Somatization disorder

Somatoform Disorder

2. Dissociative and Somatoform
Disorders

Dissociative disorders include:

Dissociative Amnesia, Dissociative Fugue,
Depersonalization Disorder, Dissociative Identity Disorder

Somatoform disorders include:

Conversion Disorder, Somatization Disorder, Pain
Disorder, Hypochondriasis, Body Dysmorphic Disorder

Factitious disorder

3. Outline

o Somatoform Disorders
e Somatization Disorder
e Pain Disorder
Hypochondriasis
e Conversion Disorder
Body Dysmorphic Disorder
o Dissociative Disorders
e Dissociative Amnesia
e Dissociative Fugue
e Depersonalization Disorder
+ Dissociative Identity Disorder

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4. qual Property of Knewmeige com

Somatic Symptom Disorder

Diagnosis

Conversion Disorder

Hypochondriasis

Pain Disorder

Body Dysmorphic Disorder

Somatization Disorder

Factitious Disorder

Malingering

E) knowmedge

High-Yield Description

Often voluntary motor or sensory related
Mimic neurologic phenomenon

Patient attributes any complaint to a serious disease
Preoccupation with this false belief

Chronic pain involving psychological factors

False perception or an exaggeration of a defect in a
patient's physical appearance

Multiple physical symptoms >6 months
No identifiable medical cause

Conscious simulation of symptoms
Subconscious benefit from the “sick” role

Conscious simulation of symptoms
Goal in mind {e.g. money, insurance, time off, etc.)

5. Somatoform Disorders

+ Patient believes symptoms or signs are real
+ Psychological distress manifests as physical symptoms
Somatization disorder + No identifiable pathology
+ Often presents with dysmenorrhea, sensation of lump in throat, vomiting,
shortness of breath, burning in the sex organs, painiul extremities, amnesia

+ Sudden and dramatic onset of a single symptom
- Often presents with paralysis, pseudoseizure, blindness, sensory deficit
Conversion disorder - No associated pathophysiological or anatomical explanation
+ Usually involves neurologic or orthopedic manifestation
+ Lack of appropriate concer of sign or symptom (La belle indifference)

+ Stressful events are translated into somatic complaints

+ The primary symptom is distresstul pain that is not intentionally feigned
Pain disorder + Cannot be physiologically explained

+ Associated with precipitating traumatic event at the outset

+ Most frequently involves pain of the face, low back, neck, or pelvic area

+ Physical symptoms disproportionate to demonstrable organic disease:
Hypochondriasis + À fear of disease and conviction that one is sick
* Persistent and unsatisfying pursuit of medical care (doctor shopping)

6. de Somatoform Disorder

= Physical symptoms suggesting physical
disorders for which there is no evidence
of organic or physiologic cause.

= Somatization disorder: medical attention
seeking that is recurrent with multiple
somatic complaints over several years

7. “I’m very
tired all the
time” > 6

Ss months

“I can’t do more
than one thing at
a time”
“No
_ concentration”

8. History ctd.

» In 1859, Paul Briquet, a French physician,
observed the multiplicity of the symptoms
and the affected organ systems and
commented on the usually chronic course
of the disorder.

The disorder was called Briquet's syndrome
for a time, although the term somatization
disorder became the standard in the United
States when the third edition of DSM (DSM-
III) was introduced in 1980.

5

v

9. Somatization Disorder

» Somatization disorder is a chronic syndrome of
multiple somatic symptoms that cannot be
explained medically and is associated with
psychosocial distress and medical help-seeking.

e It requires a history of several years
duration, beginning before the age of 30.

10. Somatization Disorder: Causes

« History of family illness or injury
e Links to antisocial personality disorder
= Behavioral inhibition system
- Impulsivity
+ Novelty-seeking
- Provocative sexual behavior
= Socialization
= Gender roles

11. Somatization Disorder (Briquet’s
syndrome)

s Many physical complaints
== = Beginning before age 30
s Must include

| | — Four different pains
— Two gastrointestinal symptoms
| — One sexual symptom

| — One pseudoneurological symptom
cs Symptoms are unfounded or
EN exaggerated

2

12. Clinical Picture

Symptoms may involve:

e1.Gastrointestinal

e2. Pain

23. Cardiopulmonary

+4. Conversion or pseuc
neurological

+5. Sexual

13. Somatization Disorder & Undifferentiated
Somatoform Disorder

o

Pain, neurolic problems,
gastrointestinalcomplaints,
& sexual symptoms

© Common w/ anxiety disorder

More common in women

Physical complaints more
than 6 months

50% suffer from other
disorders

4%-11% of pop. at some
point in time

14. Somatoform Disorders

e Somatization disorder

patients have a history of many physical complaints
that can not be explained by a medical condition, the
complaints are not intentionally produced

up to 20% of patients in primary care setting
develops during adolescence (majority women)
0.2-2% in Women, 0.2% in Men

difficult to treat (reassurance, stress reduction, more
adoptive methods of interacting with family are
encouraged)

15. TABLE
Lifetime Prevalence of Additional Psychiatric
Syndromes in Briquet’s Syndrome Patients

Inpatient Outpatient
Psychiatric Syndrome N=16 (%) N=78 (%)
Organic mental disorder 1(6.2) 1(1.3)
Alcohol dependence 5(31.2) 13(16.7)
Drug dependence 5(31.2) 18(23.1)
Mania 6(37.5) 31(39.7)
Major depressive disorder 15(93.8) 68(87.2) |
Schizophrenia 6(37.5) 21(26.9)
Antisocial personality 425.0) 13(16.7)
Anorexia nervosa o(o) 5(6.4)
Obsessive-compulsive disorder 8(50.0) 21(26.9)
Phobic disorder 4(25.0) 30(38.5)
Panic disorder 5(31.2) 35(44.9)
Mental retardation 0(0) 441.3)
Ego-dystonic homosexuality o(o) 3(3.8)
Transsexualism 1(6.2) o0(0)
Mean number syndromes positive 4.7=23 4.3=1.9

(including Briquet's)

16. Somatization disorder is best treated when the
patient has a single identified physician as primary
caretaker. When more than one clinician is
involved, patients have increased opportunities to
express somatic complaints.

Once somatization disorder has been diagnosed,
the treating physician should listen to the somatic
complaints as emotional expressions rather than as
medical complaints. Nevertheless, patients with
somatization disorder can also have bona fide
Physical illnesses; therefore, physicians must always
use their judgment about what symptoms to work
up and to what extent.

17. Treatment of Somatization
Disorder
e Psychotherapy
® Relaxation techniques
o Hypnosis
o Antianxicty drugs
® Antidepressants

o Regular physical examination

18. 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.

20. Allin your head

Allin your head

« If something is all in your head, you have
imagined it and it is not real.

Stop thinking that everybody hates you. It's all in

your head.

21. what mer see when they look in the mirror:

CAR rf Loch

What wsorser see when they look im mirror:
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22. youre a
victim of

your Own