Somatoform Disorders: (Now titled Somatic Symptom Disorder or Illness anxiety disorder in DSM-V)

Somatoform Disorders  Three central features of Somatoform Disorders:  Physical complaints without organic basis  Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms  Symptoms or magnified health concerns are not under conscious control(Guggenheim2000)

Somatization disorder Somatization disorder Somatization disorder Multiple recurrent physical complaints over many years Multiple recurrent physical complaints over many years No organic etiology for these complaints No organic etiology for these complaints Begins by age 30 Begins by age 30 Pain, GI, sexual, pseudoneurologic symptoms: impaired coordination or balance, paralysis or localized weakness, difficulty swallowing, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, amnesia, sensory loss, loss of consciousness Pain, GI, sexual, pseudoneurologic symptoms: impaired coordination or balance, paralysis or localized weakness, difficulty swallowing, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, amnesia, sensory loss, loss of consciousness

Interventions for somatization Be aware of own responses Be aware of own responses Rule out organic basis for complaints Rule out organic basis for complaints Focus on anxiety reduction, not physical symptoms Focus on anxiety reduction, not physical symptoms Minimize secondary gain(I.e. increased attention and decreased responsibilities) Minimize secondary gain(I.e. increased attention and decreased responsibilities)

Conversion Disorder Conversion Disorder Functional Neurological Symptom: Turn psychological stress into physical ways. Converts an emotional crisis into a physical issue. Functional Neurological Symptom: Turn psychological stress into physical ways. Converts an emotional crisis into a physical issue. No actual physical cause, but it affects the senses and can be very persistent. No actual physical cause, but it affects the senses and can be very persistent. Pilot Going Blind when tasked to bomb a city. Pilot Going Blind when tasked to bomb a city. Ricky Bobby Ricky Bobby

Intervention –conversion d/o Focus on anxiety reduction, not physical symptoms Focus on anxiety reduction, not physical symptoms Use matter-of-fact approach Use matter-of-fact approach Encourage client to discuss conflict Encourage client to discuss conflict Minimize secondary gains Minimize secondary gains Provide diversionary activities Provide diversionary activities Encourage expression of feelings Encourage expression of feelings

Pain Disorder Physical symptom of pain-one or more anatomic sites Physical symptom of pain-one or more anatomic sites May occur with a General medical condition May occur with a General medical condition Pain –not relieved by analgesics Pain –not relieved by analgesics Onset, severity, exacerbation and maintenance affected by psychological stressors Onset, severity, exacerbation and maintenance affected by psychological stressors Therapy focuses on Therapy focuses on Pain management Pain management Encourage participation in activities Encourage participation in activities Provide distractions Provide distractions

Hypochondriasis or Illness anxiety disorder Hypochondriasis or Illness anxiety disorder Client is preoccupied with fear that he/she has or will get a serious disease Client is preoccupied with fear that he/she has or will get a serious disease History of seeing many doctors History of seeing many doctors Misinterpretation of bodily sensations or functions despite medical evaluations and reassurance Misinterpretation of bodily sensations or functions despite medical evaluations and reassurance Preoccupation with symptoms is not as intense or distorted as in delusional disorder Preoccupation with symptoms is not as intense or distorted as in delusional disorder Significant distress/impairment in function Significant distress/impairment in function Dependent attention Dependent attention

Hypochondriasis interventions Rule out presence of actual disease Rule out presence of actual disease Focus on anxiety, not physical symptoms Focus on anxiety, not physical symptoms Provide diversionary activities Provide diversionary activities Avoid negative responses to client demands/conference with staff Avoid negative responses to client demands/conference with staff Provide client with correct information Provide client with correct information

Body Dysmorphic Disorder Preoccupation with imagined or exaggerated defects in physical appearance Preoccupation with imagined or exaggerated defects in physical appearance Causes clinically significant stressor impairment in social or occupational function… person may undergo repeated plastic surgeries for nose repair or to change face etc. Causes clinically significant stressor impairment in social or occupational function… person may undergo repeated plastic surgeries for nose repair or to change face etc.