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Somatization disorder


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Somatization disorder

  1. 1. Dr. Parag Moon Dept. Of Neurology, GMC ,Kota
  2. 2.  A group of disorders in which people experience significant physical symptoms for which there is no apparent organic cause  Symptoms are often inconsistent with possible physiological processes  People do not consciously produce or control the symptoms but truly experience the symptoms  Symptoms pass only when the psychological factors that led to the symptoms are resolved
  3. 3. Conversion disorder Loss of functioning in some part of the body for psychological rather than physical reasons Somatization disorder History of complaints about physical symptoms, affecting many different areas of the body, for which medical attention has been sought but no physical cause found Pain disorder History of complaints about pain, for which medical attention has been sought but that appears to have no physical cause Hypchondriasis Chronic worry that one has a physical disease in the absence of evidence that one does; frequently seek medical attention Body dysmorphic disorder Excessive preoccupation with some part of the body the person believes is defective
  4. 4.  Somatoform and Pain Disorders  Subjective experience of many physical symptoms, with no organic causes  Psychosomatic Disorders  Actual physical illness present and psychological factors seem to be contributing to the illness  Malingering  Deliberate faking of physical symptoms to avoid an unpleasant situation, such as military duty  Factitious Disorder  Deliberate faking of physical illness to gain medical attention
  5. 5.  Somatoform disorders are problems that appear to be medical but are due to psychosocial factors ◦ Unlike psychophysiological disorders, in which psychosocial factors interact with physical ailments, somatoform disorders are psychological disorders masquerading as physical problems
  6. 6.  Dissociative disorders are patterns of memory loss and identity change that are caused almost entirely by psychosocial factors rather than physical ones
  7. 7.  When a physical ailment has no apparent medical cause, physicians may suspect a somatoform disorder  People with a somatoform disorder do not consciously want, or purposely produce, their symptoms ◦ They believe their problems are genuinely medical  There are two main types of somatoform disorders: ◦ Hysterical somatoform disorders ◦ Preoccupation somatoform disorders
  8. 8.  People with hysterical somatoform disorders suffer actual changes in their physical functioning ◦ These disorders are often hard to distinguish from genuine medical problems ◦ It is always possible that a diagnosis of hysterical disorder is a mistake and that the patient’s problem has an undetected organic cause
  9. 9.  DSM-IV-TR lists three hysterical somatoform disorders: ◦ Conversion disorder ◦ Somatization disorder ◦ Pain disorder associated with psychological factors
  10. 10.  Recognized since the time of ancient Egypt.  An early name for somatization disorder was hysteria, a condition incorrectly thought to affect only women. (The word hysteria is derived from the Greek word for uterus, hystera.)  In the 17th century, Thomas Sydenham recognized that psychological factors, which he called antecedent sorrows, were involved in the pathogenesis of the symptoms.
  11. 11.  In 1859, Paul Briquet, a French physician, observed the multiplicity of the symptoms and the affected organ systems and commented on the usually chronic course of the disorder.  The disorder was called Briquet's syndrome for a time, although the term somatization disorder became the standard in the United States when the third edition of DSM (DSM-III) was introduced in 1980.
  12. 12.  Somatization is “the tendency to experience and communicate somatic distress and symptoms unaccounted by pathological findings.”  Can coincide with another illness.
  13. 13.  Prevalance- 0.2% to 2% among women and is less than 0.2% in men  Usually begins in the teenage and young adulthood years.  Onset after 30 years is extremely rare  More common in less educated and lower socioeconomic groups
  14. 14.  Observed in 10% to 20% of female first-degree relatives.  Male relatives of women with somatization disorder have an increased risk of antisocial personality, substance abuse disorders, and somatization disorder.
  15. 15.  Psychosocial Factors ◦ interpretations of the symptoms as social communication  avoid obligations  express emotions  symbolize a feeling or a belief ◦ the symptoms substitute for repressed instinctual impulses ◦ A behavioral perspective  Biological Factors ◦ characteristic attention and cognitive impairments ◦ decreased metabolism in the frontal lobes and in the nondominant hemisphere ◦ genetic components ◦ Research into cytokines
  16. 16.  Patients with somatization disorder have the tendency to react to psychosocial distress and environmental stressors with physical bodily symptoms.  Can be vague and dramatic in reporting their medical history.  Frequently move abruptly from complaining of one symptom to another symptom.
