Chapter -5

Somatoform Disorder

General characteristics Physical signs and symptoms lacking a known

medical basis in the presence of psychological factors that are judged to be in the initiation exacerbation or maintenance of the disturbance.

Cause significant or impairment in functioning. Symptoms are produced unconsciously and are

not the result of malingering or factitious disorder. Primary gain somatic symptoms represents a

symbolic resolution of an unconscious psychological conflicts serve to reduce anxiety and conflict no external incentive

Secondary gain the sick role external benefits or unpleasant duties avoided

Management of somatoform Disorders

Brief frequent visits

Limit number of physician involve in care

Focus on psychosocial not physical symptoms

Minimize medical investigations coordinate necessary investigations

Psychotherapy CBT biofeedback conflict resolution

Minimize psychotropic drugs anxiolytics in short term and antidepressants for depression

Attend to transference and countertransference.

Classification

Body dysmorphic disorder Conversion disorder Hypochondrriasis Pain disorder Somatization disorder.

Body dismorphic disorder

Preoocupation with imagined defect in appearenc or excess concern around a slight anomaly

Usualy related to the face

Male=female ,prevalence 1-2.2%in the community ;6-15%in dermatology/cosmetic surgery clinics

May lead to avoidance of social situations

Conversion disorder

1. One or more symptoms or deficits affecting voluntary mimic motor or sensory function that mimic a neurological or GMC.( E.G impaired co- ordination local paralysis double version, seizures or convulsions)

2. Psychological factor through to be etiological related to the symptoms as the initiation of symptoms is preceded by conflicts other stressors.

3. More common in ruler population and in individual with little medical knowledge.

4. Spontaneous remission in 95% of actual cases 50% of chronic cases (>6 months)

Hypochondriasis

Preoccupation with fear of having ,or the idea that one has ,a serious disease based on a misinterpretation of one or more bodily sign or symptoms

evidence does not support diagnosis of a physical disorder

Fear of having a disease despite medical reassurance

Belief is not of delusional intensity (as in delusional disorder somatic type)as person acknowledges unrealistic interpretation

Duration is ≥6months ; onset in 3rd -4th decade of life

Community prevalence 1.1-4.5%; prevalence in general medical practice 4-9%; higher in psychiatric settings

Pain disorder

Pain is primary symptom and is of sufficient to warrant medical attention

Usually no organic pathology but when it exists , reaction is excessive

Lifetime prevalence 12%

Psychiatric disorders (mood , anxiety, substance) may precede , co-exist or result from pain disorder.

Somatization disorder

Recurring , multiple, clinically significant physical complaints which result in patient seeking treatment or having impaired functioning

≥8 physical symptoms that have no organic pathology including each of :

four pain symptoms related to at least four different sites or functions

two gastrointestinal symptoms not including pain

one sexual sympton not including pain

one pseudo-neurological symptom not including pain( e.g. numbness, paresthesia )

Onset before age 30 – extends over a period of years

Somatization disorder

Lifetime prevalence 0.2-2% among women and 0.2% among men

Cultural factors may influence sex ratio

complications: anxiety, depression , unnecessary medications or surgery

Often a misdiagnosis for an insidious illness so rule out all organic illness(e.g. multiple sclerosis)

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