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 3rd -4th decade of life
Community prevalence 1.1-4.5%; 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
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