Somatoform disorder

SOMATOFORM
DISORDER
Presented by:
Ms. Bhoomika Patel
Assistant Professor
Sumandeep Nursing college
Sumandeep Vidyapeeth

INTRODUCTION
 CHARECTERISED BY REPEATED
PRESENTATION WITH PHYSICAL SYMPTOMS
WHICH DO NOT HAVE ANY PHYSICAL
BASIS AND PERSISTENT REQUEST TO
INVESTIGATION AND TREATMENT DESPITE
REPEATED ASSURANCE BY TREATING
DOCTOR
SUMANDEEP NURSING COLLEGE,SVDU

EPIDEMIOLOGY
 5-7 % IN GENERAL, COMMON IN W, RURAL
AREA AND LESS EDUCATED PERSON.
 CONVERSION: 5-30%, W, ADULT, LOWER
SOCIO ECONOMICAL GROUP.
 HYPOCHONDRIASIS: 1-5%, EQUAL,
 FACTITIOUS: 0.8 TO 1.0

ETIOLOGY
 GENETIC
 BIOCHEMICAL: DECREASE SEROTONIN
&ENDORPHINS
 NEUROANATOMICAL: BRAIN DYSFUNCTIONS,
 PSYCHODYNAMIC: EGO DEFENSE MECHANISM,
DEFENSE AS A GUILT, TRAUMATIC EVENTS,, CHILD
ABUSE, NEGLECT
 FAMILY DYNAMICS: IF ANABLE TO
EXPRESS,(TERTIARY GAIN)
 LEARNING THEORY: (PRIMARY AND SECONDARY
GAIN), PAST EXPERINCE OF HAVING DISEASESUMANDEEP NURSING COLLEGE,SVDU

 Somatization disorder
is characterized by
chronic multiple
somatic symptoms are
vague, presented in a
dramatic manner and
involve multiple organ
systems. They have a
tendency to seek relief
through
overmedicating with
prescribed analgesics
or antianxiety agents.
SOMATIZATIO
N DISORDER

SIGNS & SYMPTOMS
 Multiple somatic
complaints, unexplained by
medical findings.
 Complaints of pain in at
least four different
locations.
 Two gastrointestinal , one
sexual or reproductive and
one neurological symptom.
 Moderate to serve anxiety.

CONTI…
 Inability to voluntarily
control the symptoms.
 Dependency with
demanding, attention
getting behaviours.
 Secondary gain
 Significant distress or
impairment in social or
occupational areas.
 Drug abuse and
dependence are common
complication of
somatization disorder. SUMANDEEP NURSING COLLEGE,SVDU

 Also called illness
anxiety disorder.
Hypochondriasis is
defined as a persistent
pre-occupation with
fear or belief of having
a serious disease despite
repeated medical
reassurance.
 Occasionally medical
disease may be present,
but in the individual
with hypochondriasis,
the symptoms are
excessive in relation to
the degree of pathology
HYPOCHONDRIA
SIS
V

SIGNS & SYMPTOMS
 Fear or preoccupation
with body functioning
mispereceived as a major
illness, long history of
“doctor shopping”
 Repeated health care visits
seeking verifications of
fear.
 Symptoms reported in
specific detail. SUMANDEEP NURSING COLLEGE,SVDU

CONTI…
 Involvement of one or
more body systems.
 Unconvinced by repeated
examinations ,
investigations and
reassurance that disease
does not exists.
 Impaired social and family
relationship.

 The main feature of this
disorder is severe
persistent pain without
any physical basis. It may
be of sufficient severity so
as to cause social or
occupational impairment.
Preoccupation with the
pair is common.
 Psychological
implications in the
etiology of the pain
complaint may be
evidenced by the
correlation of a stressfulll
situation with the onset of
the symptoms.
PERSISTENT
SOMATOFORM
PAIN
DISORDER.

CONTI..
PRIMARY GAIN
 Appearance of the pain
enables the client to
avoid some unpleasant
activity
SECONDARY
GAIN
 The pain promotes
emotional support or
attention that the client
might not otherwise
receive

SYMPTOMS
Frequent visits to
physicians
Excessive use of
analgesics
Request for surgery
Symptoms of
depression
Dependence on
addictive substance

 Conversion disoreder is
a loss of or change in
body function resulting
from a psychological
conflict, the physical
symptoms of which can
not be explained by any
known medical
disorder or
pathophysiological
mechanism. clients are
unaware of the
psychological basis and
are therefore unable to
control their symptoms
CONVERSION
DISORDER

