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Somatoform disorder


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it is a mental disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms.

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Somatoform disorder

  1. 1. Somatoform Disorder M.S Sara Dawod
  2. 2. Introduction • The term somatoform derives from the Greek “soma” means body and mind. • The somatoform disorders are a group of disorder that include physical signs and symptoms (for example pain, nausea and dizziness) for which an adequate medical explanation cannot be found. • Patients with somatoform disorder are convinced that their suffering comes from presumably untreated bodily derangement.
  3. 3. Symptoms of somatoform disorder • May include frequent headaches, back pain, abdominal cramping and pelvic pain. • Other symptoms include pain in the joints, legs and arms, also may cause gastrointestinal problems, such as nausea, bloating, vomiting and food intolerance. It can also cause problem with sexual function for both men and women. • Five specific somatoform disorders are recognized.
  4. 4. Somatization disorder • The essential feature of somatization disorder is multiple somatic complaints of long duration, beginning before the age of 30 years. It was known before as hysteria, or breiquest syndrome, it is common for women and may coexist with other mental disorders.
  5. 5. Diagnosis • Criteria A: • Requires that the onset of symptoms before the age of 30 that occurs over period of several years, and cause impairment in social, occupational, or other important areas of functioning.
  6. 6. Diagnosis • Criteria B: Each of the following criteria must have been met, with the individual symptoms occurring at any time during a period of the disturbance: • Four pain symptoms: 4 different sites: head, back, abdomen, chest, extremities, joints, rectum, during menstruation, during sexual intercourse or during urination. • two gastrointestinal symptoms: nausea, bloating, vomiting, diarrhea, intolerance of several food. • One sexual symptoms: irregular or excessive menses, erectile or ejaculatory dysfunction, vomiting throughout pregnancy.
  7. 7. Diagnosis • One pseudo neurological symptom (fake) they include impaired coordination or balance, paralysis, blindness, difficult, swallowing, loss of touch or pain sensation, double vision, lump in throat, hallucination and none of which is explained by physical cause.
  8. 8. Diagnosis • Criteria C : 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 affect of a substance. • When there is a related medical condition, the physical complaints or resulting social or occupational impairment are in excess of what be expected from history, physical examinations and laboratory findings.
  9. 9. Diagnosis • Criteria D: • The symptoms are not intentionally produced or feigned as in factitious or malingering. • Other notes: • It is chronic disease. • Somatization disorder is commonly associated with other mental disorders, including major depressive, personality disorder, substance-related disorder, generalized anxiety disorder, phobia and schizophrenia.
  10. 10. Conversion disorders • They were previously known as hysteria. • Conversion is used by freud who thought that anxiety and psychological conflict were converted into physical symptoms. • Greek used the word hysteria which refers wandering uterus which symbolized the longing of women's body for production of child. • Onset: late childhood and early adulthood, rarely before 10 years or after 35 years. • Has short duration, within 2 weeks. • More F than M and in left side than right side of the body.
  11. 11. Conversion disorder • Psychiatric examination: no psychosis. • Symptoms include: loss of voluntary motor (impaired coordination, balance, paralysis, difficulty swallowing, urinary retention, seizures) or sensory functioning (loss of touch or sensation (anesthesia) or pain, sudden blindness, deafness, hallucination, aphonia (loss of voice), anosmia (loss of smell) that appears to represent physiology dysfunction but related to psychological conflict follows an event or experience perceived as major stressor. • Characterized by the presense of one or more neurological symptoms (paralysis, blindness) that cannot be explained a known neurological or medical disorder.
  12. 12. Diagnostic criteria • A : one or more symptoms or deficits affecting voluntary motor or sensory function. • B : psychological factors are judged to be associated with the symptoms or deficit because the initiation of symptoms is perceived by stress or conflict. • C : the symptoms or deficit is not intentionally produced or feigned as in factitious or malingering disorder. • D : the symptoms cannot after appropriate investigation or explained by a general medical condition or effected of a substance. • E : the symptoms cause significant distress or impairment in social, occupational functioning. • F : the symptoms is not limited to pain or sexual dysfunction.
  13. 13. Other associated features 1. Primary gain : by keeping internal conflict out side their awareness they represent an unconscious psychological conflict. 2. Secondary gain : seeking attention, receiving support. 3. La belle indifference : the patient seems to be unconcerned about what appears to be a major impairment.
  14. 14. Etiology of conversion disorder • Psychoanalytic perspective: result when the person experiences an emotionally arousing event but the emotion is not expressed and the memory is cut of form of consciousness and these emotions are expressed as hysterical symptoms. • Later he said it occurs as a result of Electra complex (sexual trauma by father during childhood which is converted into somatic symptoms) .
  15. 15. Etiology of conversion disorder • Possible genetics . • Social and cultural factors: general sexual relax than before and increase psychological and medical concepts.
  16. 16. Hypochondriasis • The term is derived from the old medical term hypochondruim (below the ribs). • Defined as a persons preoccupation with the fear of contracting or belief of having a serious disease, disease phobia despite medical reassurance. • It begins at any age and most common in early adulthood. • It is chronic disorder.
  17. 17. Diagnosis A. Preoccupation with fears of having, or the idea that has a serious disease based on the persons misinterpretation of bodily symptoms. B. The preoccupation persists despite medical evaluation. C. The belief in criterion A is not of delusional intensity and is not restricted to a concern about appearance. D. The preoccupation causes significant distress or impairment in social, occupational of functioning. E. The duration of the disturbance is at least 6 months.
