Somatoform Disorders  Definition?  Common Features  Lots of Physical Complaints  Appear to be Medical Conditions  But No Identifiable Medical Cause  Pathological Concern about  Functioning of body or  Physical appearance  Cultural Factors

 Five Somatoform Disorders  Hypochondriasis  Somatization Disorder  Conversion Disorder  Pain Disorder  Body Dysmorphic Disorder

 Physical Complaints/No Known Medical Cause  Preoccupied with Bodily Symptoms  Misinterpretation of Symptoms  Vicious Cycle  Severe Anxiety About Possibly Having a Serious Disease  Strong Disease Conviction  Differentiated from Illness Phobia  Many Medical Visits and Tests  Reassurance Doesn’t Help

 Psychological Treatment  Challenge illness-related misinterpretations  Provide more substantial and sensitive reassurance  Stress management and coping strategies  Medical Treatment?

 Many Physical Complaints/No Known Medical Cause Many Physical Complaints/No Known Medical Cause  Concern about Symptoms but Not What They Mean Concern about Symptoms but Not What They Mean  Life/Identity Revolves Around Symptoms Life/Identity Revolves Around Symptoms

 Treatment Treatment  Difficult to Treat Difficult to Treat  No Proven Treatments No Proven Treatments  Treatment Focuses on Treatment Focuses on  Reduction of Medical Visits Reduction of Medical Visits  Assign a “Gatekeeper” Physician Assign a “Gatekeeper” Physician  Reducing Secondary Gain Reducing Secondary Gain

 Physical Symptoms /No known medical cause Physical Symptoms /No known medical cause  Popularized by Freud as… Popularized by Freud as…  Connection to trauma [Dissociative process?] Connection to trauma [Dissociative process?]  Physical Malfunctioning Physical Malfunctioning  Often involves sensory-motor areas Often involves sensory-motor areas  Paralysis, Blindness, Mutism, Anesthesia Paralysis, Blindness, Mutism, Anesthesia  La Belle Indifference La Belle Indifference

 Treatment Treatment  No Well Established Treatments No Well Established Treatments  Address the Trauma Address the Trauma  Remove Sources of Secondary Gain Remove Sources of Secondary Gain  Reduce supportive consequences of talk about physical symptoms Reduce supportive consequences of talk about physical symptoms

 Complaints of pain/no known medical cause Complaints of pain/no known medical cause  Pain is Real Pain is Real  Pain May Initially Have Organic Cause Pain May Initially Have Organic Cause  Psychological Factors Maintain Pain Psychological Factors Maintain Pain  Can Be Debilitating Can Be Debilitating

 Malingering Malingering  Factitious Disorders Factitious Disorders  Munchausen’s Syndrome by Proxy Munchausen’s Syndrome by Proxy

 Previously known as dysmorphophobia Previously known as dysmorphophobia  Preoccupation with Defect in Appearance Preoccupation with Defect in Appearance  “Imagined” Ugliness “Imagined” Ugliness  Fixation or Avoidance of Mirrors Fixation or Avoidance of Mirrors  Ideas of Reference Ideas of Reference  Suicidal Ideation and Tendencies Suicidal Ideation and Tendencies

 Treatment Treatment  Plastic surgery? Plastic surgery?  Medications (i.e., SSRIs) that work for OCD provide some relief Medications (i.e., SSRIs) that work for OCD provide some relief  Exposure and Response Prevention Exposure and Response Prevention

 DSM-5 Changes  Conversion Disorder – Same/Similar  Body Dysmorphic Disorder - Moved to OCD Section  Hypochondriasis – Renamed Illness Anxiety DO, sort of  Somatic Symptom Disorder (new!)  Combined:  Hypochondriasis, maybe  Somatization Disorder  Pain Disorder

 Somatic symptom disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms. To be diagnosed with SSD, the individual must be persistently symptomatic (typically at least for 6 months).

 Several important changes have been made from previous editions of DSM. The DSM-IV disorders of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed, and many, but not all, of the individuals diagnosed with one of these disorders could now be diagnosed with SSD. The DSM-IV diagnosis of somatization disorder required a specific number of complaints from among four symptom groups. The SSD criteria no longer have such a requirement; however, somatic symptoms must be significantly distressing or disruptive to daily life and must be accompanied by excessive thoughts, feelings, or behaviors.

 Another key change in the DSM-5 criteria is that while medically unexplained symptoms were a key feature for many of the disorders in DSM-IV, an SSD diagnosis does not require that the somatic symptoms are medically unexplained. In other words, symptoms may or may not be associated with another medical condition. DSM-5 narrative text description that accompanies the criteria for SSD cautions that it is not appropriate to diagnose individuals with a mental disorder solely because a medical cause cannot be demonstrated. Furthermore, whether or not the somatic symptoms are medically explained, the individual would still have to meet the rest of the criteria in order to receive a diagnosis of SSD.