Dr. Ziad N. Arandi discusses somatoform disorders, which are characterized by physical symptoms that cannot be fully explained by medical factors. He outlines four main somatoform disorders - somatization disorder, hypochondriasis, pain disorder, and conversion disorder - providing details on diagnostic criteria and characteristics for each. The treatment approach focuses on supportive psychotherapy, behavioral modification, relaxation therapy, and in some cases antidepressants or benzodiazepines.

1. Dr. Ziad. N. Arandi
Assistant Professor of Psychiatry- An-Najah National University
B. C. Psych - London
D. P. L Psych - London
J. B. C. Psych - Amman
President of Palestinian Psychiatrists Association

2. Somatoform disorders (Literally ‘Soma’ means ‘Body’.)
=
‫اضطراب‬‫ات‬‫جسدي‬‫ه‬‫الشكل‬
‫هو‬‫نفسي‬ ‫اضطراب‬‫ه‬‫باعراض‬ ‫تتميز‬‫أو‬ ‫اعتالل‬ ‫بوجود‬ ‫توحي‬ ‫والتي‬ ‫جسدية‬‫مرض‬
‫خالل‬ ‫من‬ ‫كامل‬ ‫بشكل‬ ‫تفسر‬ ‫أن‬ ‫يمكن‬ ‫ال‬ ‫أعراض‬ ‫وهي‬ ،‫الجسم‬ ‫في‬‫فحص‬‫الحالة‬
‫خالل‬ ‫من‬ ‫أو‬ ‫العامة‬ ‫الطبية‬‫الطبيه‬ ‫الفحوصات‬

3. Somatoform Disorders are characterized by:
Complaining of body symptoms
that suggest medical problem.
Meanwhile, no underlying
organic causes can be found.

4.  Patient preoccupied by these symptoms feels
anxious, which leads to sick illness behavior.
Over concern
Anxiety
Sickness
behavior
Doctor’s Help
Examinations
&
investigations
No underlying
physical
causes!
Stress Related
Produce
unconsciously

5. Symptoms without identifiable cause
Gain Deliberate
Psychiatric
Disorder
Agrees to
Procedure
Malingering External √
Factitious Disorder Sick Role √ √ √
Somatoform Disorder √ √

6. The exact cause of somatic symptom disorder isn't
clear, but any of these factors may play a role:
1. Genetic and biological factors.
2. Family influence.
3. Personality trait of negativity.
4. Decreased awareness of or problems
processing emotions.
5. Learned behavior.

8. Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

9.  Characteristics:
1. Multiple somatic symptoms in absence of
underlying physical causes.
2. Recurrent and chronic symptoms for two
years.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

10.  Prevalence: ranging from 0.2% - 2%.
 Female › male.
 Age: before 30 years.
 Lower social class.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

11. Diagnostic Criteria:
1. Four pain symptoms.
2. Two gastrointestinal symptoms.
3. One sexual symptom.
4. One pseudo-neurological symptoms.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

12. 1. Four pain symptoms: head, abdomen and back.
2. Two gastrointestinal: nausea, vomiting and diarrhea.
3. One sexual symptom: irregular menses and E.D.
4. One pseudo-neurological symptom: dizziness, vertigo, lump
in throat, paralysis and urinary retention.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

14. Literally;
‘Hypo’ means ‘Below’
‘Chondriasis’ means ‘Chondrium’.

15.  Patient is preoccupied with fears of having a serious
disease, based on person’s misinterpretation of body
symptoms.
 Persistence despite reassurance.
 Last for six months.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

16.  Prevalence: ranging from 1% - 5%.
 Female = Male.
 Age: from 20 to 30 years.
 Upper social class.
 Chronic Course.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

17. 1. Serious illness from the surrounding.
2. Medical Student.
3. People interesting in Googling!
4. Early childhood problems.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

18.  Diagnostic Criteria:
1. Preoccupation with fears of having a serious
disease.
2. The preoccupation persists despite medical
reassurance.
3. The belief in Criterion A is not of delusional
intensity.
4. The preoccupation causes clinically significant
distress important areas of functioning.
5. The duration is at least 6 months.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

21. 1. Pain in one or more anatomical sites.
2. Psychological factor have an important role in
the onset, severity, exacerbation and
maintenance of the pain.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

22.  Prevalence: 0.5%
 Female › Male.
 Age: ranging from 30 to 50 years.
 upper social class.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

23.  Pain is not consciously produced.
 Pain is vague in description.
 Clarifying the patient’s pain rather than
challenging or insight.
 Mainly depression or anxiety are comorbidities.
 Common side is the left side.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

26.  In the past it was called Hysteria
 Hysteria derived from the hystrum.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

27.  Mental disorder characterized by:
1. Loss of the physical function of the organs.
2. Sudden onset after a psychological events.
3. Mainly it involve one or more neurological
systems.
4. Can’t be explained by any neurological
disease.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

28.  Prevalence : 0.5%
 Female › male.
 Age : before 20 years.
 Rural › urban.
 Lower social class.
 less educated.
 Left side is commoner!
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

29.  Left side is more to be affected.
 Signs can’t be fully explained by general
medical condition.
 Manner of presenting symptoms is dramatic
and histrionic or la belle indifference, i.e. less
concern about the suffering.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

30. 1. One or more symptoms affect voluntary motor
or sensory.
2. The symptom is not due to a general medical
condition.
3. One or more diagnostic features provide
evidence of incongruity with recognized
neurological or medical disorder.
4. The symptom causes clinically significant
distress or impairment in areas of functioning
medical evaluation.
Somatization Disorder
Hypochondriasis.
Pain disorder.
Conversion disorder.

33. The goal is
management not Cure

34. Keep in control of the
case
(Gate keeper)

35. Schedule regular
appointments

36. Listing
Empathy
Sympathy
Warmth
Trust
Explanation
Suggestion

37. Explain Tension ↔ Symptom cycle
Sessions:
20 minutes / month
= 4 hours / year

38.  Supportive psychotherapy
 Behavioral Modification
 Relaxation therapy with graded physical
exercise.
 Cognitive psychotherapy.
 In site oriented psychotherapy
 Cope stress psychotherapy

39. Antidepressants especially
duloxetine (Cymbalta).
Benzodiazepines for short period for
coexisting depression and anxiety
comorbidities.