  18. 18. Dysmorphic disorder • The disorder was recognized and named more than 100 years ago by Emil Krapelin, who consider it a compulsive neurosis. • The typical patient with dysmorphobia is convinced that some part of his body is too large, too small, or misshapen. • Defects in appearance, especially facial marks or features. • The common complaints are generally about the nose, ears, breasts, buttocks, lips, teeth, eyes and penis. Imagined of face or head such as hair thinning, acne, wrinkles, scars, excessive facial hair, facial asymmetry, shape, size, but any part of the body maybe involved.
  19. 19. Dysmorphic disorder • M=F • Frequent checking of deficit or excessive grooming behavior or avoid mirror or excessive exercises, dieting, changing clothes, or delusional ideas that difficult to change. • Often are comorbid with OCD.
  20. 20. Diagnosis A. Preoccupation with an imagined defect in apperance. If a slight physical anomaly is present, the persons concern is markedly excessive. B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The preoccupation is not better accounted for by another mental disorder.
  21. 21. Pain disorders • DSM-IV-TR defines pain disorder as the presence of pain that is the predominant focus of clinical attention. • Patient with chronic pain which is not caused by any physical or specific psychiatric disorder, that pain is sufficient to cause distress or functional impairment, such as pelvic pain and headache.
  22. 22. Diagnosis A. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention. B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. psychological factors are judged to have an important role in the onset and severity of pain. D. The symptoms or deficit is not intentionally produced or feigned (as in factitious disorder or malingering). E. The pain is not better accounted for by a mood, anxiety, or psychotic disorder and doesn’t meet criteria for dyspareunia (pain in intercourse).
  23. 23. Pain disorder • Acute: duration of less than 6 months. • Chronic: duration of 6 months or longer.
  24. 24. Etiology of pain disorder 1. Biological factors: some neurotransmitters in the brain like serotonin, endorphins deficiency play a role in the central nervous system modulation of pain. 2. Interpersonal factors: the pain has conceptualized as a mean for gaining advantage in interpersonal relationship; secondary gain is most important to patient with pain disorder. 3. Behavioral factors: pain behaviors are reinforced when ignored or punished or can function.
  25. 25. Etiology of somatoform • Multifactor causing with a complex interaction of psychological, neurobiological and familial factors at root of somatoform disorder. 1. Psychological factors: life change that have been stressful such as marriage, death of love one, ruble at work, depression is commonly root of SF disorder. Also Freud believed that hysteria is caused by the repression of conflict (sexual) which is converted to physical symptoms to protect persons from anxiety.
  26. 26. Etiology of somatoform 2. Neurobiological factors: • Physiology play a key role in development of somatoform disorder. • According to endocrines', pituitary and adrenal gland, mechanism in the body's reaction when defending against stress.
  27. 27. Etiology of somatoform • Abnormal central nervous system regulation in the coming sensory information, because decrease awareness in connection between mind and body. • Genetics (possible, not strong). • Sociocultural perspective: social restriction on women (prevent women from expressing aggression or sexuality such as hysteria).
  28. 28. Etiology of somatoform • Learning perspective: people assume sick role because it is reinforcing and it allows them to escape unpleasant events or avoid responsibilities.
  29. 29. Treatment • Cognitive behavioral therapy: • Identify and change the emotion that trigger their somatic concern. • Change their cognition regarding their symptoms. • Change their behaviors and stop playing sick role. • Pay less attention to their body and identify negative thought.
  30. 30. Pain disorder treatment • Validate the pain (real), relaxation, rewarding the person for less focus on pain, deal with stress, engage in more activities, distraction, provide information. • Rehabilitation/reduce the pain through discussing the psychological factors. • Medications/ antidepressant such as tricyclic and amphetamine and tofranil. • Psychotherapy/cognitive therapy/negative and positive thoughts and attitudes. • Plasebocupsules (have a sugar) that will reduce his pain.
  31. 31. Dysmorphic disorder treatment • When it is secondary to a psychiatric disorder such as schizophrenia or major depression the primary illness should be treated. • It should be explained that no real deformity, and that some people develop mistaken beliefs about their appearance, some people can be helped by reassurance and continued support. • cosmetic surgery is usually successful for patients who have clear reasons for requesting operation, and followed by improvement of self esteem and confidence.
  32. 32. Dysmorphic disorder treatment • Their is some evidence of beneficial effects from antidepressant medications, especially in patients with prominent depressive symptoms such as floxetine (prozac) and clomipramine (anafranil). • Exposure therapy and response prevention (not to look at mirror).
  33. 33. Hypochondriasis • Reduce excessive attention, challenging negative thought and discouraging seeking reassurance from doctor, increase engagement in health activities.
  34. 34. Somatization disorder • Dose not dispute the validity of persons physical complains minimize the use of diagnostic test and medication maintaining contact with the person regardless of weather he or she is complaining of illness. • Direct persons attention to sources of anxiety and depression than focusing on symptoms, relaxation. • Focus on social concern associated with symptoms and teach social skills (communication, monitor negative thought and change them).
  35. 35. Somatization Treatment • Primary physicians should see the patient, physical examination should be conducted to each new somatic complaint. • Treating the somatic complaints as emotional expressions rather than as medical complaints. • Increase the patients awareness of the possibility that psychological factors are involved in the symptoms. • Psychotherapy, individual and group helped them cope with their symptoms to express underlying emotions and to develop alternative strategies for expressing their feeling. • Psychotropic medications use drugs; whenever somatization disorder coexists with mood or anxiety disorder.
  36. 36. Conversion disorder treatment • Resolution of the disorder symptoms is usually spontaneous by insight oriented supportive or behavior therapy. • Psychoanalysis: good choice of treatment and it focuses on stress and coping. • Hypnosis, and behavioral relaxation, exercises are effective in some cases. • Supportive therapy.