorder and Malingering
Factitious disorder and malingering must both be ruled
out before moving on to a somatoform disorder.
A patient with factitious disorder takes on physical
symptoms for internal gain. For example, someone who
longs for sympathy may exaggerate or feign stomach
pain.
A patient who is malingering takes on physical
symptoms for external gain. External gain can be
something like money (in the form of disability
payments, for example) or something a little more
subtle such as avoidance of situations (such as family
gatherings)
DD between malingering & Factitious
disorders
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Both are different names for the same condition.
Factitious disorder attempts to achieve psychological benefit,
malingering attempts to achieve external benefit.
Factitious disorder is conscious, malingering is primarily
unconscious.
Malingering is a much more chronic condition than factitious
disorder.
Malingering patients complain of a wider variety of symptoms
Treatment
Treatment for somatoform disorders is usually therapy based
1.Medical treatments can be used, especially when another disorder is
being treated in conjunction, but there is not much evidence that they
are very effective for somatoform disorders by themselves
2.cognitive behavioral therapy was the most effective form of
treatment.
Some common forms of therapy that may be used to treat
somatoform disorders include:
-Adlerian Therapy
-Behavior Therapy
-Existential Therapy
-Gestalt Therapy
-Person-centered Therapy
-Psychoanalytic
-Rational-emotive Therapy
-Reality Therapy
-SupportGroups.com
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