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Somatoform disorders


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Unexplained Symptoms that do not have medical explanations.......and could be of psychological problems

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Somatoform disorders

  1. 1. BY Emmanuel , Godwin 5th Year Medical Student University of Nigeria , Enugu Campus
  2. 2. •INTRODUCTION •LIST OF CATEGORIES OF CONSTITUTE DISORDERS;ICD-10,DSM-IV TR •SOMATIZATION DISORDER Introduction Risk factors/ Etiology Epidermiology Diagnostic Criteria Course and Prognosis Physical and Psychiatric Presenting Symptoms Treatment Differential Diagnosis
  3. 3. The term somatoform derives from the Greek ‘’soma’’ which means body, Somatoform disorders are a broad group of disorders characterized by the presentation of physical symptoms with no medical explanation(s). The symptoms are severe enough to interfere with the patient’s ability to function in social or occupational activities.
  4. 4.  Symptoms cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributed to another mental disorder eg panic disorder.  The symptoms of a somatoform disorder are considered to be due to a hard wiring problem within the brain where thoughts are sent down into the body through the Autonomic Nervous System to become symptoms instead of being sent up into the conscious area of the brain.  Medical test results are either normal or do not explain the person’s symptoms ,and history and physical examination do not indicate the presence of a medical condition that could cause them
  5. 5.  Patients with this disorder often become worried about their health because doctors are unable to find a cause for their symptoms. This may cause severe distress.  Somatoform disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms) – sufferers perceive their plight as real.
  6. 6.  Additionally, a somatoform disorder should not be confused with the more specific diagnosis of a somatization disorder  . Various laboratory tests, physical examinations, and surgeries on these individuals show no evidence supporting the idea that these exaggerating symptoms are present.  Somatoform disorder is difficult to diagnose and treat since doing so requires psychiatrists to work with neurologists on patients with this disorder.
  8. 8.  Seven somatoform disorders are listed in the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) of the American Psychiatric Association as follow:
  9. 9.  1)Somatisation disorder , a disorder characterized by multiple physical complaints which do not have a medical explanation before age 30;  (2) Conversion disorder, a somatoform disorder involving the actual loss of bodily function which includes blindness , paralysis, and numbness due to excessive anxiety or characterized by one or two neurological complaints  3) Hypochondriasis, characterized less by a focus on symptoms than by patients' beliefs that they have a specific disease
  10. 10.  4) Body dysmorphic disorder, characterized by a false belief or exaggerated perception that a body part is defective;  (5) Pain disorder, characterized by symptoms of pain that are either solely related to, or significantly exacerbated by, psychological factors
  11. 11.  6) Undifferentiated somatoform disorder, which includes somatoform disorders not otherwise described that have been present for 6 months or longer; and  (7) Somatoform disorder not otherwise specified, which is the category for somatoform symptoms that do not meet any of the somatoform disorder diagnoses mentioned above
  12. 12. ICD-10 CATEGORIES  Somatisation disorder, characterised be at least two      year history of medically unexplained symptoms Undifferentiated somatoform disorder Hypochondriacal disorder Persistent Somatoform Pain disorder Somatoform autonomic dysfunction Hypochondriacal-dysmorphophobia Neurasthenia
  13. 13.  The ICD-10 classified conversion disorder as a dissociative disorder
  14. 14. ADDITIONAL PROPOSED SOMATOFORM DISORDERS ARE;  Abridged somatization disorder- at least 4 unexplained somatic complaints in men and 6 in women  Multisomatoform disorder –at least 3 unexplained somatic complaints from the Primary Care Evaluation of Mental Disorders(PRIME-MD) scale for at least 2years of active symptoms.
  15. 15. Somatization Disorder
  16. 16. INTRODUCTION  By Definition, it is a disorder consisting of multiple symptoms affecting multiple organs.  A.K.A. Briquet’s syndrome or hysteria.  Is a somatoform disorder.  Is an illness of multiple somatic complaints in multiple organ systems that occurs over a period of several years and results in significant impairment or treatment seeking, or both. a
  17. 17. • Characterised by recurring, multiple, clinically significant complaints about pain, gastrointestinal, sexual and pseudoneurological symptoms. • Complaints must begin before individual turns the age of 30 (usually during the person’s teenage years)and could last for several years, resulting in either treatment seeking behavior or significant treatment.
  18. 18. RISK FACTORS/ETIOLOGY  Affects women more than men  Is usually begins by the age of 30  Data suggest that there may be a genetic linkage to the disorder  Male relatives tend to have antisocial personality disorder  Female relatives tend to have histrionic personality disorder
