somatoform disorders

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Somatoform disorders

Somatoform disorders are a group of disorders in which patients are convinced that their sufferings come from undetected and untreated bodily derangements. They include: Somatization disorder Conversion & Dissociation disorder Pain disorder Hypochondriasis Body dysmorphic disorders
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Somatization disorder

The patient has multiple medically unexplained symoptoms that can not be explained as organic pathology or on any known patholophysiological mechanism . Somatization Disorder is an illness of multiple somatic complaints in multiple organ systems that occurs over a period of several years and results in significant impairment or treatment seeking, or both. The complaints are multiple, chronic and affect multiple organ systems.
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Somatization disorder

The disorder is an expression of the basic mechanism by which patients respond to their stressors and express them as somatic symptoms. The disorder is associated with significant psychological distress, impaired social and occupational functioning, and excessive medical-help-seeking behavior The condition was previously called hysteria.

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Somatization disorder

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Somatization disorder
Etiology: symptoms substitute for repressed instinctual impulses Psychosocial Factors Predisposing factors include physical and sexual abuse and parental complaints of unexplained poor physical health in childhood. Social, cultural, and ethnic factors may also be involved in the development of symptoms. Biological factors Hypersensitivity of the limbic system towards bodily stimuli was suggested.

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Somatization disorder

Clinical features The symptoms may refer to any part or system of the body. They depend on the patient’s sociocultural background and life experience.Nausea and vomiting (other than during pregnancy), difficulty swallowing, pain in the arms and legs, shortness of breath unrelated to exertion, amnesia, and complications of pregnancy and menstruation are among the most common symptoms. Patients frequently believe that they have been sickly most of their lives. *

Somatization disorder

Neurological symptoms include incoordination, weakness, paralysis, dysphagia, lump in the throat, aphonia, urinary retention, anesthesia, hallucination, diplopia, blindness, pseudoseizures and coma.
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Somatization Disorder

Suicide threats are common, but actual suicide is rare. If suicide does occur, it is often associated with substance abuse. complaints in a dramatic, emotional, and exaggerated fashion, with vivid and colorful language; they may confuse temporal sequences and cannot clearly distinguish current from past symptoms Female patients with somatization disorder may dress in an exhibitionistic manner. Patients may be perceived as dependent, self-centered, hungry for admiration or praise, and manipulative.
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Somatization DisorderManagement

Good history and physical examination are necessary for the diagnosis. Once certain of the diagnosis, we should avoid excessive and unnecessary investigations. Somatization disorder is best treated when the patient has a single identified physician as primary caretaker. When more than one clinician is involved, patients have increased opportunities to express somatic complaints.
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Somatization Disorder management

Psychotherapy, both individual and group, decreases these patients' personal health care expenditures by 50 percent, largely by decreasing their rates of hospitalization. In psychotherapy settings, patients are helped to cope with their symptoms, to express underlying emotions, and to develop alternative strategies for expressing their feelings
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Somatization Disorder management
British Journal of Psychiatry (1993), 162, 472в€”480The Management of Chronic SomatisationSomatisation' is a process in which there is inappropriate focus on physical symptoms and psychosocial problems are denied. In some patients this process becomes chronic (in excess of six months). Special skills and strategies are required by non-psychiatrists to manage these patients, for whom the acceptance of psychiatric treatment should be facilitated. When taking the history, doctors should be aware of psychosocial cues; there after they should be consistent and unambiguous in their management. *

Somatoform disorders in general practicePrevalence, functional impairment and comorbidity with anxiety and depressive disorders†Margot W. M. De Waal, MSc, Ingrid A. Arnold, MD andJust A. H. Eekhof, PhDDepartment of General Practice and Nursing Home Medicine, Leiden University Medical CentreAlbert M. Van Hemert, PhD+Author AffiliationsDepartment of Psychiatry, Leiden University Medical Centre, Leiden, The NetherlandsM.W.M. de Waal, LUMC Department of General Practice and Nursing Home Medicine, PO Box 2088, 2301 CB Leiden, The Netherlands. Tel: +31 71 5275318; fax: +31 71 5275325; e-mail: M.W.M.de_Waal@lumc.nl
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Military deployment to the Gulf War as a riskfactor for psychiatric illness among US troopsNANCY FIEDLER, GOZDE OZAKINCI,WILLIAM HALLMAN,DANIELWARTENBERG, NOEL T. BREWER, DRUE H. BARRETTand HOWARD M. KIPEN

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F45.1 Undifferentiated Somatoform Disorder

The diagnosis should be considered if the complete and typical clinical picture of somatization disorders has not been fulfilled. No physical basis of the symptoms presented remains the basis for the diagnosis.Differential diagnosis:frequently occur in major depression and schizophrenia.chronic history of multiple somatic complaintsbegin before the age of 30adjustment disorder with unexplained somatic complaints should last by definition less than 6 mothsTherapy and prognosis:chronic and relapsing but some cases experience only one episodetreatment approaches – as in somatization disorder

