SOMATOFORM DISORDERS

Submitted by Aamna Haneef Bs (Hons)

Submitted to Ms. Mirrat Gull

Sir Ganga Ram Hospital, Lahore

Soma means body and Somatoform Disorders involves patterns in which individuals complains of bodily symptoms that suggest the presence of medical problems, but for which no organic basis can be found that satisfactorily explains the symptoms. Such individuals are typically preoccupied with their state of health and with various presumed disorders or diseases of bodily organs.

A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought. Each of the following criteria have been met; Four pain symptoms, Two gastrointestinal symptoms, One sexual symptom & One pseudoneurological symptom (Common symptoms-Headache, nausea, deafness, blurred vision, double vision, chest, stomach pain, dizziness, heart palpitation,

It is chronic but fluctuating disorder, a year seldom passes without individuals seeking some medical attention just like doctor shopping going from one physician to the next. Diagnostic criteria are met before age 25, but initial symptoms are often present by adolescence; Menstrual difficulties may be earliest symptoms in women. Sexual symptoms are often associated with marital discord

Studies have reported widely variable prevalence of Somatization Disorder, ranging from 0.2% to 2% among women Less than 2% in men Diagnosis depends on whether the interviewer is a physician or a non physician who may less frequently diagnose Somatoform Disorder

Schizophrenia Anxiety Disorder Panic Disorder Generalized Anxiety Disorder Mood disorder Depressive disorder Conversion Disorder Dissociative Disorder Factitious Disorder Malingering

It is originally known as Hysteria, involves a pattern in which one or more symptoms affecting voluntary, motor or sensory function that mimic neurological or other general medical condition. It is initiated by psychological factors and is not intentionally produced or feigned. The symptoms manifest themselves as sensory symptoms, motor symptoms and visceral (internal organs) symptoms.

 With motor symptoms or deficits(impaired coordination or balance, paralysis, lump in throat) With sensory symptoms or deficits(loss of touch or pain sensation, double vision, deafness, hallucination) With seizures or convulsions With mixed presentation

The onset is usually from late childhood to early adulthood. In middle or old age, the probability of neurological or other general medical condition is high. Recurrence is common predicting future episodes. Factors that are associated with good prognosis include acute onset, presence of clearly identifiable stress, short interval between onset and treatment & above average intelligence.

Reported rates of Conversion Disorder have varied widely, ranging from 11/100,000 to 500/100,000 in general population samples. Other results shows that conversion is identified as, 3% of outpatients 1% and 14% of inpatients

Pain Disorders Sexual Dysfunction Somatization Disorder Schizophrenia Mood Disorder Hypochondriasis Body Dysmorphic Disorder Dissociative Disorder Factitious Disorder Malingering

Pain disorder is characterized by pain in one or more anatomical sites which are clinically significant. There may have been clear physical reasons for pain, but psychological factors play a major role in maintaining it. The pain has organic basis, is real and it hurts. It is not intentionally produced or feigned.

Specify if:
Pain Disorder associated with psychological factors Pain Disorder associated with both

The course of the disorder depends upon its onset; acute onset resolves in short time and chronic phase may take years to resolve. Important factors that influence recovery are, Individuals acknowledgement of pain Participation in regularly scheduled activities Not allowing pain to become the determining factor in ones life

Prevalence of Pain Disorder is unclear. Pain Disorder associated with general medical condition and psychological factors is more common than Pain Disorder associated with psychological factors.

Conversion Disorder Depressive Disorder Anxiety Disorder Factitious Disorder Malingering

Preoccupation with fears of having a serious disease based on persons misinterpretation of bodily symptoms. The preoccupation persists despite medical evaluation. The duration of the disturbance is at least 6 months. Some people may have both, disease conviction( mistaken belief of having a disease) and illness phobia (fear of developing disease) Specify if:
With poor insight(during the current episode the person does not realize that concern is excessive

Hypochondriasis can begin at any age but most common is early adulthood. The course is usually chronic.

