Somatization disorders are characterized by physical symptoms that have no medical cause and persistent requests for treatment. Potential causes include genetics, low serotonin levels, psychodynamic factors like expressing unacceptable emotions through physical symptoms, family dynamics where illness reduces conflict, and learning that illness gains attention and avoids responsibilities. Types include somatization disorder with many vague symptoms, hypochondriasis with a preoccupation of having a serious disease, somatoform autonomic dysfunction with autonomically-controlled symptoms, and persistent somatoform pain disorder with severe pain. Treatment involves antidepressants, psychotherapy, and helping patients address psychological rather than physical factors and develop coping skills.

1. SOMATOFORM
DISORDERS
PREPARED BY
MRS. DIVYA PANCHOLI
ASSISTANT PROFESSOR, SSRCN, VAPI
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2. DEFINITION
•These disorders are characterized by repeated
presentation with physical symptoms which
do not have any physical basis, and a
persistent request for investigations and
treatment despite repeated assurance by the
treating doctors.
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3. ETIOLOGY FOR
SOMATIC DISORDERS
•1. Physiological
•a. Genetic. anxiety disorder in first-degree relatives,
implying a possible inheritable predisposition
• b. Biochemical. Decreased levels of serotonin and
endorphins may play a role in the etiology of somatic
symptom disorder,
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4. 2. PSYCHOSOCIAL
• a. Psychodynamic Theory.
• low self-esteem and feelings of worthlessness and that the individual believes
it is easier to feel something is wrong with the body than to feel something is
wrong with the self.
• The individual views the self as “bad,” based on real or imagined past
misconduct, and views physical suffering as the deserved punishment.
• The psychodynamic theory of conversion disorder proposes that emotions
associated with a traumatic event that the individual cannot express because of
moral or ethical unacceptability are “converted” into physical symptoms.MRS. DIVYA PANCHOLI
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5. CONTI…
• The unacceptable emotions are repressed and converted to a
somatic hysterical symptom that is symbolic in some way of the
original emotional trauma.
• Frequent childhood hospitalizations provided a reprieve from the
traumatic home situation and a loving and caring environment
that was absent in the child’s family.
• MRS. DIVYA PANCHOLI
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6. B . FAMILY DYNAMICS.
• Some families have difficulty expressing emotions openly and resolving conflicts
verbally.
• When this occurs, the child may become ill, and a shift in focus is made from the
open conflict to the child’s illness, leaving unresolved the underlying issues that
the family cannot confront openly.
• Thus, somatization by the child brings some stability to the family, as harmony
replaces discord and the child’s welfare becomes the common concern.
• The child in turn receives positive reinforcement for the illness. This shift in
focus from family discord to concern for the child is sometimes called tertiary
gain.MRS. DIVYA PANCHOLI
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7. C. LEARNING THEORY.
• Somatic complaints are often reinforced when the sick role relieves the
individual from the need to deal with a stressful situation, whether it be within
society or within the family.
• The sick person learns that he or she may avoid stressful obligations, may
postpone unwelcome challenges, and is excused from troublesome duties
(primary gain);
• becomes the prominent focus of attention because of the illness (secondary
gain); or relieves conflict within the family as concern is shifted to the ill person
and away from the real issue (tertiary gain).
• These types of positive reinforcements virtually guarantee repetition of the
response.
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8. D. PAST EXPERIENCE WITH
PHYSICAL ILLNESS.
•Past experience with serious or life-threatening physical
illness, either personal or that of close family members, can
predispose an individual to illness anxiety disorder.
•Once an individual has experienced a threat to biological
integrity, he or she may develop a fear of recurrence. The
fear of recurring illness generates an exaggerated response
to minor physical changes, leading to excessive anxiety and
health concerns.
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9. MRS. DIVYA PANCHOLI
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10. CLASSIFICATION
1. SOMATIZATION DISORDER
2. HYPOCHONDRIASIS
3.SOMATOFORM AUTONOMIC DYSFUNCTION
4.PERSISTENT SOMATOFORM PAIN DISORDER
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11. 1. SOMATIZATION DISORDER
•Somatization disorder is characterized by
chronic multiple somatic symptoms in the
absence of physical disorder.
•The symptoms are vague, presented in a
dramatic manner and involve multiple organ
systems.
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12. SYMPTOMS OF
SOMATIZATION DISORDER
• Multiple somatic complaints, unexplained by medical findings
• Complaints of pain in at least four different locations- 2 Gastrointestinal,
1 sexual or reproductive and 1 neurologic symptom
• Moderate to severe anxiety
• Inability to voluntarily control the symptoms
• Dependency with demanding, attention getting behaviours
• Secondary gain
• Significant distress or impairment in social or occupational areas
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14. 2.HYPOCHONDRIASIS
• Also known as “DR.
SHOPPING SYNDROME”
• Hypochondriasis is defined as
a persistent preoccupation with
a fear or belief of having a
serious disease despite
repeated medical reassurance.
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15. SYMPTOMS OF HYPOCHONDRIASIS
• Fear of preoccupation with body functioning misperceived as a
major illness
• Repeated health care visits seeking verification of fear (doctor
shopping)
• Symptoms reported in specific detail
• Involvement of one or more body systems
• Unconvinced by repeated examinations, investigations and
reassurance that disease does not exist
• Impaired social and family relationshipsMRS. DIVYA PANCHOLI
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16. 3. SOMATOFORM AUTONOMIC
DYSFUNCTION
•In this disorder, the symptoms are
predominantly under autonomic control, as if
they were due to a physical disorder. Some of
them include palpitations, hiccoughs,
hyperventilation, irritable bowel, dysuria, etc.
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17. 4. PERSISTENT SOMATOFORM PAIN
DISORDER
•The main feature in 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 pain is common.
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18. TREATMENT
•DRUG THERAPY
• Antidepressants
• Benzodiazepines
•PSYCHOLOGICAL
TREATMENT.
• Supportive psychotherapy
• Relaxation therapy
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19. NURSING INTERVENTIONS
• Before a somatoform determination, a physical examination
and diagnostic testing are necessary to rule out any underlying
pathology
• Create an accepting safe and supportive atmosphere that allows
open communication with the patient
• Should focus on the whole person, including psychological,
social and family factors in addition to the physical symptoms
• It must be remembered that they are not consciously trying to
be sick or avoid responsibilities
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20. CONTI..
• Respond to patient with understanding and patience
• Identify types of primary and secondary gain achieved by symptoms
• Minimize time and attention given to physical symptoms
• Encourage patient to keep a diary of daily happenings and feelings,
along with physical symptoms
• Encourage the patient to make decisions and take responsibility for
situations related to them
• Help the patient to identify more effective coping mechanisms rather
than the somatic symptoms
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22. YOU CAN REFER FOLLOWING LINK ALSO
• https://www.youtube.com/watch?v=oVO7tZS2ZdI
• https://www.youtube.com/watch?v=ViZskHsUdBU
• https://www.youtube.com/watch?v=8G5WFKUzvA8
• https://www.youtube.com/watch?v=gaAdSGVgd3Y
• https://www.youtube.com/watch?v=719a0kAzeo4&t=5s
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