Somatoform Disorder

Presented by
Doon Psychotherapeutic Centre
 Introduction
• The somatoform disorders are characterized by repeated presentation with
physical symptoms which do not have any adequate physical basis (and are
not explained by the presence of the psychiatiatric disorder), and a persistent
request for investigations and treatment despite repeated assurance by the
treating doctors.
 Introduction
• • The term somatoform derives from the Greek “soma” means body and
mind.
• • The somatoform disorders are a group of disorder that include physical
signs and symptoms (for example pain, nausea and dizziness) for which an
adequate medical explanation cannot be found.
• • Patients with somatoform disorder are convinced that their suffering comes
from presumably untreated bodily derangement.
DSM 5 Classification
 Somatoform disorder
• The essential feature of somatization disorder is multiple somatic complaints
of long duration, beginning before the age of 30 years. It was known before
as hysteria, it is common for women and may coexist with other mental
disorders.
 Symptoms of somatization
• Multiple somatic symptoms in the absence of any physical disorder.
• The symptoms are recurrent and chronic (of many years duration, usually); at least 2
year duration is needed for diagnosis.
• The symptoms are vague, presented in a dramatic manner, and involve multiple
organ systems.
• There is frequent change of treating physicians
• Some degree of impairments of social and family functioning attributable to the
nature of symptoms and resulting behavior.
 Diagnosis
• Criteria A: Requires that the onset of symptoms before the age of 30 that occurs
over period of several years, and cause impairment in social, occupational, or other
important areas of functioning.
• Criteria B: Each of the following criteria must have been met, with the individual
symptoms occurring at any time during a period of the disturbance:
• Four pain symptoms: 4 different sites: head, back, abdomen, chest, extremities,
joints, rectum, during menstruation, during sexual intercourse or during urination.
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• two gastrointestinal symptoms: nausea, bloating, vomiting, diarrhea,
intolerance of several food.
• One sexual symptoms: irregular or excessive menses, erectile or ejaculatory
dysfunction, vomiting throughout pregnancy.
• One pseudo neurological symptom (fake) they include impaired coordination
or balance, paralysis, blindness, difficult, swallowing, loss of touch or pain
sensation, double vision, lump in throat, hallucination and none of which is
explained by physical cause
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• Criteria C : either (1) or (2):
• • After appropriate investigation, each of the symptoms in criterion (B)
cannot be fully explained by a known general medical condition or the direct
affect of a substance.
• • When there is a related medical condition, the physical complaints or
resulting social or occupational impairment are in excess of what be
expected from history, physical examinations and laboratory findings.
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• Criteria D: • The symptoms are not intentionally produced or feigned as in
factitious or malingering.
• • Other notes:
• • It is chronic disease.
• • Somatization disorder is commonly associated with other mental disorders,
including major depressive, personality disorder, substance-related disorder,
generalized anxiety disorder, phobia and schizophrenia.
 Treatment
The treatment is often difficult. It mainly consist of:-
• Supportive Psychotherapy –
• Behavior modification
• Relaxation therapy
• Drug therapy
 Hypochondriasis
• The term is derived from the old medical term hypochondruim (below the
ribs).
• Defined as a persons preoccupation with the fear of contracting or belief of
having a serious disease, disease phobia despite medical reassurance.
• It begins at any age and most common in early adulthood.
• It is chronic disorder.
 Diagnosis
• A. Preoccupation with fears of having, or the idea that has a serious disease
based on the persons misinterpretation of bodily symptoms.
• B. The preoccupation persists despite medical evaluation.
• C. The belief in criterion A is not of delusional intensity and is not restricted
to a concern about appearance.
• D. The preoccupation causes significant distress or impairment in social,
occupational of functioning. E. The duration of the disturbance is at least 6
months.
 Aetiology
1. Psychodynamic theory- hypochondriasis is believed to be based on a narcissistic
personality, caused by a narcissistic libido. Here other parts of body become erotogenic
zones, which act as substitutes for genitals. Hypochondriacally focused organs symbolise
the genitals. It must be remembered that this is only a theoretical psychodynamic
construct.
As a symptom of depression
Hypochondriacally symptoms are commonly present in major depression. In fact, according to
some, in major depression. In fact, according to some, hypochondriasis is almost always a part
of another psychiatric syndrome, most commonly a mood disorder. Thus, hypochondriasis has
been visualized as a masked depression or depressive equivalent , through not everyone agrees
with this view.
 Treatment
• The treatment of hypochondria is often difficult. It basically consist of:
• Supportive psychotherapy
• Treatment of associative or underlying depression and/ or anxiety, if present
 Pain disorders
• DSM-IV-TR defines pain disorder as the presence of pain that is the
predominant focus of clinical attention.
• • Patient with chronic pain which is not caused by any physical or specific
psychiatric disorder, that pain is sufficient to cause distress or functional
impairment, such as pelvic pain and headache.
 Diagnosis
• A. Pain in one or more anatomical sites is the predominant focus of the clinical
presentation and is of sufficient severity to warrant clinical attention. B. The pain
causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
• C. psychological factors are judged to have an important role in the onset and
severity of pain.
• D. The symptoms or deficit is not intentionally produced or feigned (as in factitious
disorder or malingering).
• E. The pain is not better accounted for by a mood, anxiety, or psychotic disorder
and doesn’t meet criteria for dyspareunia (pain in intercourse).
 Pain disorder
• Acute: duration of less than 6 months. •
• Chronic: duration of 6 months or longer.
 Etiology of pain disorder
• 1. Biological factors: some neurotransmitters in the brain like serotonin,
endorphins deficiency play a role in the central nervous system modulation
of pain.
• 2. Interpersonal factors: the pain has conceptualized as a mean for gaining
advantage in interpersonal relationship; secondary gain is most important to
patient with pain disorder.
• 3. Behavioral factors: pain behaviors are reinforced when ignored or
punished or can function.
 Hyperventilation syndrome
• This is a very common clinical syndrome which is often missed, particularly
when it does not present in its full blown form. The syndrome is
characterized by a habit of hyperventilation which becomes particularly
marked in the presence of psychosocial stress, or any emotional upheaval.
• In its mild form it is characterized by excessive fatigue, chest pain, headache,
• Palpitation and the feeling of lightheadness, in severe hyperventilation
syndrome carpopaedal spasm (tetany), paraesthesias and loss of
consciousness may occur.
 Treatment
• Relaxation technique
• Teaching relaxed breading technique
• Breathing in bag technique – the aim of this technique is to have the patient
re- breathe the expired air. Re breathing in a paper bag, which is carried by
the patients quickly revert the symptoms. It is really important to emphasis a
safe use of a bag, to prevent the possibility of suffocation.
 Irritable bowel syndrome
• This is a common syndrome, often known by a large variety of names, such
as spastic colitis, irritable colon syndrome, colon neurosis.
• The patient usually present with one or more of the following symptoms
• Abdominal pain, discomfort of cramps.
• Alteration of bowel habit.
• A sensation of incomplete evacuation.
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• It is a fairly common disorder occurring in nearly 40% of all patients
attending a gastroenterology( GE) clinic. Although females more frequently
have IBS in America, in India males are more often affected. It is more or
less a stable disorder with frequent exacerbations.
 Treatment
• A stable and doctor- patient relationship.
• Supportive psychotherapy is best carried out in medical or GE clinic by the treating
physician. These patients often resent psychiatric referrals.
• Identification of current life stressors, environmental manipulation, and learning of
coping skills aimed at dealing with stressors are very helpful.
• Anti-anxiety and antidepressant medication may be helpful at times. At other times,
they just act like placebos.
• Symptomatic management is often useful.