Prevalence
The prevalence of Hypochondriasis in the general population is 1% to 5%.

Generalized Anxiety Disorder Major Depressive Episode Obsessive Compulsive Disorder Panic Disorder Body Dysmorphic Disorder Old Age concerns

Child

Adult

The disorder is characterized by preoccupation with imagined defect in appearance, a slight defect in appearance has markedly excessive concern. That is why the disorder has been referred to as imagined ugliness. One interesting aspect of Body Dysmorphic Disorder is sometimes people either become fixated on mirrors or avoid mirrors to an almost phobic extent.

It usually begins during adolescence but can also begin in childhood. The onset may be gradual or abrupt. The disorder may not be diagnosed for many years, often because individuals with the disorder are reluctant to reveal their symptoms.

Prevalence
Clinical settings, Body Dysmorphic Disorder with Anxiety is approx. 5% Cosmetic surgery & dermatology, Body Dysmorphic Disorder ranges from 6% to 15%

Normal concerns about appearance Healthy exercise Anorexia Nervosa Gender Identity Disorder Major Depressive Episode Personality Disorder Obsessive-Compulsive Disorder Delusional Disorder

PSYCHODYNAMIC PERSPECTIVE-Defense against anxiety Conservation of energy stated that strong emotions either sexual or of hostility that are repressed, forced out of consciousness; eventually will overflow and transform itself in the form of somatic symptoms. The individual often experiences la belle indifference that he doesnt seem at all disturbed by his disability. The primary gain is relief from anxiety and relief from responsibilities is the secondary

COGNITIVE PERSPECTIVE-Misinterpreting Bodily Sensations According to Cognitive theory somatoform disorders are basically disorders of perception and thinking, by misinterpreting and exaggerating normal bodily sensations. Somatization and hypochondriasis involves over attention of body symptoms, whereas conversion is based on withdrawal of attention. This perspective fails to explain why over attention or under attention to body occurs.

BEHAVIORAL PERSPECTIVE-Learning to adopt sick role The person adopt sick role either directly, by being ill, or indirectly, by having the sick role modeled, or by reinforcement at the time of illness. Thus operant conditioning predisposes a person to adopt the sick role in adult life. The sick role involve sacrifices like loss of power or pleasurable activities, but these are tolerated for so long because their learning histories have made the rewards of the sick role more reinforcing than the rewards of illness free life.

SOCIOCULTURAL PERSPECTIVEReinforcement of the sick role Sociocultural theorists focus on larger cultural forces. The likelihood of a person using the sick role as coping style depends on his or her cultures modeling of and reaction to unexplained somatic symptoms. Several non-western(china) cultures in which frank expression of emotional disturbance is considered unacceptable evidence somatizing patterns to be relatively more common.

NEUROSCIENCE PERSPECTIVE-Genetics and Brain dysfuction Studies have shown that, among the first degree relatives of patients with somatization disorder, women shows increase frequency of somatization disorders. Individual with somatization disorder(esp conversion) receive normal sensory input from their disabled organs but the processing of sensory signals in the cerebral cortex is dysfunctional. Further, 70% of the clients have problems in their left side of the body that suggests it may stem from right cerebral hemisphere.

Behavior Therapy Physical Therapy Cognitive-Behavioral Therapy Rational Emotive Therapy Psychodynamic Therapy Family Therapy Group Therapy Psychoeducation Stress reduction exercises Distraction Techniques

1. Is there any organic basis for somatoform disorders? 2. What is the primary gain of somatoform disorders? 3. What is the difference between hypochondriasis and somatization disorder? 4. Does above average intelligence support good prognosis of conversion disorder? 5. What is the criteria for duration, to diagnose Hypochondriasis? 6. Which disorder has usually chronic course? 7. Why Body Dysmorphic Disorder is not diagnosed early after its onset?

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