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Somatoform Disorders
An Outline: Psy 530
Carolyn R. Fallahi, Ph. D.
Somatoform disorders: persons who are overly preoccupied with their health or
body. All of these disorders share one thing in common = no identifiable medical
condition causing the physical complaints.
Hypochondriasis: physical complaints without a clear cause; anxiety focused on
the possibility of having a serious disease.
 Shares many features with panic disorder
 Essential problem anxiety, but the expression is different from anxiety
disorders
 Reassurance from a medical professional not lasting
 Differs in many ways from illness phobia
 Prevalence estimates
DSM-IV common features of Somatoform Disorders
 Presence of physical symptoms that suggest a general medical condition
 Symptoms not fully explained by medical condition
 Not due to substances or other mental disorders
Somatoform Disorders can be clustered into 2 larger categories:
 Classical hysterical disorders – somatization disorder, CD, pain disorder
 Preoccupation disorders – hypochondriasis, BDD
Issues related to Somatoform Disorders
 No reliable information about prevalence rates
 Lobo et al (1996) 9.4% of a large primary care sample = somatizers
 Low base rate in the general population
 Ethnicity understudied; Farooq et al (1995) Asian patients
 Etiology: onset & risk factors obscure; systematic knowledge lacking
 Preliminary thoughts: parental rearing, childhood development, stressful
life events, personality, and communication & relationship with
professionals
Research Studies:
 Torgerson (1986) genetic twin study – transmission environmental, esp
sexual abuse.
Somatization Disorder
 Multiple physical complaints without clear/known physical causes
 Condition can last years
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4 pain symptoms (back, abdomen, joints)
2 gastrointestinal symptoms (diarrhea, food intolerance)
1 sexual symptom (irregular menses, indifference to sexual activity)
1 pseudoneurological symptom (poor balance, numbness, paralysis)
before the age of 30
frequent and multiple medical consultations
alters the person’s lifestyle
full-blown somatization disorder rare - .2% men; .2 to 2.0% women;
lifetime 0.1% in general population.
Historical explanations: ancient Greeks – wandering uterus; 19th C Briquet
polysymptomatic somatic condition = Briquet’s syndrome; Guze & Perley
(1963) “somatization disorder”.
Contemporary Thoughts: small subset of patients; functional symptoms;
what happens?
Somatosensory amplification
Maintenance of the disorder
Prognosis
Conversion Disorder
 Symptoms look neurological, e.g. glove anesthesia.
 4 subtypes: motor symptoms or deficits; seizures or convulsions; sensory
symptoms or deficits; mixed presentation
 important requirement: temporal relation between symptoms &
psychological stressor.
 Distress or la belle indifference
 Prevalence unknown, but estimates .001 and .3% population.
 Historical explanations: “neuroses”; Charcot & hysterical conversions
under hypnosis; defense mechanisms; Freud’s explanation.
 Contemporary Theories: Ullman & Krasner (1975) learned via
behaviorism; Folks, Ford, & Regan (1984) sociocultural influences; Kellner
(1991) neurophysiological studies show patients with CD do not habituate
in the same ways as other patients; the role of emotional arousal.
 Onset late childhood or early adulthood.
 Grief & sexual trauma often involved.
 Mace & Trimble (1996) 10 year follow-up.
Pain Disorder
 Severe acute or chronic pain in one or more body parts is not entirely or
adequately explained by a known medical condition
 Psychological factors involved.
 Acute versus chronic
 Prevalence unknown – relatively common
 Historical explanations: Aristotle; Descartes; Epicetus; Religious leaders;
unidimensionality of pain.
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After 20th C, integrated explanations that were organic & psychological.
Fordyce (1976) behaviorist explanations
Cognitive-behavioral explanations.
High frequency trauma & personality disturbance.
Engle (1959) pain-prone personality
Occupational factors important
Hypochondriasis: unjustified fears or convictions that one has a serious/fatal
illness.
 6 months & not of delusional intensity
 3 to 14% medical patients (Kenyon, 1976); 16% general population illness
phobia (Agras et al, 1969); 10% general practice (Palson, 1988); patients
with increased exposure to medical settings
 Historical explanations: “Below the cartilage” – excess of black bile; 17thC
Thomas Sydenham = equivalent to hysteria; Freud
 Contemporary Theories: behavioral theories; learned disorder; cognitive
explanations; somatosensory amplification.
 Chronic condition.
 Children’s symptoms versus adult’s symptoms.
 Sexual trauma
Body Dysmorphic Disorder
 Preoccupation with an imagined or exaggerated body
disfigurement/excessive concern that there is something wrong with the
shape/appearance of body parts.
 Examples.
 Cognitive features.
 Typical behaviors.
 Prevalence unknown, but…. Rosen (1995) & Connolly & Gipson (1978)
 Not equal to unhappiness about one’s appearance.
 Historical explanations: 19th C Enrico Morselli – sudden onset &
persistence of an idea that the body is deformed with severe anxiety.
Morselli – obsessive nature. Recent views = no to phobic anxiety.
 Core problem: perception of abnormality.
 Contemporary theories: Rosen (1995) cognitive-behavioral explanation.
 Gradual / sudden onset; course continuous & chronic.
 Only anecdotal evidence.
 Beings in adolescence.
 Sociocultural factors. Perfectioinstic features.
Factitious Disorder
 Physical symptoms produced or feigned intentionally to assume the sick
role.
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Eager to undergo extensive medical procedures.
Pathological compulsion to deceive medical professionals = pseudologia
phantastica.
Different from malingering.
Munchhausen Syndrome; munchhausen-by-proxy.
Historical explanation: Munchhausen syndrome coined by Asher (1951) to
describe patients who sought hospitalization at different hospitals under
often dramatic circumstances for self-induced or simulated illnesses.
Etiology not well understood, many authors feel it is the patient’s need for
being taken care of.
Trauma & abuse early in life.
Early experiences with medical procedures & grudge against medical
profession.
Onset adulthood & chronic.
Poor prognosis if patient goes from hospital to hospital.
Severe personality disorders associated with this diagnosis.
Issues of differential diagnosis & comorbidity