  19. 19. Epidemiology • Lifetime prevalence in the general population is estimated to be 0.2% - 2% in women and 0.2% in men. • The disorder is inversely related to social position and occurs most often among patients who have little education and low incomes. • Research has shown comorbidity with other psychological disorders particularly mood disorders and anxiety disorders; also between somatization disorders and personality disorders especially antisocial, histrionic, avoidant and dependent personality disorders.
  20. 20. • About 10-20% of female first degree relatives also have somatization disorder, and male relatives have increased rates of alcoholism and sociopathy.
  21. 21. DSM-IV-TR Diagnostic Criteria for Somatization Disorder • 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 or significant impairment in social, occupational, or other important areas of functioning. • Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance: – four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination) – two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)
  22. 22. – one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy) – one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)
  23. 23. • 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 effects of a substance (e.g., a drug of abuse, a medication) – when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings • The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering).
  24. 24. Course and Prognosis • Somatization disorder is a chronic, undulating, and relapsing disorder that rarely remits completely. It is unusual for the individual with somatization disorder to be free of symptoms for greater than 1 year, during which time they may see a doctor several times. Research has indicated that a person diagnosed with somatization disorder has approximately an 80 percent chance of being diagnosed with this disorder 5 years later. Although patients with this disorder consider themselves to be medically ill, good evidence is that they are no more likely to develop another medical illness in the next 20 years than people without somatization disorder.
  25. 25. Treatment • Somatization disorder is best treated when the patient has a single identified physician as primary caretaker. When more than one clinician is involved, patients have increased opportunities to express somatic complaints. • Once somatization disorder has been diagnosed, the treating physician should listen to the somatic complaints as emotional expressions rather than as medical complaints. Nevertheless, patients with somatization disorder can also have bona fide physical illnesses; therefore, physicians must always use their judgment about what symptoms to work up and to what extent.
  26. 26. Treatment  Patient should be seen during regularly scheduled brief monthly visits  To date, cognitive behavioral therapy (CBT) is the best established treatment.  CBT helps with the patient realizing that the ailments are not as catastrophic and enabling them to slowly get back to doing activities that they once were able to do without fear of ‘worsening their symptoms’. 
  27. 27. • Psychotherapy, both individual and group, decreases these patients' personal health care expenditures by 50 percent, largely by decreasing their rates of hospitalization. In psychotherapy settings, patients are helped to cope with their symptoms, to express underlying emotions, and to develop alternative strategies for expressing their feelings.
  28. 28. • ECT has been used in treating somatization disorder among the elderly. • Psychotherapeutic treatment of coexisting disorder is indicated.
  29. 29. DIFFERENTIAL DIAGNOSIS  Medical  Multiple sclerosis  Myasthenia gravis  SLE  AIDS  Thyroid  Chronic Systemic infection
  30. 30. DIFFERENTIAL DIAGNOSIS  Psychiatric  Major Depression  Generalised Anxiety Disorder  Schizophrenia
  31. 31. REFERENCES              ^ Jump up to: a b American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. ISBN 978-0-89042-025-6. pp 485 Jump up ^ Oyama, Oliver. "Somatoform Disorders – November 1, 2007 – American Family Physician." Website – American Academy of Family Physicians. Web. 30 Nov. 2011. <>. ^ Jump up to: a b c d La France, Jr. W. Kurt (2009). "Somatoform disorders". Seminars in Neurology 29 (3): 234–46. doi:10.1055/s-0029-1223875 . PMID 19551600. Jump up ^ LaFrance, W. Curt (2009). "Jr., MD., MPH". Somatoform Disorders. 29: 234–246. Jump up ^ Curt, LaFrance; Jr, W Curt (1 July 2009). "Somatoform disorders". Seminars in neurology 29 (3): 234. doi:10.1055/s-0029-1223875 . PMID 19551600. Retrieved 29 November 2012. Cite uses deprecated parameters (help) Jump up ^ LaFrance, C.W. "Somatoform Disorders". SEMINARS IN NEUROLOGY, V. 29 (3), 06/2009, pp. 234–246. Jump up ^ Oyama O., Paltoo C., Greengold J. (2007). "Somatoform disorders". American Family Physician 76 (9): 1333–8. Jump up ^ Schacter, D. L., Gilbert, D. T., & Wegner, D.M. (2011). Psychology: Second Edition. New York, NY: Worth Jump up ^ Hales, Robert E; Yudofsky, Stuart C (2004). Essentials of Clinical Psychiatry. ISBN 9781585620333. Jump up ^ Escobar JI, Rubio-Stipec M, Canino G, Karno M (1989). "Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples". J. Nerv. Ment. Dis. 177 (3): 140–6. doi:10.1097/00005053-198903000-00003 . PMID 2918297. Jump up ^ Lynch DJ, McGrady A, Nagel R, Zsembik C (1999). "Somatization in Family Practice: Comparing 5 Methods of Classification". Primary care companion to the Journal of clinical psychiatry 1 (3): 85–89. doi:10.4088/PCC.v01n0305 . PMC 181067. PMID 15014690. Jump up ^ Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000) Jump up ^ Frances Allen (2013). "The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill". British Medical Journal 346. doi:10.1136/bmj.f1580 .
  32. 32. Thank You