CONTI…
EXAMPLES
Paralysis,
Difficulty in swallowing,
Urinary retention,
Anosmia,
Pseudocyesis
aphonia
anosmia

SIGNS & SYMPTOMS
 Symptoms of a
conversion disorder
include the loss of
one or more bodily
functions, such as:
 Blindness
 Inability to speak
 Numbness
 Paralysis

CONTI..
A debilitating symptom
that begins suddenly
History of a
psychological problem
that gets better after the
symptom appears
Lack of concern that
usually occurs with a
severe symptom

This disorder,formerely
called
dysmorphoohobia,is
charecterised by the
exaggerated belief that
the body is deformed or
defective in some
specific way. the most
common complaints
involve imagined or
slight flaws of the face
or head.
BODY
DYSMORPHIC
DISORDER

CONTI..
 EXAMPLES
 Thinning hair
 Wrinkals,
 Scars,
 Facial sweeling etc.
 Other complaints with
nose, ear, eyes, teeth
mouth

SYMPTOMS
Social and
occupational
imapairement
Excessive anxiety,
Repeated visit to
plastic surgeon and
dermatologist
Unnecessary surgical
procedures

Factitious disorder
 Pretend to be ill in order to receive
attention.
 Also called as munchausen syndrome
 Physical or psychological symptoms
 Deceptive behaviour in absence of
rewards
 Ex: self inflicted wounds, self injury,
manipulating thermometer, urinary tract
manipulation and use of medication

MANAGEMENT

 Individual psychotherapy
 Group psychotherapy
 Behaviour therapy
 Psychopharmacology: antidepressants,
TCAs,SNRIs (venlaflaxin, duloxetine)
anticonvulsant.

EVIDENCE: 1
 Conversion disorder in children
and adolescents: A disorder of cognitive
control.
 Level of evidence : 3c

P I C O
To assess
cognitive function
in children
and adolescents p
resenting with
acute conversion s
ymptoms.
Fifty-seven
participants aged
8.5-18 years (41
girls and 16 boys)
with conversion sy
mptoms and 57
age- and gender-
matched.
Comparison
between
participants who
have conversion
symptoms and
gender matched
healthy controlled
group
Children
and adolescents wit
h
acute conversion sy
mptoms have a
reduced capacity to
manipulate and
retain information,
to block interfering
information, and to
inhibit responses,
all of which are
required for
effective attention,
executive, and
memory.

 EVIDENCE: 2
Somatoform disorders in the general hospital
inpatient settin
Level of evidence: 3a
Reference:
http://www.sciencedirect.com/science/article/pii/0
163834389900789

P I C O
Somatoform
disorders in the
general hospital
_ _ Thirty-one percent of
patients diagnosed as
somatoform on final
follow-up assessment
had not been
diagnosable as
somatoform on initial
assessment. The findings
emphasize the
necessity of ongoing
assessment in improving
diagnostic certainty, as
well as the prevalence
and importance of
medical comorbidity
among patients with
somatoform disorders in
this setting

 EVIDENCE : 3
Children of People with Somatization Disorder
Level of evidence: 5

P I C O
Children of
People with
Somatization
Disorder
The Diagnostic
Interview for
Children and
Adolescents
were scored
- Children of SD-P
had significantly
more psychiatric
disorders and
suicide attempts
than did
children of SOM
or the CON. SD-
P and CON had
significantly
more
unexplained
physical
symptoms than
SOM.

MULTIPLE CHOICE QUESTION
1) What Do You Mean By Somatoform Disorder?
A. Person Is Having A Serious Disease
B. Physical Symptoms Which Do Not Have Physical Basis
C. Psychological Symptoms
D. One Type Of Anxiety
2)A Person Is Having A Belief Of Having A Serious Disease,It
Means It Is
A. Somatization Disorder
B. Neurotic Disorder
C. Hypochondriasis
D. Conversion Disorder SUMANDEEP NURSING COLLEGE,SVDU

3) A Person Is Went To Ask For Surgery Of Nose As He Felt Of
Having Some Defect, It Indicate That Patient Is Having
A. Body Dysmorphic Disorder
B. Somatization Disorder
C. Bipolar Disorder
D. None Of The Above
4) Delusion Of Bromosis Means
A. Feeling Of Grandiosity
B. False Belief That One Is Emitting An Offensive Body
Odor
C. False Belief Of Having Disease
D. All Of The Above
5) Historically Somatoform Disorder Was Found As
A. Hysterical Neurosis
B. Hysteria
C. Neurosis
D. Psychosis SUMANDEEP NURSING COLLEGE,SVDU

Somatoform disorder

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