Somatoform disorders• Characterized by complaints of physical symptoms that cannot be explained by known physical mechanisms• These disorders have in common the belief that physical symptoms are real despite evidence to the contrary.• The affected individual experiences changes or loss in physical function.
• The physical symptoms are not under the individuals voluntary control• Significant impairment occurs in social or occupational functioning
• Individuals with somatoform disorders will present in the medical rather than the psychiatric setting because of their belief that the problems are medical• The individual should receive a thorough medical evaluation – if possible, avoiding repeating tests that have already had negative results
• The diagnosis of somatoform disorder will be made after a thorough medical evaluation in which no organic basis for the symptoms is validated
• Level and setting of care to be provided is determined – In general, the individual will be treated on an outpatient basis, unless underlying mood disorder is present leading to risk for self-harm• Referral to psychiatric treatment is generally rejected by the individual with a somatoform disorder
• GOAL: – To maintain a long-term relationship with a specific health care provider to prevent patient from seeking multiple providers with multiple recommendations for testing, treatments, and drugs
Psychotherapy• Psychodynamic – assist the individual to express conflicts and emotions verbally rather than displacing them onto physical symptoms.• Behavioral – establish a program whereby adaptive behavior is reinforced and illness behaviors do not receive secondary gains.
Psychotherapy• Cognitive – restructure belief system that perpetuates illness- related behaviors.• Family therapy – assist family members to define appropriate boundaries and support patient in increasing self- responsibility.
• Somatic therapies – Somatoform disorders are usually not treated with psychopharmacologic drugs because these patients are susceptible to dependency on drugs used.
• Mood disorders, especially depression, are a common comorbid problem in individuals with somatoform disorders• Antidepressant drugs may be used to treat the mood disorder.