  17. 17.  Usually present with numerous symptoms, such as headaches, back pain, persistent lack of sleep, stomach upset, and chronic tiredness  Without demonstrable medical causes  Have a persistent conviction of being ill, despite repeated negative results on laboratory tests, diagnostic tests, consultations with specialists, and recurrent hospitalizations
  18. 18.  Has impaired social/work/personal functioning  Symptoms may be exacerbated by stress  No element of feigning symptoms to occupy sick role (Facititious Disorder) or for material gain (Malingerer)
  19. 19.  Physical examination is normal  May reveal some skin lesions or scars that resulted from previously performed surgeries  Affects the patient’s perception of wellness  Patient begins to believe that she or he is physically disabled and unable to work  Characteristically deny the influences of psychosocial distress in producing the symptoms,resist psychiatric referral
  20. 20.  Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria
  21. 21.  Medical conditions - multiple sclerosis, brain tumour, hyperparathyroidism, hyperthyroidism, lupus erythematosus  Affective (depressive) and anxiety disorders- 1or2 symptoms of acute onset and short duration  Hypochondriasis - patient´s focus is on fear of disease not focus on symptoms  Panic disorder - somatic symptoms during panic episode only
  22. 22.  Conversion disorder - only one or two  Pain disorder - one or two unexplained pain complaints, not a lifetime history of multiple complaints  Delusional disorders - schizophrenia with somatic delusions or depressive disorder with hypochondriac delusions, bizzare, psychotic sy.  Undifferentiated somatization disorder - short duration (e.g. less than 2 years) and less striking symptoms
  23. 23.  The major importance for successful management   Trusting relationship between the patient and one (if possible) primary care physician  Frequent changes of doctors are frustrating and countertherapeutic.  Regularly scheduled visits every 4 or 6 weeks.  Brief outpatient visits - performance of at least partial physical examination during each visit directed at the organ system of complaint.
  24. 24.  Explain to the patient and family relationship between psych and somatic  Empathic attitude  Avoid more diagnostic tests, laboratory evaluations and operative procedures unless clearly indicated  Treatment of underlying depression and anxiety.  Potentially addicting medications should be avoided
  25. 25.  Psychotherapy, both individual and group ◦ decreases personal health care expenditures (50%) ◦ decreasing their rates of hospitalization. ◦ helped to cope with their symptoms ◦ to express underlying emotions ◦ to develop alternative strategies for expressing their feelings
  26. 26. • Increased Activity Involvement –Combats stress –Improves overall mood –Provides Distraction from somatic symptoms –Pain perception has a subjective component—improved mood and distraction reduce the experience of pain –Exercise has physiological effects that combat somatization and stress
  27. 27. • Directly acts on physical symptoms, given its effects on breathing, heart rate, muscle tension, etc. • Patients report benefit soon upon learning the technique • Helps with stress management • Includes Diaphragmatic Breathing, Progressive Muscle Relaxation, Biofeedback
  28. 28. – Establish consistent sleep patterns (same bedtime and waketime everyday) – Go to bed only when sleepy (stimulus control) – If not asleep within 20-30 minutes leave bed and return when sleep again (stimulus control) – Comfortable sleep environment – Avoid alcohol/caffeine during 6 hours before bedtime – Exercise regularly, but not within 4 hours of bedtime
  29. 29. • Much like CBT for depression – Looking for adaptability of thoughts – Eliminating distortions • Use somatic symptoms as anchors for examining thoughts • Look for variations in adaptability of thoughts and discuss their effect • Patients are likely to have difficulty identifying thoughts/emotions.
  30. 30. Thanks
  31. 31.  Somatization Disorders:Diagnosis, Treatment, and Prognosis;Psychosocial: vol 32no2 Feb 2011  Somatisation in neurological practice;J Neurol Neurosurg Psychiatry. Oct 2004; 57(10): 1161–1164.  Somatization A Debilitating Syndrome in Primary Care; Psychosomatics 42:1, January- February 2001  Kaplans and Sadocks textbook of psychiatry