This powerpoint presentation represents definition of the Somatoform disorder, its subtypes, etiology in perspective of theories along differential diagnosis in an attempt to shed light on the disorder adequately
Ms. Mirrat Gull
Sir Ganga Ram Hospital, Lahore
“Soma” means „body‟ and Somatoform
Disorders involves patterns in which individuals
complains of bodily symptoms that suggest the
presence of medical problems, but for which no
organic basis can be found that satisfactorily
explains the symptoms.
Such individuals are typically preoccupied
with their state of health and with various
presumed disorders or diseases of bodily
A history of many physical complaints
beginning before age 30 years that occur over
a period of several years and result in
treatment being sought. Each of the following
criteria have been met;
• Four pain symptoms,
• Two gastrointestinal symptoms,
• One sexual symptom &
• One pseudoneurological symptom
(Common symptomsHeadache, nausea, deafness, blurred
vision, double vision, chest, stomach
It is chronic but fluctuating disorder, a year
seldom passes without individual‟s seeking
some medical attention just like “doctor
shopping” going from one physician to the next.
Diagnostic criteria are met before age
25, but initial symptoms are often present by
Menstrual difficulties may be earliest
symptoms in women.
Sexual symptoms are often associated with
Studies have reported widely variable
prevalence of Somatization Disorder, ranging
0.2% to 2% among women
Less than 2% in men
Diagnosis depends on whether the
interviewer is a physician or a non physician
who may less frequently diagnose Somatoform
It is originally known as “Hysteria”,
involves a pattern in which one or more
symptoms affecting voluntary, motor or sensory
function that mimic neurological or other
general medical condition.
It is initiated by psychological factors and
is not intentionally produced or feigned. The
symptoms manifest themselves as sensory
symptoms, motor symptoms and visceral
(internal organs) symptoms.
• With motor symptoms or deficits(impaired
coordination or balance, paralysis, lump in
• With sensory symptoms or deficits(loss of
touch or pain sensation, double
vision, deafness, hallucination)
• With seizures or convulsions
• With mixed presentation
The onset is usually from late childhood to
In middle or old age, the probability of
neurological or other general medical
condition is high.
Recurrence is common predicting future
Factors that are associated with good
prognosis include acute onset, presence of
clearly identifiable stress, short interval
between onset and treatment & above
Reported rates of Conversion Disorder
have varied widely, ranging from 11/100,000 to
500/100,000 in general population samples.
Other results shows that conversion is
3% of outpatients
1% and 14% of inpatients
Pain disorder is characterized by pain in
one or more anatomical sites which are
clinically significant. There may have been
clear physical reasons for pain, but
psychological factors play a major role in
The pain has organic basis, is real and it
hurts. It is not intentionally produced or feigned.
• Pain Disorder associated with psychological
• Pain Disorder associated with both
The course of the disorder depends upon its
• acute onset resolves in short time and
• chronic phase may take years to resolve.
Important factors that influence recovery are,
Individual‟s acknowledgement of pain
Participation in regularly scheduled activities
Not allowing pain to become the determining
factor in one‟s life
Prevalence of Pain Disorder is unclear.
Pain Disorder associated with general
medical condition and psychological factors is
more common than Pain Disorder associated
with psychological factors.
Preoccupation with fears of having a
serious disease based on person‟s
misinterpretation of bodily symptoms. The
preoccupation persists despite medical
evaluation. The duration of the disturbance is at
least 6 months.
Some people may have both, disease
conviction( mistaken belief of having a disease)
and illness phobia (fear of developing disease)
With poor insight(during the current episode the
person does not realize that concern is excessive
Hypochondriasis can begin at any age but
most common is early adulthood. The course is
The prevalence of Hypochondriasis in the
general population is 1% to 5%.
Generalized Anxiety Disorder
Major Depressive Episode
Obsessive Compulsive Disorder
Body Dysmorphic Disorder
Old Age concerns
The disorder is characterized by
preoccupation with imagined defect in
appearance, a slight defect in appearance has
markedly excessive concern. That is why the
disorder has been referred to as “imagined
One interesting aspect of Body
Dysmorphic Disorder is sometimes people
either become fixated on mirrors or avoid
mirrors to an almost phobic extent.
It usually begins during adolescence but
can also begin in childhood. The onset may be
gradual or abrupt. The disorder may not be
diagnosed for many years, often because
individuals with the disorder are reluctant to
reveal their symptoms.
Clinical settings, Body Dysmorphic Disorder
with Anxiety is approx. 5%
Cosmetic surgery & dermatology, Body
Dysmorphic Disorder ranges from 6% to 15%
Normal concerns about appearance
Gender Identity Disorder
Major Depressive Episode
“Conservation of energy” stated that
strong emotions either sexual or of hostility that
are repressed, forced out of consciousness;
eventually will overflow and transform itself in
the form of somatic symptoms. The individual
often experiences la belle indifference that he
doesn‟t seem at all disturbed by his disability.
The primary gain is relief from anxiety and
relief from responsibilities is the secondary
According to Cognitive theory somatoform
disorders are basically disorders of perception
and thinking, by misinterpreting and
exaggerating normal bodily sensations.
Somatization and hypochondriasis
involves over attention of body
symptoms, whereas conversion is based on
withdrawal of attention. This perspective fails to
explain why over attention or under attention to
BEHAVIORAL PERSPECTIVE-Learning to
adopt sick role
The person adopt sick role either directly,
by being ill, or indirectly, by having the sick role
modeled, or by reinforcement at the time of
illness. Thus operant conditioning predisposes
a person to adopt the sick role in adult life.
The sick role involve sacrifices like loss of
power or pleasurable activities, but these are
tolerated for so long because their learning
histories have made the rewards of the sick
role more reinforcing than the rewards of illness
SOCIOCULTURAL PERSPECTIVEReinforcement of the sick role
Sociocultural theorists focus on larger
cultural forces. The likelihood of a person using
the sick role as coping style depends on his or
her culture‟s modeling of and reaction to
unexplained somatic symptoms.
Several non-western(china) cultures in
which frank expression of emotional
disturbance is considered unacceptable
evidence somatizing patterns to be relatively
and Brain dysfuction
Studies have shown that, among the first
degree relatives of patients with somatization
disorder, women shows increase frequency of
Individual with somatization disorder(esp
conversion) receive normal sensory input from
their “disabled” organs but the processing of
sensory signals in the cerebral cortex is
dysfunctional. Further, 70% of the clients have
problems in their left side of the body that
suggests it may stem from right cerebral
1. Is there any organic basis for somatoform
2. What is the primary gain of somatoform
3. What is the difference between
hypochondriasis and somatization disorder?
4. Does above average intelligence support
good prognosis of conversion disorder?
5. What is the criteria for duration, to diagnose
6. Which disorder has usually chronic course?
7. Why Body Dysmorphic Disorder is not
diagnosed early after its onset?
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