1. Prof. Dr. Elham Al-Jammas 6\10\2013
Somatoform Disorders
Prof. Dr. Elham Al-Jammas \10\2013

2. Objectives
1. To define the term Somatoform disorder,& its different types 2. To determine the criteria of diagnosing somatoform disorders 3. To be able to diagnose the different types of somatoform disorders. 4. To have the ability to treat such disorder

3. Definition
Soma=BODY Somatoform disorders: are mental illnesses that cause physical pain and other symptoms without any physical explanation. Or:pathological concern of individuals with the appearance or functioning of their bodies when there is no identifiable medical condition causing the physical complaints Dissociative disorders individuals feel detached from themselves or their surroundings, and reality, experience, and identity may disintegrate. Historically, both somatoform and dissociative disorders used to be categorized as hysterical neurosis in psychoanalytic theory neurotic disorders result from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms Somatoform disorder refers to what many people used to call a psychosomatic disorder

4. Epidemiology
Prevalence :: Women 0.2 – 2 % Men 0.2 % Female: Male ratio :: 5-1 Types(DSM1V) : 1.Hypochondriasis 2.Convertion 3.Pain disorders 4.Somatization disorder 4.Body dysmorphic syndrome

5. Predisposing factorstors
-Begins before age of 30
-Low income and poor
education -Commonly Coexist with
other mental disorders -Personality: Avoidant
Paranoid self defending and obsessional features

6. Etiology
No one knows exactly why symptoms of somatoform disorders appear. 1.MA theory of pain 2.Childhood illness and history of parental anxiety toward illness 3.increased frequency of somatization disorders in first degree relatives 4.Childhood sexual abuse 5psychoanalytic theory : It could be substitution psychological conflict.

7. Stress can cause physical symptoms even when no physical disorder is present. Sometimes physical symptoms result from the body's automatic response to emotional stress, as when heart rate and blood pressure increase in response to fear. Sometimes a physical symptom appears to be a metaphor for an emotional experience, as when people with a “broken heart” have chest pain. Or a physical symptom may reflect identification with another person's pain. For example, people may have chest pain after a family member or friend has had a heart attack

10. Diagnosis of Somatoform Disorders:
Diagnosis combines the medical and the psychological A patient who visits a healthcare provider with unexplained symptoms must be thoroughly examined to rule out any possibilities of physical illness or trauma. A medical doctor confronted with a patient who is preoccupied with inexplicable symptoms may recommend a mental health evaluation if he suspects a somatoform disorder. A mental health evaluation must be conducted carefully to rule out other diagnoses. The perceived symptoms, the preoccupation with the symptoms, and the repeated search for help may be part of a larger mental health problem. Additionally, two related disorders must be ruled out

11. Criteria for Somatoform Disorders
It is important to remember that someone who plays sick for a day does not have a somatoform disorder. Three criteria are required for diagnosis: 1.The physical symptoms cannot be fully explained by a medical condition, another mental illness, or by the effects of a substance 2.The diagnosis is not factitious disorder or malingering 3.The symptoms significantly impair in social, occupational, or other daily life functioning..

13. Types of Somatoform Disorders Somatization Disorder (a. k. a
Types of Somatoform Disorders Somatization Disorder (a.k.a. Briquet's syndrome)
Somatization disorder patients usually have a pretty long history of doctor visits for a variety of symptoms. There are specific criteria in the DSM for somatization disorder: a history of somatic symptoms prior to the age of 30; pain in at least four different sites on the body; two gastrointestinal problems other than pain such as vomiting or diarrhea; one sexual symptom such as lack of interest or erectile dysfunction; one pseudo neurological symptom similar to those seen in conversion disorder such as fainting or blindness

14. Undifferentiated somatoform disorder
This is a somewhat vague version of somatization disorder, requiring only one symptom for 6 months
Conversion disorder
The DSM describes conversion disorder with the following criteria: one or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition; psychological factors are judged to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit; a diagnosis where the stressor precedes

15. conversion insistence on the presence of a particular illness.
large variety of unsubstantiated physical complaints.
persistent complaints of pain with disproportionate disability.
personality style featuring physical manifestations of psychological problems.
sensory or motor symptoms suggesting neurologic origin.

18. Pain disorder
As its name suggests, patients with pain disorder report pain that has no apparent physical cause; in pain disorder the patient is not "faking" the pain as in malingering. They have chronic pain for several months that causes stress and disrupts daily life. The pain may or may not be associated with a medical condition

19. hypochondriasis

21. Hypochondriasis
. The DSM lists the following criteria for hypochondriais : a preoccupation with fears of having a serious disease based on the misinterpretation of bodily symptoms; the preoccupation persists despite medical evaluation and reassurance; 3.the belief in the presence of disease and symptoms is not of delusional intensit 4. and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder) 5.; the preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; 6. the duration of the disturbance is at least 6 months 7.; the preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder

22. Body dysmorphic disorder
A person with body dysmorphic disorder:- obsessesion over a physical imperfection or deformity that may or may not exist. For example, a small scar on a hand might cause someone to constantly wear gloves and take extreme measures to prevent anyone from seeing their hands. The DSM defines body dysmorphic disorder as a somatoform disorder marked by a preoccupation with an imagined or trivial defect in appearance that causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

24. Somatoform Disorder not Otherwise Specified ( NOS )
This diagnosis is reserved for those conditions that are characteristic of somatoform disorders but fail to meet the criteria for more specific diagnosis

27. Factitious Disorder and Malingering
Factitious disorder and malingering must both be ruled out before moving on to a somatoform disorder.
A patient with factitious disorder takes on physical symptoms for internal gain. For example, someone who longs for sympathy may exaggerate or feign stomach pain.
A patient who is malingering takes on physical symptoms for external gain. External gain can be something like money (in the form of disability payments, for example) or something a little more subtle such as avoidance of situations (such as family gatherings)

28. DD between malingering & Factitious disorders
Both are different names for the same condition.
Factitious disorder attempts to achieve psychological benefit, malingering attempts to achieve external benefit.
Factitious disorder is conscious, malingering is primarily unconscious.
Malingering is a much more chronic condition than factitious disorder.
Malingering patients complain of a wider variety of symptoms

29. Treatment Treatment for somatoform disorders is usually therapy based
1.Medical treatments can be used, especially when another disorder is being treated in conjunction, but there is not much evidence that they are very effective for somatoform disorders by themselves
2.cognitive behavioral therapy was the most effective form of treatment.

30. Some common forms of therapy that may be used to treat somatoform disorders include:
-Adlerian Therapy
-Behavior Therapy
-Existential Therapy
-Gestalt Therapy
-Person-centered Therapy
-Psychoanalytic
-Rational-emotive Therapy
-Reality Therapy
-SupportGroups.com
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32. Thank you