Conversion & Dissociation Disorder

Conversion and dissociation disorder is an illness of symptoms or deficits that affect voluntary motor or sensory functions, which suggest another medical condition, but that is judged to be caused by psychological factors because the illness is preceded by conflicts or other stressors. The symptoms or deficits of conversion & dissociation disorder are not intentionally produced, are not caused by substance use, are not limited to pain or sexual symptoms, and the gain is primarily psychological and not social, monetary, or legal. It was originally combined with the syndrome known as somatization disorder and was referred to as hysteria, conversion reaction, or dissociative reaction.
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Conversion & Dissociation Disorder
Historyconversion disorders were understood to be conditions in which a psychological conflict occurred to which the patient could not consciously admit. According to Freud, there was at least one motive which could be allowed to emerge into consciousness. For example, a woman may develop hysterical symptoms because a forbidden Oedipal wish—to be closer to a man who, to her, represents her father—is in conflict with unconscious feelings of guilt that she is thereby displacing her mother in such a relationship. The resolution of both these unconscious wishes with a symptom like a paralysis which prevented a man from courting her would constitute the primary gain of her illness. *

Conversion & Dissociation Disorder

History cont’dThis notion of primary gain is basic to the Freudian dynamic theory. It should not be confused with secondary gain which is more often mentioned and which represents the advantages that follow from the sick role (e.g. the loss of the use of a limb), with such benefits as extra attention, nursing, special consideration, and perhaps financial reward in compensation cases. According to this theory, secondary gain is an important part of the reinforcing mechanisms in the maintenance of hysterical symptoms—a rather common-sense idea. However, primary gain is part of the causal system. *

Conversion & Dissociation Disorder

In both ICD-10 and DSM-IV dissociative symptoms are regarded as arising from emotional conflict.In ICD-10 , ‘in the dissociative disorders it is presumed that ... ability to exercise a conscious and selective control is impaired . DSM-IV adopts a different approach. Conversion disorders are classified under ‘somatoform disorders', in which the common feature of all conditions is the presence of physical symptoms that suggest a general medical condition. The symptoms are required to cause clinically significant distress or impairment in social, occupational, or other areas of functioning. *

Conversion & Dissociation Disorder

The difference between conversion disorder and somatization disorder lies in the number of symptoms and in the fact that conversion disorders are primarily limited to voluntary motor or sensory function without pain, but resemble neurological disease. In DSM-IV it is assumed that in dissociative disorder there is a disruption in the integrated functions of consciousness. Several types are listed: dissociative amnesia, dissociative fugue, dissociative identity disorder or depersonalization disorder, and dissociative disorder not otherwise specified.
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Conversion disorder

Clinical symptoms Motor symptoms: Weakness, paralysis, seizures, aphonia and abnormal movements, tremor. Sensory deficits : Anesthesia, blindness, deafness, peripheral nerve sensory loss, visual hallucinations. Visceral symptoms: Vomiting, diarrhea, urinary retention, pseudocyesis, globus hystericus.
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Dissociative symptoms

Stupor is marked by a profound diminution or absence of voluntary movement, but normal responsiveness to external stimuli such as light, noise, and touch. There is an apparent disturbance of consciousness but the patient is neither asleep nor unconscious. Amnesia In amnesia of psychological origin (psychogenic amnesia) there is a loss of knowledge of personal identity with preservation of other information, often including complex learned information or skills. The patient may not know who he is, but knows who is the President, or his doctor.
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Dissociative symptoms
Fugue The main phenomenon is sudden unexpected travel away from home or a customary place of work. There is also inability to recall their personal past history. Sometimes a partial or completely new identity is assumed. The memory for some recent traumatic or stressful event may be lost, although these matters are discovered when other informants become available. Dissociative identity disorder (formerly multiple personality disorder ) the presence of two or more distinct identities, or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self'. At least two of these identities or personality states must recurrently take control of the person's behaviour. There should also be inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
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Conversion disorder

Data indicate that conversion disorder is most common among rural populations, persons with little education, those with low intelligence quotients, those in low socioeconomic groups, and military personnel who have been exposed to combat situations. It is more in females than males.
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Conversion disorder

Patients withconversion disorder reported a higher incidence of physical/sexual abuse, a larger number of different types of physical abuse, sexual abuse of longer duration, and incestuous experiences more often than comparison patients. In addition, within the group of patients with conversion disorder, parental dysfunction by the mother—not the father—was associated with higher scores on the Dissociative Experiences Scale and the Somatoform Dissociation Questionnaire. Physical abuse was associated with a larger number ofconversion symptoms (Structured Clinical Interview for DSM-IV Axis I Disorders).The present results provide evidence of a relationship between childhood traumatization and conversion disorder. *

Conversion disorder

Treatment Resolution of the conversion disorder symptom is usually spontaneous, although it is probably facilitated by insight-oriented supportive or behavior therapy. The most important feature of the therapy is a relationship with a caring and confident therapist Parenteral amobarbital or lorazepam may be helpful in obtaining additional historic information, especially when a patient has recently experienced a traumatic event
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