Somatoform disorders are characterized by physical symptoms that cannot be explained medically despite the individual's belief that the symptoms are real. They include somatization disorder, conversion disorder, pain disorder, and hypochondriasis. Diagnosis involves ruling out physical causes through medical evaluation. Treatment focuses on psychotherapy to help express emotions verbally rather than physically, establish adaptive behaviors, and restructure beliefs. Medication may be used for comorbid mood disorders but not the somatoform symptoms themselves.

1. Sheila Lechado, RN
Somatoform Disorders

2. OVERVIEW

3. Somatoform disorders
• Characterized by complaints of physical
symptoms that cannot be explained by known
physical mechanisms
• These disorders have in common the belief
that physical symptoms are real despite
evidence to the contrary.
• The affected individual experiences changes
or loss in physical function.

4. • The physical symptoms are not under the
individual's voluntary control
• Significant impairment occurs in social or
occupational functioning

5. CLASSIFICATION

6. • Somatization disorder
• Undifferentiated somatoform disorder
• Conversion disorder
• Pain disorder
• Hypochondriasis
• Body dysmorphic disorder
• Somatoform disorder not otherwise specified

7. DIAGNOSTIC EVALUATION

8. • Individuals with somatoform disorders will
present in the medical rather than the
psychiatric setting because of their belief that
the problems are medical
• The individual should receive a thorough
medical evaluation
– if possible, avoiding repeating tests that have
already had negative results

9. • The diagnosis of somatoform disorder will be
made after a thorough medical evaluation in
which no organic basis for the symptoms is
validated

10. MANAGEMENT

11. • Level and setting of care to be provided is
determined
– In general, the individual will be treated on an
outpatient basis, unless underlying mood disorder
is present leading to risk for self-harm
• Referral to psychiatric treatment is generally
rejected by the individual with a somatoform
disorder

12. • GOAL:
– To maintain a long-term relationship with a
specific health care provider to prevent patient
from seeking multiple providers with multiple
recommendations for testing, treatments, and
drugs

13. Psychotherapy
• Psychodynamic
– assist the individual to express conflicts and
emotions verbally rather than displacing them
onto physical symptoms.
• Behavioral
– establish a program whereby adaptive behavior is
reinforced and illness behaviors do not receive
secondary gains.

14. Psychotherapy
• Cognitive
– restructure belief system that perpetuates illness-
related behaviors.
• Family therapy
– assist family members to define appropriate
boundaries and support patient in increasing self-
responsibility.

15. • Somatic therapies
– Somatoform disorders are usually not
treated with psychopharmacologic drugs
because these patients are susceptible to
dependency on drugs used.

16. • Mood disorders, especially depression, are a
common comorbid problem in individuals
with somatoform disorders
• Antidepressant drugs may be used to treat the
mood disorder.