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 3 rd -4 th decade of life  Community prevalence %; 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)

 Thank you