1. Somatoform Disorders By : Dr Seddigh HUMS Dr Seddigh

2. An Overview of Somatoform Disorders SSomatoform Disorders SS omatization disorder CC onversion disorder HH ypochondriasis BB ody dysmorphic disorder PP ain disorder

3.  Hypochondriasis

4. Hypochondriasis: An Overview  Clinical Description  Anxiety or fear be or having a seriuos disease  bodily symptoms  Hypochondrium

5. Hypochondriasis: An Overview  Statistics  4% to 6% of medical patients  15% rate  Female : Male = 1:1  Onset at any age  Peaks: age (20-30)  Medical students

6. Hypochondriasis  Causes  Familial history  Genetics  Modeling/learning  Other factors  Stressful life events  “Benefits”

7. Hypochondriasis  Causes  Disorder of cognition or perception  Physical signs and sensations

8. Hypochondriasis in DSM IV A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms B. The preoccupation persists despite apprpriate medical evaluation and reassurance C. The belief in Criterion A is not of delusional intensity

9. Hypochondriasis D. The preoccupation causes significant distress or impairment in functioning E. The duration of the disturbance is at least 6 months rumination about illness, suggestibility unrealistic fear of infection, fascination with medical information fear of prescribed medication. rumination about illness plus at least one of five other symptoms form a distinct diagnostic entity performing better than the current DSM-IV hypochondriasis diagnosis Am J Psychiatry 161:1680-1691, September 2004

10.  Hypochondriasis  Somatoform Disorder or Anxiety Disorder???

11. Hypochondriasis  Differ phobia  Hypochondriasis: already have  Reassurance temporary  Better prognosis 1- good socioeconomic 2- anxiety or depression (sensitive) 3-acute onset 4-no personality dx 5- no medical problem accidents and criminal victimization develop various diseases. Am J Psychiatry 163:907-912, May 2006

12. Hypochondriasis - Treatment  Group therapy  Insight oriented and HX  Cognitive-Behavioral  Identify and challenge misinterpretations  “Symptom creation”  Stress-reduction Physical exam medications (SSRI)

13.  Body Dsmorphic Disorder

14. Body Dysmorphic Disorder  Clinical Description  Imagined defect in appearance  Impaired function  Social  Occupational  Not attracted  Dysmorphophobia

15. Body Dysmorphic Disorder  Statistics  1% to 15% (unknown)  Female >: Male = ~1:1  Onset = 15 – 30 y/o  Most remain single  Lifelong, chronic course  With MDD, Anxiety & Psychosis

16. Body Dysmorphic Disorder: Causes  Little scientific knowledge  Cultural imperatives  Body size  Skin color  Serotonin ( OCD )

17. Body Dysmorphic Disorder in DSM IV A.Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive. B.The preoccupation causes clinically significant distress or impairment in functioning C.The preoccupation is not better accounted for by another mental disorder

18. Body Dysmorphic Disorder  Comorbidity with depression  Some believe it is similar to OCD  Obsessions  Compulsions  5 most common locations for perceived deficits:  Skin – 73%  Hair – 56%  Nose – 37%  Stomach – 22%  Breasts/chest/nipples – 21% partial remission 0.21 Gender and ethnicity did not significantly predict remission Am J Psychiatry 163:907-912, May 2006

19. Body Dysmorphic Disorder  Clinical Description  mirrors  Suicidal ideation and behavior  Unusual behaviors  Ideas of reference  Checking/compensating rituals  Delusional disorder: somatic type? Suicidal ideation mean of 57.8% per year attempted suicide mean of 2.6% per year. completed suicide (0.3% per year). Am J Psychiatry 163:1280-1282, July 2006

20.  Treatment Treatment  The Plastic Surgery Solution? The Plastic Surgery Solution?  Popular but Expensive Popular but Expensive  Most are Disappointed with Results Most are Disappointed with Results CBT: Exposure and Response Prevention – very effective Pimozide,TCA,MAO INH Clomipramine, SSRI’s – moderately effective  Treatment Treatment  The Plastic Surgery Solution? The Plastic Surgery Solution?  Popular but Expensive Popular but Expensive  Most are Disappointed with Results Most are Disappointed with Results CBT: Exposure and Response Prevention – very effective Pimozide,TCA,MAO INH Clomipramine, SSRI’s – moderately effective Body Dysmorphic Disorder With olanzapine treatment, body dysmorphic disorder symptoms minimally improved Pimozide augmentation of fluoxetine treatment for body dysmorphic disorder was not more effective than placebo, Am J Psychiatry 162:377-379, February 2005

21.  Pain Disorder

22.  Clinical Description Clinical Description  Pain is Real Pain is Real  Pain May Have Organic Cause Pain May Have Organic Cause  Psychological Factors Have an Important Role in: Psychological Factors Have an Important Role in:  onset onset  severity severity  exacerbation OR exacerbation OR  maintenance of the pain maintenance of the pain  Clinical Description Clinical Description  Pain is Real Pain is Real  Pain May Have Organic Cause Pain May Have Organic Cause  Psychological Factors Have an Important Role in: Psychological Factors Have an Important Role in:  onset onset  severity severity  exacerbation OR exacerbation OR  maintenance of the pain maintenance of the pain Pain Disorder

23.  Clinical Description  Pain in one or more areas  Significant impairment  Etiology may be physical  Maintained by psychological factors

24. Pain Disorder  Statistics  Fairly common  5% - 12%  Sex female 2 times  Age from 30 & 40 y/o

25. Pain Disorder in DSM IV A. Pain in one or more anatomical sites that is of sufficient severity to warrant clinical attention B. The pain causes clinically significant distress or impairment in functioning C. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance or the pain D. The symptom or deficit in not intentionally produced or feigned (as in Factitious Disorder or Malingering) E. The pain is not better accounted for by another mental disorder

26.  Treatment Treatment  Behavioural Management,CBT& Insight oriented Behavioural Management,CBT& Insight oriented  Medication Medication not effective : analgesic,antianxiety & sedative effctive :TCA,SSRI & AMPHETAMINE  Others Others BIOFEEDBACK HYPNOSIS  Treatment Treatment  Behavioural Management,CBT& Insight oriented Behavioural Management,CBT& Insight oriented  Medication Medication not effective : analgesic,antianxiety & sedative effctive :TCA,SSRI & AMPHETAMINE  Others Others BIOFEEDBACK HYPNOSIS Pain Disorder

28. THANKS FOR YOUR KIND ATTENTION